Response to severe stress and impaired adaptation. Adjustment disorder with disruption to work or school

Adaptation is a special feature of an organism that allows it to adapt to change. environment if this does not happen, symptoms of its violation appear. This usually happens in a short time and does not cause any particular inconvenience to the body.

Violation of adaptation is a psychosomatic deviation

Adaptation of the human body can occur with a change in various external factors such as temperature, stress, Atmosphere pressure, the type of main food, the content of trace elements in the water consumed, the level of oxygen in the air. Adaptation is normal normal functioning the body itself, but with its pathology or the appearance of a violation, it can fail. If there are symptoms of impaired mental adaptation, treatment is necessary.

What factors can influence the level of adaptation

The main reason for the violation of mental adaptation is the weakening of the immune system. The immune system is key in shaping the response to the world. It is responsible for the response to pathogens, to changes in the number of micro and macro elements, as well as to climate change. That is, it contributes to mental adaptation when external physical or chemical factors decrease or increase.

The immune system in these cases stimulates or inhibits the production of its own factors (immunoglobulins, circulating immune complexes, enzymes and hormones). Another important factor is maintaining a normal level blood cells. These elements are responsible for adapting the body to a change in the diet or the entry of harmful microorganisms.

Weakened immunity makes it difficult to adapt

The normal number of erythrocytes, leukocytes, lymphocytes provides the so-called homeostasis, that is, the constancy of the internal fluids of the body. The constancy of blood and lymph has an important role in the adaptive capacity of the organism. At their normal level, they are responsible for the proper functioning of the body and its adaptation to the environment.

With a decrease in the amount of iron entering the body, they are able to short span time to maintain normal level hemoglobin and color index. The level of iron in the body contributes to its more stable state during mental adaptation. If there is no iron in the body enough then symptoms of anemia appear. Balanced diet is also an indispensable element of the body's adaptation to new environmental factors. It provides cells and tissues with everything necessary for their normal functioning.

Factors that reduce the adaptive capacity of the body

The main factors that affect the adaptation of the body are as follows:

Iron deficiency anemia makes it difficult for the body to adapt to unfavorable factors external environment

Immunodeficiency states

They can be caused by chronic diseases, AIDS, viral or helminthic infestations, lack of nutrition or fluid intake, these are disorders whose symptoms appear immediately.

These pathologies affect such body environments as:

• Blood.
• Lymph.
• Hormonal fluids.

Violation of them is constant, which leads to an increase in the body's response to changes in external factors, that is, to a weakening of adaptive capabilities. The body slowly gets used to new influences, and they cause it more harm. The person becomes more sensitive to changes in temperature. That is, a change in the average daily temperature is regarded by the body as extreme cold or extreme heat.

Changes in the composition of body fluids lead to a decrease in adaptive abilities

Also, these changes in the body lead to a decrease in the fight against new bacteria and viruses. When new pathogens enter the body, it cannot use all its capabilities to fight it. Thus, he becomes more susceptible to new diseases, which, even with little harmful pathogens, can cause irreparable damage. human body treatment won't fix it.

Violation of mental adaptation, a decrease in hemoglobin and erythrocytes in the blood also leads to new physical exertion. Due to the low level of hemoglobin, the oxygen supply to tissues and cells is reduced, that is, they cannot cope with a greater load.

Sharp changes in climate

Man is very susceptible to environmental changes. An increase or decrease in temperature and humidity has a very negative effect on his health, especially on the respiratory system. A sharp change in these physical factors can lead to hyper- or hyposecretion of the mucosa. respiratory tract. In any case, this is stress for the body, which will lead to an inflammatory process.

When the climate changes, the body can respond by changing the secretion of the organs of the respiratory system.

The difference will be only in the presence of a pathological secret. That is, with hyposecretion, which will be caused by a decrease in humidity or an increase in temperature, a person will be tormented by a dry, hacking cough. And with an increase in humidity or a decrease in temperature, he will be disturbed by a cough with copious excretion sputum.

Of particular danger are factors that lead to the formation of sputum, since bacteria multiply well in it and lead to purulent processes. This can lead to pneumonia or a lung abscess.

Change in atmospheric pressure

Changing pressure is a serious stress for the body. It can lead to both a decrease in the solubility of gases in the blood, and to its increase. Reduced solubility leads to the so-called decompression sickness. It occurs when the pressure rises.

Reduced oxygen supply to tissues causes brain hypoxia

Most often, decompression sickness manifests itself when diving on great depths in untrained people. This leads to a decrease in the solubility of nitrogen in the blood and the formation of bubbles from it, which can clog large and small blood vessels. This stress can be fatal, because there is no effective fight against it.

On the other hand, climbing high into the mountains leads to another pathology to which the body is not able to adapt - mountain sickness. Here, the mechanism of occurrence is the opposite - an increase in the solubility of gases in the blood leads to a decrease in the return of oxygen from the bloodstream to the tissues, which leads to hypoxia. That is, oxygen starvation of tissues occurs, first of all, symptoms of cerebral hypoxia appear. Treatment is carried out with mandatory application oxygen.

Changing diet and fluid intake

Changing the nutrition or microelement composition of drinking water negatively affects the body. Each food contains a certain amount of proteins, fats and carbohydrates. When the diet changes, in connection with the departure to another area, it changes. In this case, even with a normal, sufficient diet, there may be a lack of one or more of these essential substances.

Enzyme deficiencies may occur with a change in diet

All this does not depend on energy value product, but on the form of its location. For example, a person who has been eating rabbit and chicken all his life will find it difficult to digest pork, this is stress for the body. This will be due to the fact that it is adapted to produce the amount of enzymes for a certain type of meat, and they will not be enough for coarser ones.

Changing loads

It is very difficult for an untrained body to respond to increased loads. If a person walked all his life to work for 5 minutes, then 30 minutes will lead to increased fatigue, symptoms such as shortness of breath, tachycardia, etc. will appear. But if a person overcame all his life long distances, then for him a decrease in activity is stress, which will lead to hypodynamia, which will negatively affect many body systems.

Stress as a result of difficult situations

For many people, stressful situations lead to a breakdown in the body's usual rhythm, but not for everyone. For those who work in extreme conditions, stress does not cause discomfort. Their nervous system is able to respond quickly to new and unexpected tasks, which keeps it functioning normally. Ordinary stress does not require therapy, it passes along with the elimination of the provoking factor. If it is delayed or severely affected the condition, appropriate treatment is necessary.

Stress affects the body's nervous system

How to improve the adaptive capacity of the body

There are many tips for improving the mental adaptation of the body so that it can tolerate stress well in the future.

Treatment for reduced adaptation

If there are the first signs of reduced mental adaptation, treatment should be carried out. This can be done in two ways: medical and psychological. Medical method consists in the use of immunostimulating drugs, such as Eleutherococcus, Echinacea and their tablet counterparts. Treatment psychological method stimulates a person to active physical and social life. Most often, these types of therapy are combined into one complex.

Immunostimulating drugs are prescribed for the treatment of reduced adaptation.

by the most important criterion in the mental adaptation of the body to stress is the activity of life. The more active a person's life, the more resistant he will be to extreme situations, both physical and psychological. This is the most important factor. Here we should not forget that activity is considered not only physical activity, but also an important part of the emotional and social sphere.

The combination of all this will allow you to adapt to any situation with least consequences for the body. Social and physical life is the best hardening for the body. If there are the first symptoms of a violation of mental adaptation, it is necessary to consult a doctor.

Answers to questions about the role of adaptation in the life of an individual and why its violations occur are provided in the video:

Adjustment disorder is a specific diagnosis, the symptoms of which are manifested mainly in the form of a persistent backlash to a sharp and, as a rule, stressful change in the usual situation, an unfavorable event, etc.

Most often, such a diagnosis as adjustment disorder occurs against the background of stress or complex impact stress factors and internal problems. A person whose psyche is affected by such a diagnosis as adjustment disorder exhibits extremely unfavorable symptoms that significantly worsen the quality of life in general and its professional and social state in particular.

Introduction to Adjustment Disorder

The symptoms that accompany such a diagnosis appear as a maladaptive response to stressful circumstances. Consider the example of the army.

A person lived in a familiar environment, and suddenly - the agenda. Upon arrival in the ranks of the army, the life of a citizen undergoes many changes with their own characteristics and limitations. The life characteristic of the army, of course, becomes familiar with time. But at first (usually during the first 3-4 months of being in the army), consciousness resists what happened, which causes stress.

Such a diagnosis as an adaptation disorder recedes when the stress factor ceases to act. If the provoking factors and the symptoms accompanying them remain, the body, as a rule, gets used to it and switches to new level stress resistance. Any special treatment does not apply under these conditions.

If the patient has to experience events that go beyond normal reality, causing significant damage to his professional or social activities, With big share likely to develop a diagnosis of adjustment disorder. If the stress is prolonged, the diagnosis may persist throughout life. There are no age, gender or any other restrictions.

Key symptoms and signs of a pathological condition

The manifestations of such a deviation can take the most varied look. As a rule, the main symptoms are anxious and depressive, often a mixed form. In most cases, maladjustment is accompanied by symptoms such as a sense of weakness and inability to cope with the events that have occurred. Often, manifestations are reinforced by a feeling of some kind of external threat, excessive irritability, suspiciousness, a sense of internal tension.

In many patients, the picture is complemented by a deterioration in mood, up to a melancholy state. The usual circle of interests is greatly narrowed. There is physical and mental exhaustion, it becomes difficult to concentrate and remember something new, there are difficulties in various issues that require quick and balanced decision-making, analysis and responsibility for the consequences.
Thus, the symptoms include the following:

• depressed mood;
• persistent anxiety;
• depression and inner feelings;
• violations of normal behavior;
• anxiety;
• internal discomfort.

Causes of maladaptation

The problem arises against the backdrop of a too emotional, close and personal reaction of a citizen to stressful circumstances that have arisen and very serious life changes.
The most common causes of stressful situations include:

• relationship difficulties;
• material difficulties;
• conflicts in the family;
• problems at the place of study / work;
• abrupt changes in the traditional way of life;
• detection of serious health problems;
• severe illness and/or death loved one;
• failures of the intimate plan.

Under certain circumstances (for example, in the case of forced residence in a disadvantaged and unsafe area), maladaptation can take a long course.

Possible risk factors

Under certain circumstances, the propensity for the occurrence of the violation in question can increase significantly. Thus, the list of key risk factors should include the following provisions:

• genetic predisposition;
• features of individual adaptability;
• characteristic social skills;
• lack of opportunities to eliminate haunting circumstances;
• gender affiliation.

There are suggestions that women, due to psycho-emotional characteristics, are more at risk of developing the problem under consideration.

People with serious illnesses, as well as people living in unfavorable difficult conditions, are traditionally at increased risk. According to average statistics, about half of the representatives of these groups show a tendency to maladjustment

Certain factors experienced by the patient in early childhood can lead to the occurrence of the disorder under study. The following are examples:

• frequent moving;
• features of the social status of the family (for example, too poor or too rich);
• various kinds of extreme impacts, for example, living in a zone of military operations;
• trauma that can lead to the development of problems with adaptation to life.

People who are predisposed to the development of such a problem as maladaptation are at risk in relation to other common psycho-emotional failures, for example, depression, anxiety, bipolar disorder etc.

Features of the manifestation and diagnosis of deviations

Most often, the violation in question completely stops causing discomfort and anxiety to the patient, on average, six months after the end of adverse events. If the violation becomes chronic form, its manifestations can persist for 6 months or more - this usually happens if the source of stress does not disappear.

The presence of a problem is said, first of all, when a person experiences difficulties in social and other spheres of life. Among the characteristic manifestations can be noted:

• painful and discomfort in the chest area;
• restless and anxious state;
• lack of strength to solve urgent problems, plan for the future, achieve important goals;
• difficulties in everyday life;
• parallel development of behavioral failures and psycho-emotional background.

In the process of diagnosing, the treating specialist studies the nature of the impact of stressors and draws conclusions regarding the intensity of their severity.

Additionally, examinations are prescribed to confirm or refute the presence of such problems as: post-traumatic stress, anxiety, depression etc. To clarify the diagnosis, the patient may be referred for a psychiatric consultation.

Treatment Methods

Choosing the right treatment, the specialist evaluates individual characteristics of the patient's condition and draws up a program that allows you to effectively neutralize the manifestations that prevent a person from leading a full-fledged life. Additionally, treatment is aimed at eliminating the likelihood of developing a depressive state.

Remember: treatment can be compiled exclusively by a specialist and it must be comprehensive.

1. Psychotherapy. considered as the main therapeutic method allowing to effectively deal with the problem of maladaptation. It is used, first of all, to search for provocative moments and the subsequent development of mechanisms of resistance to newly emerging stresses. As a rule, it is short-term and can be carried out in different forms: family, individual, behavioral, group.
2. Medical treatment. Usually used in combination with psychotherapy methods in order to alleviate the general characteristic symptoms. The patient may be recommended drugs that have a calming and antidepressant effect. Medications are used to relieve associated symptoms.

There are no preventive measures as such. It is only necessary to minimize exposure to stressful situations and seek medical help in a timely manner - then positive results will not make you wait long. Be healthy!

Adaptation disorder (disorder of adaptive reactions) arises as a result of significant changes in the way of life, due to the emergency that has taken place. According to the Handbook of Diagnostics and Statistics of Mental Disorders, adjustment disorder, which can be triggered by stressors of varying intensity, has various manifestations.

Adjustment disorder usually occurs after a transitional period. In most cases, depressive disorders of various duration and structure are observed; in some patients, depression as part of an adjustment disorder is manifested by a subjective feeling of low mood, hopelessness and hopelessness.

Outwardly, the victims look older than their age. There is a decrease in skin turgor, early appearance wrinkles and graying hair. They do not actively enter into a conversation, they hardly support a conversation, they speak in a low voice, the pace of speech is slow. The victims note that it is difficult for them to collect their thoughts, any undertaking seems impossible, it takes a strong-willed effort to do something. They note the difficulty of concentrating on one issue, the difficulty in making decisions, and then in putting it into practice. Victims, as a rule, are aware of their failure, but they try to hide it, inventing various reasons to justify their inaction.

Sleep disturbances are almost always noted (difficulty falling asleep, frequent waking up at night, early waking up with anxiety), lack of a sense of cheerfulness in the morning, regardless of the total duration of sleep. Sometimes nightmares are noted. During the day, the mood is lowered, tears easily come to the eyes for a minor reason.

They observe fluctuations in blood pressure that appear before the change of weather, attacks of tachycardia that were not previously characteristic, sweating, cold extremities and a feeling of tingling of the palms, deviations in work digestive system(decreased appetite, discomfort in the abdomen, constipation). In some cases, in people who suffer from an adjustment disorder, the feeling of anxiety comes to the fore, along with a subjectively little perceived decrease in mood.

Outwardly, the victims look tense, during the conversation they sit in a “closed position”: slightly leaning forward, crossing their legs and crossing their arms over their chest. Enter into conversation reluctantly, wary. At first, they do not express complaints, but after the conversation begins to touch on a “topical topic”, the pace of speech accelerates, a “metallic tone” appears in the voice. During a conversation, they hardly follow the outline of the conversation, cannot wait until the interlocutor expresses his opinion, constantly interrupting him. Answers to questions are often superficial, ill-conceived. Easily suggestible and quickly amenable to persuasion. They take on the task assigned with great responsibility, but subsequently, due to the difficulty of concentrating, they cannot track the sequence of execution of instructions, make gross mistakes and either do not complete the task or complete it with a great delay.

There is also a sleep disturbance, however, unlike the representatives of the previous group, difficulties in falling asleep in these cases are primarily expressed in the fact that before going to bed “various anxious thoughts on significant issues. From the side of cardio-vascular system in the same way as in the previous group, an increase in blood pressure is observed (however, it is more stable and less dependent on changes in weather conditions), deviations in the digestive system (decreased appetite, moving with the appearance of a feeling of hunger, often accompanied by the absorption of a large amount of food) .

Some individuals with adjustment disorder develop anxiety along with a subjectively felt lowering of mood. Moreover, in the early morning hours immediately after waking up, anxious mood, which "does not give the opportunity to lie in bed." Then, within 1-2 hours, it decreases, and melancholy begins to predominate in the clinical picture,

During the day, the victims of this group are inactive. By own initiative they don't ask for help. During the conversation, they complain of low mood, apathy. Representatives of this group complain of anxiety only when viewed in evening time or in the event that a doctor draws attention to its presence.

Anxiety increases in the evening and gradually decreases towards midnight. The victims themselves consider this period of time to be “the most stable and productive”, when there is no feeling of melancholy and anxiety. Many of them emphasize, realize that during this period of the day it is necessary to rest, but they begin to do household chores or watch on TV " interesting film”, and go to bed only deep after midnight.

In some cases, adjustment disorder manifests itself in a change in lifestyle. Sometimes a person subconsciously relieves himself of responsibility for the well-being and health of his family members. In some cases, victims believe that it is necessary to change their place of residence. Often they move to a new place of residence, where they also cannot adapt to living conditions. Representatives of this group begin to abuse alcohol, gradually break ties with the family and adjoin an environment with lower social demands and needs. Sometimes, subconsciously relinquishing responsibility for the well-being and health of their family members, they join sects. As the victims themselves explain in these cases, "new friends help to forget the old grief."

In a number of victims with an adaptation disorder, it manifests itself in the neglect of generally accepted norms of behavior. At the same time, we are not talking about the fact that a person considers this or that unseemly act to be unacceptable, but “necessity forces one to do so”, but that it is consciously defined as “quite acceptable”. In these cases, we are talking about a decrease in individual moral criteria of the individual.

Adjustment Disorder and Grief Reaction

Adjustment disorders include pathological grief reactions.

Before description clinical picture pathological grief reaction, it is advisable to describe how the uncomplicated grief reaction associated with the loss (the emotional and behavioral response of the body to an irreparable loss) proceeds.

Initially, the word “loss” (loss) was understood as a personal experience associated with the loss of a loved one. Somewhat later, divorce and other types of break with a loved one began to be attributed to loss. In addition, loss includes the loss of ideals and the former way of life, as well as the amputation of a body part and the loss important function organisms due to somatic disease. There is a special form of loss observed in individuals who have suffered from a chronic disease. For example, when chronic diseases cardiovascular system, a person is forced to lead the life of a semi-disabled person, to which he gradually adapts, and subsequently gets used to it. After carrying out the necessary surgical operation and recovery of function, a grief reaction over a limited life may occur.

There are losses of a slightly different type that can also provoke a grief reaction: loss of social status, membership in a certain group, work, housing. Special place among the losses (mainly among lonely people) is the loss of beloved pets.

Losses do not only include the loss of a loved one. A significant loss can also be the loss of an individual's ideals or way of life.

Grief is, to a certain extent, a natural response to loss. According to S.T. Wolff and R.C. Simons, the “purpose” of the grief reaction is the liberation of the individual from ties with the individual who is no longer there.

The intensity of the grief reaction is more pronounced with a sudden loss. However, the severity of the grief reaction is influenced by family relations with the deceased. As you know, in 75% of cases, couples who have lost children, certain time cease to function as a single family, and subsequently the family often breaks up. Depression, suicide attempts, alcoholism, and sexual problems are common among these couples.

When a person dies, not only parents suffer. The surviving siblings not only feel guilty about being alive, but also perceive the torment of their parents as confirmation that the dead children were loved more.

The external expression of the reaction of grief (mourning) is largely determined by cultural affiliation. Ethnocultural traditions (rituals) either contribute to the weakening of the grief reaction, or prohibit it from being shown.

There are three phases in the grief reaction. The first phase is the protest phase. It is characterized by a desperate attempt by the individual to restore relations with the deceased. This is expressed in the first reaction of the type "I do not believe that this happened." Some individuals cannot accept what has happened and continue to behave as if nothing had happened. Sometimes the protest manifests itself in the subjective sensation of dullness of all senses (nothing is heard, nothing is seen and nothing is felt). As some authors point out, this blocking of the surrounding reality at the very beginning of the protest phase is a kind of massive defense against the perception of loss. Sometimes, realizing that the individual has died, close relatives seek to return him in an unrealistic way, for example, a wife, embracing the body of her deceased husband, turns to him with the words: “Come back, don’t leave me now.” The protest phase is characterized by sobs and lamentations. At the same time, pronounced hostility and anger are often observed, often directed at doctors. The protest phase can last from a few minutes to several months. Then it gradually gives way to a phase of disorganization (the phase of awareness of the loss). In this phase, there is a realization that the loved one is no more. Emotions are very intense and painful. The main mood is deep sadness with loss. The individual may also experience anger and guilt, but deep sadness remains the predominant affect. It is significant to note that. Unlike depression, a person's self-esteem does not decrease with a grief reaction.

The grief reaction is accompanied by various somatic sensations that the environment can provoke. These include:

• loss of appetite:
• feeling of emptiness in the stomach:
• feeling of constriction in the throat;
• feeling short of breath:
• feelings of weakness, lack of energy and physical exhaustion.

They can also be provoked by surrounding events. Sometimes these memories are subjectively so difficult that the individual tries to avoid them.

One of the manifestations of adaptation disorder is the unwillingness to communicate and the reduction of contacts with the surrounding microsocial environment. Patients become introverted, they are unable to show spontaneity and warmth characteristic of them earlier to others.

Individuals with grief reactions often indicate feelings of guilt towards a deceased loved one. At the same time, they may be irritable and hostile. Those with grief reactions from their relatives want to hear the words “I will help you get him back”, not words of sympathy.

In general, in this phase of the course of the grief reaction, the patient notes disorganization, aimlessness and anxiety. The individuals themselves, assessing this time retrospectively, say that everything they did was "done automatically, without feelings, and it required a lot of effort."

In this phase, the individual gradually begins to recognize the loss. He increasingly remembers the deceased, about his last days and minutes. Many seek to avoid these memories because they are very painful: the individual realizes that this connection is no more.

Many individuals dream of seeing the deceased in a dream. Some quite often see the dead in a dream alive. For them, waking up (returning to reality) is often extremely painful. Sometimes in daytime individuals have auditory hallucinations: “someone tiptoed down the corridor and slammed the window”, “the deceased calls out by name”. These hallucinations often cause severe fear and make you turn to specialists for help because of fears of "going crazy." It should be noted that, as some researchers believe, the fear of going crazy that occurs in individuals with adjustment disorder does not belong to adjustment disorders and does not entail the development of serious diseases.

The disorganization phase is followed by a reorganization phase lasting from a few weeks to several years. In this phase, the personality again turns its face to reality. The individual begins to remove objects belonging to the deceased from prominent places. By this time, unpleasant memories associated with the death of a loved one gradually fade, and pleasant memories associated with the deceased begin to emerge in memory.

In the third stage, the individual often begins to show interest in a new field of activity and at the same time restore old ties. At times, a person may feel guilty about being alive and enjoying life when the deceased is absent. This syndrome was once described as survivor syndrome. It should be noted that the feeling of guilt that arises is sometimes expressed quite strongly and can sometimes be projected onto a new person who has appeared in the life of an individual.

Despite the fact that much has changed, the majority of people with adjustment disorder remain some common patterns of relationship to the deceased:

• memories of the deceased;
• internal maintenance of fantasies about reunion with the deceased (the idea of ​​such a possibility in the future is supported by most religions);
• communication with the deceased is maintained through the process of identification (over time, people gradually begin to identify themselves with the deceased by habits, values ​​and activity, for example, a wife begins to continue her husband’s business in the same vein, sometimes without realizing it at all).

Finally, it should be said that a person who has experienced a loss (ordeal) becomes more mature and wiser. If an individual survives the grief reaction with dignity without loss, he develops new values ​​and habits, which allows him to become more independent and better cope with life's adversities.

Pathological grief reaction

The most severe manifestation of a pathological grief reaction is the absence of a grief reaction as such: individuals who have lost a loved one experience neither mental pain nor longing, there are no memories of the deceased. They also do not have somatic adaptation disorders. Sometimes, after the loss of a loved one, an individual expresses anxiety and fear for his health due to the presence of a real chronic disease.

Often when pathological disorder adaptation, the individual begins to realize his loss only after 40 days or after the anniversary of the death of a loved one. Sometimes the loss of a loved one begins to be perceived very acutely after another significant loss. A case is described when an individual's wife died, after whose death he began to mourn his mother, who died 30 years ago.

Sometimes a person begins to grieve for his loved one, who died at the same age that the individual has currently reached.

In some cases, progressive social isolation may develop, when the individual practically ceases to communicate with the surrounding microsocial environment. Social isolation can be accompanied by persistent hyperactivity.

The resulting profound sadness and guilt of the survivor may gradually develop into clinical depression with self-hatred. Often, at the same time, hostile feelings arise in relation to the deceased, which are unacceptable both for the individual himself and for the surrounding microsocial environment. Occasionally, individuals with severe hostility subsequently develop paranoid reactions. Especially in relation to the doctors who treated the deceased.

Among persons with adjustment disorder, mortality and morbidity with the loss of the second half during the first year of mourning is increased compared with the general population.

In some cases, people with adjustment disorder continue to mentally communicate (talk) with the deceased and in their fantasies believe that everything they do, they do in the same way as they did with the deceased. At the same time, they realize that the loved one is no longer alive.

Currently, there is no unified classification of adaptation disorders associated with emergencies. AT various classifications interpret the concepts of the type of flow (acute and chronic) in different ways and determine the duration of a particular syndrome in different ways.

According to the ICD-10, in adjustment disorder, “symptoms show a typical mixed and changing picture and include an initial state of stupor with some narrowing of the field of consciousness and reduced attention, inability to adequately respond to external stimuli and disorientation.” This state may be accompanied by either further withdrawal from the surrounding reality (up to a dissociative stupor), or agitation and hyperactivity (flight reaction or fugue). Vegetative signs are often present panic anxiety, partial or complete dissociative amnesia of the episode is possible.

When it is possible to eliminate stressful situation, duration acute disorder adaptation does not exceed a few hours. In cases where stress continues or cannot by its nature be stopped, symptoms begin to disappear after 24-48 hours and are minimized in for three days. At the same time, according to the diagnostic criteria for adjustment disorder, the response of the person exposed to the traumatic event includes intense fear, helplessness, or horror.

During or after exposure to a distressing event (stressor), the individual must have three or more of the following adjustment disorders:

• subjective feeling of numbness, alienation, or lack of emotional resonance;
• reduction of the perception of the surrounding reality (the state of "stunned" or "stunned");
• derealization;
• depersonalization;
• dissociative amnesia (inability to remember important aspects injury).

The person constantly relives the traumatic event in at least one of the following ways:

• recurrent representations, thoughts, dreams, illusions, flashback episodes; about the feeling of revival of the experienced experience;
• distress when exposed to reminiscent moments of the traumatic event.

Observe the avoidance of stimuli that evoke memories of the traumatic event: thoughts, feelings, conversation, activity, place of the event, people who took part. discover severe symptoms, which cause anxiety and increase arousal: difficulty sleeping, irritability, difficulty concentrating, supervigilance, excessive startle reaction, motor restlessness.

The existing adjustment disorder causes clinically significant distress or inability to perform various functions.

Adjustment disorder lasts at least two days, but no more than four weeks.

As can be seen from the above data, the OBM-GU-TI classification itself is more detailed. However, it differs significantly from the ICD-10. First, acute stress adjustment disorder includes some of the symptoms that, according to ICD-10, are referred to as diagnostic criteria for RP. Secondly, duration acute reaction stress, according to ICD-10, “is minimized during three days even in cases where the stress continues or by its nature cannot be stopped.” According to ICD-10, “if symptoms persist, then the question arises of changing the diagnosis.” Third, according to OBM-GU-TI, if the symptoms associated with acute stress disorder last more than 30 days, the diagnosis of acute stress adjustment disorder should be replaced by the diagnosis of AKP. Therefore, according to OBM-GU-TI, RP as a diagnosis can only be made in the first 30 days after a traumatic event.

The diagnosis of "transitional period" does not exist in any classification. However, we selected it for the following reasons:

• during the transitional period, the formation of the clinical picture of subsequent psychopathological disorders occurs;
• it is during the transitional period that, as a rule, it seems possible to provide victims with highly qualified psychological and psychiatric assistance;
• the volume and quality of the psychological and psychiatric assistance provided and the social activities carried out in the transition period largely determine the effectiveness of the entire complex of rehabilitation measures aimed at resocialization of the victims.

Adjustment disorder, also referred to as a violation of adaptive reactions, is an anomaly manifested by psychotic symptoms, autonomic signs, and behavioral reactions. Adjustment disorder can occur for a variety of reasons due to exposure to intense or long-acting stress factors. The dominant initiator of violations of adaptive reactions are significant changes in the habitual way of life of the subject, due to the extreme situation.
At its core, adjustment disorder is a long-term reaction to the impact of stress factors, which is distinguished by a special intensity and depth of human negative experiences. The problems with adaptation that have arisen in a person significantly worsen his social interaction, impede the implementation of professional activity, make it impossible to have full contacts with the opposite sex.

Violations of adaptive reactions are not pronounced and occurring in a milder form of psychogenic depression or anxiety-phobic disorders. Based dominant symptoms allocate certain types adaptation disorders, in which patients are dominated by symptoms:

The causes of adjustment disorders are also:

You should know that in most cases, adjustment disorders do not occur immediately after a traumatic situation. After an extreme event, a certain time interval passes, after which violations of adaptive reactions become noticeable. During this period, unexpressed depressive symptoms are observed, for example: low mood, apathy, fast fatiguability. Such manifestations are often interpreted by people as signs of ordinary malaise.

Adjustment Disorders: Symptoms
The manifestations of adjustment disorders are diverse and unique for each person. However, there are also general symptoms characteristic of most people. First of all, the portrait of a person who suffers from an adjustment disorder changes. Outwardly, such a person looks much older than his biological age. Deep wrinkles become noticeable. Abundantly and rapidly graying hair. Under the eyes of the affected person appear dark circles. The look of the person is tired and indifferent to what is happening.
With an adjustment disorder, the conditions of social interaction are also violated. The affected person avoids contact with others or minimizes them, preferring to spend time alone. When communication is necessary, the person speaks in a low voice. The pace of a person's speech is slow. He answers questions addressed to him in monosyllables and concisely. At the same time, he himself does not ask clarifying questions to the interlocutor.

It becomes noticeable to others that it is very difficult for a sick person to collect his thoughts and concentrate on the act being performed. To begin to perform a task, he needs to make a significant strong-willed effort. The person becomes inactive and automatically performs his professional duties. The person also finds it difficult to make decisions, doubts the correctness of the choice made. With an adaptation disorder, the quality of the work performed is significantly deteriorating, the volume of work done during the working day is reduced. At the same time, the injured person understands his insolvency, but tries with all his might to disguise this fact from others.
Undergoes colossal changes and the psychological status of the patient. The person is in a depressed state and feels a dreary mood. He loses the ability to enjoy previously enjoyable activities. He narrows his circle of interests. Very often, an illogical obsessive feeling of fear joins depressive symptoms. The patient experiences overwhelming anxiety, anticipates the onset of some kind of catastrophe.

Adjustment disorder "rewards" a person with the feeling that it is impossible to cope with difficulties and overcome the problem. A person feels his failure and reproaches himself for not being able to work at full strength. Often, the affected subject has ideas of his own guilt and worthlessness. The affected person underestimates his abilities and is convinced that positive changes cannot occur in the future.
With an adaptation disorder, pronounced problems with sleep are determined. In the evening, a person cannot fall asleep for a long time. After falling asleep, he sleeps in disturbing intermittent sleep with frequent nightmares. He wakes up in the wee hours and does not feel fresh and cheerful.
Another symptom of adjustment disorder is excessive impressionability and vulnerability of a person. A sick person is very sensitive to comments and criticism from others. At the slightest provocation, she is ready to burst into tears. The affected person becomes easily suggestible, he quickly agrees with the opinion of the interlocutor and succumbs to other people's influence.

In some cases, progressive social isolation is observed, when a person completely interrupts any contact with others. In parallel with this, there may be a feeling of hostility and hatred towards some specific representatives of society. Some affected people develop paranoid ideas over time.
Of the vegetative symptoms of adaptation disorders, the dominant position is occupied by a persistent increase blood pressure. The person often suffers from headaches and feels dizzy. There are also somatic signs pathology on the part digestive tract. Some people have a worsening or even loss of appetite, and they voluntarily starve. In other persons, on the contrary, there is an insatiable feeling of hunger, and they absorb a large number of food.

Some patients with adjustment disorder begin to take drugs and abuse alcohol. There are also those victims in whom a violation of adaptive reactions leads them into the ranks of gamblers who spend all their capital in a casino or on slot machines. Some people become religious fanatics or join sects.
Feature many patients with adjustment disorder - neglect or denial of moral norms and rules of behavior existing in society. A person’s criticism of his behavior decreases, while many unseemly and illegal acts he considers normal and permissible phenomena for himself.

Treatment for Adjustment Disorder
Medical assistance in case of violation of adaptive reactions, it has several goals:

The psychotherapist explains to the patient the features of his condition, informs him about the mechanisms for the development of an adaptation disorder. Thanks to psychotherapy, it is possible to establish the trigger of pathology - the initial element that launched the cascade of pathological reactions. The subsequent implementation of activities for a different interpretation of the traumatic situation allows you to break the once formed vicious circle. During psychotherapeutic sessions, the client receives knowledge of how to competently and painlessly counteract stress factors. The patient learns what methods exist for relieving psycho-emotional stress.

In difficult situations, hypnosis treatment may be required, since very often a negative life program is hidden from a person’s conscious perception and is located on a different level of the psyche - the subconscious. To change the destructive life strategy, the patient is immersed in a state of hypnotic trance and a suggestion is performed - a special verbal setting that motivates a person to a full recovery.

These are adjustment disorders that interfere with work or study if previously this person there were no such violations in this respect. Anxiety and depression are often observed, therefore given state must be differentiated from depressive and phobic disorders.

The following are clinical characteristics adjustment disorders with disruption of work or study.

Main features: severe stress that interferes with any kind of work or study, manifested in anxiety during exams or when taking any tests, inability to write business papers, make reports or engage in artistic activities; difficulty concentrating at work, avoiding work or school, with loss of social control; these disturbances are absent during periods of time when the subject does not think about difficulties in work and study; availability of adequate intellectual and professional abilities; normal performance of work or study in the past; the application of special efforts directed at work and study, even if they are then secondarily suppressed by the symptoms described above.

Additional features: anxiety and depression; sleep disorders; compulsive behavior; disorganization of the daily routine; appetite disorders; drug, alcohol or tobacco abuse; loneliness.

Thus, a nineteen-year-old college student in his second year of college entered the mental health service because of learning difficulties. He may well have learned the first paragraph by writing it well and having mastered it, but he is unable to go any further and is therefore in danger of failing 2 or 3 subjects. He also has difficulty attending classes as he sleeps a lot.

He claims that the difficulties began about 2 years ago and continued throughout the first year of study, but he somehow managed to cope with his term papers and take exams.

The patient attended a private high school and did well until the last grade, when he had difficulties after his mother was diagnosed with a relapse of cancer and she died. He had no conflicts about being in college, and he was very eager to overcome these difficulties and continue his education in order to become a lawyer.

Discussion. Violation of the ability to learn is clinically very significant, since it greatly interferes with the patient's desire for a career. Therefore, it is classified as an adjustment disorder with impaired learning ability.

Most cases of impairment (inhibition) of the ability to work and study are a manifestation of personality disorder, usually compulsive personality disorder. But in this case, the disorder appears to have appeared suddenly in response to psychological stress, and there is no evidence to support the diagnosis of a personality disorder.

DSM-III-R Diagnosis

Axis I: Adjustment disorder with learning inhibition.

ADJUSTMENT DISORDER WITH AUTISM

The diagnosis of adjustment disorder with autism is made in cases of social autism without depression and anxiety.

ADJUSTMENT DISORDER WITH PHYSICAL COMPLAINTS

Adjustment disorder with physical complaints is manifested by symptoms such as headache, fatigue or other somatic complaints.

ADJUSTMENT DISORDER NOT CLASSIFIED ANYWHERE (NO OTHER NAME, BOTTOM)

Adjustment disorder, not classified elsewhere, is a residual category for atypical maladaptive responses to stress. Examples are inappropriate responses to physical illness, such as complete denial of the diagnosis and refusal of treatment.

DIFFERENTIAL DIAGNOSIS

Adjustment disorders should be differentiated from conditions that are not related to a mental disorder. According to the DSM-III-R, these non-psychiatric events do not cause disturbances in social and professional activities or any symptoms or manifestations that fall outside the normal criteria for stress. Due to the lack of absolute criteria for facilitating differential diagnosis between adjustment disorder and a condition unrelated to mental illness, it is desirable to examine the patient in a hospital setting.

Although uncomplicated loss of a loved one also includes temporary violation social and occupational functioning, the observed impairments remain within the normal response to the loss of a loved one and thus are not considered an adjustment disorder.

Other disorders from which adjustment disorder should be distinguished include major depressive somatization disorder, substance abuse disorder, conduct disorder, and post-traumatic disorders associated with stress.

In all cases, these diagnoses should be named as primary if they meet the appropriate criteria, even in the presence of stress or a series of stresses that may have served as a trigger. However, some patients have conditions that meet the criteria for both disorders, personality disorders and adjustment disorders.

With post-traumatic stress disorder symptoms that develop after a psychologically traumatic event or events are outside the scope of normal human experiences. It means that similar symptoms to be expected after these stresses in most people. Stress can be transferred individually (rape or assault) or among people (for example, on the battlefield). Whole line natural Disasters, such as flooding, aviation accidents, atomic bombing and death camps, are also regarded as severe stressors. Stress always contains psychological component, and often a concomitant somatic component that has a direct damaging effect on nervous system. This disorder is considered to be more severe

and long-term, when stress is caused by a person’s actions (for example, rape), than external causes(eg flood).

FORECAST

The prognosis for adjustment disorders is generally favorable with appropriate treatment. Most patients return to their previous lifestyle within 3 months. Teenagers take longer to recover than adults. For some, especially adolescents, the diagnosis of adjustment disorder is then changed to a diagnosis of mood disorder or substance abuse disorder.

TREATMENT

Psychotherapy is the preferred therapy for adjustment disorders. Group therapy may be especially useful for patients who have experienced the same stress - for example, a group of retired individuals or a group of patients who are "on artificial kidney". As a result of individual psychotherapy, the patient begins to understand the role that stress played in his illness, and outlives old traumas. Sometimes, after successful therapy, patients who have had an adjustment disorder become stronger than before the disease, although during this period they did not have any pathology.

Psychiatric treatment adjustment disorders must be managed judiciously to avoid secondary gains. Painful condition can be rewarded for a person who has not previously encountered this problem, in that it relieves him of responsibility. Thus, the physician's attention, empathy, and understanding, which are necessary for success, can be a reinforcement in the process of developing a secondary benefit. All these factors must be taken into account in psychotherapy. Once the symptoms of a secondary benefit have already developed, treatment becomes more difficult.

Sometimes in the treatment of anxiety, which often occurs in people suffering from adjustment disorder, anti-anxiety agents have a good effect; less often - tricyclic antidepressants, which are effective in depression. Indeed, when a doctor plans a course of antidepressant therapy, he must reconsider the diagnosis and consider the features of a depressive disorder. Only a few or no diseases at all can be cured by drugs alone. Patients who have adjustment disorders include behavioral disorders, sometimes commit offenses, conflict with superiors at work or at school. It is not recommended that doctors try to save such patients from responsibility for their actions. All too often, such kindness only reinforces socially unacceptable ways of reducing tension and hinders the development of criticism and subsequent improvement in emotional state.

Since stress can be clearly seen in adjustment disorders, it is often assumed that psychotherapy is not indicated and that the disorder will end on its own. But this point of view does not take into account that many individuals who have experienced the same stress do not find painful symptoms, what is it- pathological reaction. Psychotherapy can help the subject better adapt to enduring stress if it is irreversible or time-limited, and can serve as a preventative measure if the stress recurs.

PSYCHOLOGICAL FACTORS AFFECTING PHYSICAL STATE (PSYCHOSOMATIC DISORDERS)

INTRODUCTION

DSM-III and DSM-III-R diagnostic criteria for psychological factors influencing physical condition (i.e. for psychosomatic disorders), these are those psychologically significant stimuli from the environment that reliably, albeit partially, and temporarily cause a weakening or strengthening physical illness. In this condition, there is either a distinct organic pathology, for example, rheumatoid arthritis, or some known pathophysiological process, such as migraine headache. Many feel that the exclusion from the DSM-III of the nosological term psychophysiological (synonymous with the term "psychosomatic") again negates the relationship of mind (psyche) and body (soma), a concept that emphasizes a single or holistic approach in medicine in that all diseases are affected by pathological factors. Listed below are diagnostic criteria for psychological factors influencing physical illness.

BUT. Psychologically significant environmental stimuli are temporally associated with the onset or exacerbation of a specific physical disease or disorder (recorded on Axis III).

B. Physical state includes either a confirmed organic disease (eg, rheumatoid arthritis) or a known pathophysiological disorder (eg, headache, migraine).

AT. The condition does not meet the criteria for somatoform disorder.

Specifically excluded from the DSM-III-R classification: 1) classic mental disorders, in which somatic complaints are integral part diseases (eg, conversion disorder, in which somatic complaints are caused by psychological conflict); 2) a disorder in the form of somatization, in which physical symptoms not based on organically defective soil; 3) hypochondria, in which there is a heightened attention to one's health and an imaginary feeling of a serious illness; 4) physical complaints that are associated with psychological disorders(for example, disorders in the form of dysthymia, which are accompanied by muscle weakness and exhaustion); 5) physical complaints associated with habitual disorders (for example, cough associated with smoking).

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