Visible symptoms in tree foliage can be used for stress diagnosis once validated with microscopical analyses. This paper reviews and illustrates macroscopical and microscopical markers of stress with a biotic (bacteria, fungi, insects) or abiotic (frost, drought, mineral deficiency, heavy metal pollution in the soil, acidic deposition and ozone) origin helpful for the validation of symptoms in broadleaved and conifer trees. Differentiation of changes in the leaf or needle physiology, through ageing, senescence, accelerated cell senescence, programmed cell death and oxidative stress, provides additional clues raising diagnosis efficiency, especially in combination with information about the target of the stress agent at the tree, leaf/needle, tissue, cell and ultrastructural level. Given the increasing stress in a changing environment, this review discusses how integrated diagnostic approaches lead to better causal analysis to be applied for specific monitoring of stress factors affecting forest ecosystems.