Welcome to the new normal, where the fear of getting sick from a global pandemic is driving even the healthiest among us into cyclone of stress. As of late March, 60 percent of Americans said they were feeling “a lot of” stress, a 5 percent increase from the 2018 national results published by Gallup last year.

Stress isn’t always bad of course; feeling stressed is a necessary part of our survival mechanism. When humans sense an oncoming threat—anything from a tiger approaching at top speed to an email from the execs requesting you in their office—the amygdala, the part of the brain responsible for processing emotions, sounds the alarm to the rest of your body, alerting the nervous system’s control center, the hypothalamus, that you’re at risk. The hypothalamus then triggers the release of adrenaline, and later, cortisol hormones to push your body into action and prime yourself to respond to said threat. All of this together is what’s referred to as the “fight or flight” response.

On paper, it reads like a beautifully precise system, but it’s not flawless—mostly because it was really designed for acute, short-term stressors. Our traditional stress response was not designed for the constant stressors of modern life, such as demanding jobs, poverty and unemployment, and racism, putting many into a near-constant state of stress with high levels of cortisol that has a trickle-down effect on the rest of the body. For one, long-term stress weakens the immune system, making the body more susceptible to illness as well as flare-ups and outbreaks of pre-existing conditions that may have been previously under control.

Additionally, the chemicals released into the blood stream as a result of stress can have their own unwanted side effects. “Stress can manifest emotionally—for example with feeling more easily triggered, anxious or depressed—or physically, with an increase in symptoms like headaches, palpitations, and chest tightness,” says Melinda Ring, MD, the executive director of Northwestern Medicine’s Osher Center for Integrative Medicine.

“The good news is that people also hold substantial power to reduce these effects and improve their well-being by educating themselves and implementing practices that provide a counter-balance [to stress],” Dr. Ring says. Even though we can’t control what’s going on in the world around us, we do have some control over our stress levels as well as the ability to veer away from the types of behaviors that will only make matters worse. Maintaining a steady sleep schedule wherever possible, keeping alcohol and coffee intake to a minimum, and physical activity in some capacity can all have a steadying effect. There are countless online resources available to help as well, everything from meditation apps and journaling prompts to live streams of puppies and the Northern Lights.

Everybody responds to stress differently based on physiology alone—some people can get tension headaches, others digestive distress, and others might not “feel” particularly stressed despite their circumstances. But there are some universalities to be aware of. Here’s how stress can affect the body from your head to your toes—and everywhere in between—so you can better catch the signs in yourself and act accordingly.

1. Stress can majorly disrupt sleep

Waking up every hour? Unable to fall asleep? Like J Lo, are you tossing and turning, emotions are strong? That’s a classic manifestation of stress. “Stress and anxiety work to make us more vigilant and reactive,” says Alex Dimitriu, MD, a psychiatrist and the founder of Menlo Park Psychiatry and Sleep Medicine. “People may feel both ‘tired and wired,’ during the day, but have trouble relaxing, or are unable to nap.”

Stress also makes it harder to get REM sleep—aka the super restful kind that our bodies need to recharge—which further exhausts and stresses the body. “Lack of refreshing sleep, can in turn make us more impulsive and reactive, which can make stress worse—as essentially it becomes harder to stop thinking about the stressor,” Dr. Dimitriu says.

2. It can make you break out…

If you’ve ever broken out in acne right before an important meeting, it was likely stress-induced. According to Sapna Palep, MD, a board-certified dermatologist at Spring Street Dermatology, the jolt of cortisol released when you’re stressed leads to a responding increase in the production of other hormones like testosterone. Increased testosterone levels stimulate sebaceous gland activity in your skin, which boosts oil production and leads to blocked pores and more. Fun!

3. …and trigger flare-ups of other skin conditions

Conditions like eczema, psoriasis, and rosacea can all be triggered by stress, as the increased cortisol and adrenaline responsible for the fight-or-flight response can lead to inflammation. (And all of these conditions are inflammatory ones.)

4. It can thin your hair

Acne isn’t the only side effect of increased oil production. When there’s overproduction of oil on the scalp, it can cause Seborrheic dermatitis, resulting in dandruff and hair shedding. Dr. Palep notes that in addition to Seborrheic dermatitis, some people experience telogen effluvium, the medical term for significant hair loss that occurs a few months after the initial stress inducer. (Thankfully in most cases, the hair grows back.)

5. Stress can induce migraines

Experts aren’t exactly sure why migraines occur, but many believe that they can happen when there are major shifts in the substances (like neurotransmitters) normally produced in the brain. And given that stress involves a huge uptick in cortisol and adrenaline, it should be no surprise that stress is a major trigger for migraines. These stress headaches and migraines can even temporarily affect vision in the form of seeing auras. “Prior to the onset of a headache, patients typically report experiencing visual distortions described as shimmering light moving across the vision that is associated with temporary central vision loss,” says Ashley Katsikos, OD, of Golden Gate Eye Associates. Lasting between a few seconds to an hour, an aura is “an electrical or chemical wave that moves across the visual cortex of your brain.” The uptick in neurotransmitters like cortisol from stress can also cause muscles, including those around your eyelids to seize up and twitch.

6. It can cause teeth grinding

Bruxism, the medical term for grinding your teeth or clenching your jaw, is frequently spurred on by stress and pent up energy, and more often than not, you don’t even notice you’re doing it until a headache sets in or your jaw hurts. On the long term, grinding your teeth can cause them to chip or erode, and may require expensive dental repairs.

7. It can create sore muscles

If you’ve noticed back or neck pain or shoulder tightness, you can chalk that up to stress too. “Our diaphragm is our main breathing muscle. When we get stressed, it gets tight and cannot fully contract to allow a full inhalation, or fully relax to allow a full exhalation,” says Michael Hobbs, an Australia-based sports chiropractor. Instead of engaging in healthy, deep breathing, we begin taking shorter, shallow breaths that emanate from our neck and shoulders rather than our core—similar to hyperventilating—resulting in pain or tension in both regions. “When we are stressed, we lose the ability to control our diaphragm and create good quality core stability,” Hobbs adds, which may contribute to low back pain, hip pain, knee and ankle pain, even pelvic floor disfunction.

8. It can mess with your digestion…

Your gut houses hundreds of millions of semi-independently functioning neurons which send and receive signals to and from the brain (called the gut-brain axis), making your digestive system deeply sensitive to stress and other emotional responses. When your body enters fight or flight mode, it reroutes all your internal energy to battling whatever force of evil is coming your way, putting your digestive system on pause until the threat is alleviated—which disrupts your normal digestive flow and could potentially contribute to constipation, diarrhea, and/or stomach aches. Stress can also impact the functioning of your gut microbiome—aka the organisms that live in your gut that help you digest food, produce hormones, and support your immune system.

8. …and your sex drive, too

While the idea of sheltering in place may sound like the opportune time to get busy, it’s very likely that you’re not in the mood. Daily stress in general is associated with a reduced amount of sex; add a pandemic and an election year on top of that and you have a perfect storm for low libido. “We are in a state of flight/flight/freeze when stressed so, neurologically, sex seems like the last thing that’s a good idea,” says Britney Blair, PsyD, a San Francisco-based clinical psychologist and founder of the sex app Lover. “Think about it: These are primitive parts of the brain that can’t differentiate stress about COVID-19 versus stress about a sabertooth tiger attack, and the most vulnerable the human body can get is during sex and sleep,” she says.

9. It can change your menstrual cycle

Yes, stress can even disrupt your entire menstrual cycle (thanks a lot). According to Magdalena Cadet, MD, rheumatologist and assistant professor of medicine at NYU Langone Medical Center, the hypothalamus controls the hormones in your ovaries and your uterus through the endocrine system. Elevated cortisol levels caused by stress tell your hypothalamus to stop producing gonadotropin-releasing hormone (GnRH); low levels of GnRH mean that the pituitary gland doesn’t know to release other hormones that spur ovulation in the ovaries, which then throws off your menstruation. (A person could stop ovulating, or have a late or skipped period, among other potential effects.) “Imagine if you’re trying to run away from a tiger. Your body doesn’t want you to be menstruating or ovulating—it wants to save all your hormones to keep the cortisol functioning so you can run faster,” fertility reproductive endocrinologist Jane L. Frederick, MD, previously told Well+Good. It’s no wonder that so many people are sharing stories of stranger-than-usual periods during quarantine.