Ecosystems, despite their diversity, respond to stress in similar ways. The major pressures which cause the transformation of systems from healthy states to pathological states are classified into four groups: physical restructuring, overharvesting, waste residuals, and the introduction of non-native species. Signs of Ecosystem Distress Syndrome (EDS) are briefly examined in three contrasting ecosystems: desert grasslands, the Great Lakes, and the Baltic Sea. The issue is raised as to the difficulty in discerning between healthy ecosystems, recovering from a natural disturbance, and those ecosystems that have lost their original resilience due to anthropogenic stress. Knowledge of site history and a rigourous monitoring program are important in the evaluation of EDS. An assessment of how ecosystem services are affected is indicative of the consequences to the human component of ecosystems. Management strategies which are employed to mitigate the signs of EDS are usually initiated after resilience is lost or the ecosystem has transformed to an alternate, stress-induced, stable state. It is proposed that preventive strategies measure signs of EDS that serve as early warning signals, combined with "fitness tests" that measure ecosystem response to natural perturbations. The fitness test for ecosystems is based on the premise that unstressed systems are more resilient to natural disturbances than stressed systems.