[Allostatic load stress state: a novel framework for early identification, prevention, and stratified intervention of...

Stress is a series of non-specific, adaptive physiological and psychological response processes generated by the body when challenged, burdened, or threatened by internal or external environments (e.g., social pressure), with the aim of maintaining homeostasis. Currently, stress-related disorders have become a major public health issue affecting national health. Daily persistent micro-stressors are widely prevalent, and in some individuals, the cumulative effects may lead to decompensation of the regulatory system, manifesting as a subclinical state. However, current diagnostic systems mainly rely on adjustment disorder and posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, text revision (DSM-5-TR) and the International Classification of Diseases, Eleventh Edition (ICD-11), both of which have significant limitations: adjustment disorder is a diagnosis of exclusion, while PTSD only covers major traumatic events. Neither DSM-5-TR nor ICD-11 adequately identifies subclinical populations who, under the cumulative effect of daily persistent micro-stressors, have developed mild symptoms and functional decline but do not meet the diagnostic criteria. To address this gap, this paper systematically proposes the concept of "allostatic load stress state" (ALSS), defined as "a transitional clinical state arising from decompensation of the individual's regulatory system under the cumulative effect of daily persistent micro-stressors, characterized by persistent stress-related symptoms with mild functional decline, but falling below the threshold of existing diagnostic criteria". ALSS integrates the previously indistinguishable core features of "allostatic load" (physiological wear and tear) and "allostatic overload" (clinical distress), filling the gap between normal stress and clinical disorders, and for the first time provides a structured identification criterion for this subclinical population. On this basis, this paper constructs a three-stage continuous spectrum theoretical framework-"normal stress (healthy population)-allostatic load stress (subclinical population)-persistent excessive stress (clinical disorder population)"-clarifying the clinical features, prevention and intervention principles for each stage; establishes a three-dimensional integrated assessment system centered on "stressor-symptom-function" to enable early identification of ALSS; and proposes a non-pharmacological, stratified, stepwise early intervention strategy aimed at providing actionable pathways for subclinical populations and promoting a forward shift in the prevention and management of stress-related disorders.