A whole complex of psychological symptoms that manifest themselves very acutely as a response to a particular stressful situation is united by the concept of adaptation disorder.

The pathology is classified as independent and is not an exacerbation of any mental disorders. The prevalence of the disorder is very high - the ratio is 1:5, and the total duration is from several months to 2 years.

At the same time, the usefulness of psychological adaptation is always closely related to the absence of disturbances in the biological and physiological sphere. Otherwise, the expected psychotherapeutic effect without eliminating the somatic root cause will be either extremely weak even with long-term therapy, or it will not exist at all.

Likewise, it is important to take into account the patient’s initial personality type, his social status and living conditions. For example, the course of an adaptation disorder in a choleric person may be exactly the opposite of that of a melancholic person. And such variability often complicates the diagnosis of the disease.

Adaptation disorder arises and develops primarily against the background of emotional stressful situation. Provoking factors can be both psychosocial and medical:

• breakup of a very significant relationship;
• dismissal from work;
• protracted family conflicts;
• emigration;
• low self-esteem;
• perfectionism;
• systematic dissatisfaction with society psychological needs personality: a tendency to solitude or, conversely, a need for increased attention;
• major material losses;
• regular financial difficulties;
• a complete change in the usual way of life;
• divorce;
• natural disasters or military actions;
• conscription into the army;
• individual predisposition to excessive dramatization of stressful situations;
• emerging health problems, undergoing major operations;
• serious illness of a family member.

To a large extent, the situation risks getting worse in combination with the following biological and physiological factors:

• Iron-deficiency anemia;
• immunodeficiency state;
• changes in loads for the worse;
• forced changes in diet and microelement composition of water;
• changes in atmospheric pressure;
• sudden climatic changes.

The disease rarely occurs immediately. Typically, the intensity of destructive emotions increases during the first 1-3 months after the causative factor, and in some cases provokes negative social and even medical consequences.

Important. Despite the fact that the death of a loved one causes most of the similar temporary difficulties in professional and social life, such behavioral pathologies are not considered as an adaptation disorder. Everything that happens is considered within the acceptable norm for reacting to the loss of a loved one.

Symptoms

The patient has a clear connection with the stressful situation he suffered. Moreover, stress means both acute and chronic. In a situation with acute stress, clinical symptoms develop within 10-14 days.


The patient's mood is constantly depressed to a mild or moderate degree. There is a trend of improvements in evening time and a significant decrease in the morning. In almost every case there is an alarming state. There is a certain amount of anxiety that is directly related to the psychotraumatic factor. The experiences are difficult, exhausting, appear immediately after waking up and persistently persist throughout the day.

Sometimes you manage to distract yourself, and by the evening it can become much better, but only before going to bed. When you try to sleep, your anxiety gets worse again. Such painful and painful experiences become a serious obstacle in the process of learning and professional activity.

One of the symptoms of adjustment disorder is sleep disorders. The process of falling asleep is very long, the dreams are disturbing or nightmarish. Awakenings are most often premature, very early, with the inability to fall back to sleep.

Appetite is slightly reduced, but the patient often forgets about food due to complete immersion in experiences. If offered food, most often he eats the entire portion.

General state . Concentration suffers, fatigue increases, and the body feels constant lethargy. Often all this is accompanied by excessive tearfulness and varying degrees of irritability, up to open conflict and aggression.

Noted urgent need for privacy. The patient minimizes the number of contacts and closes off completely.

Behavioral disorders and decreased moral standards are manifested in actions that are unusual for the patient. Often this is driving a car or motorcycle at top speed. In this case, there is a real threat to health and life from accidents. It could also be vandalism, hooliganism or serious offenses up to criminal liability.

Rarely without physiological problems. Patients complain of difficulty breathing, pressing chest pain, tachycardia, severe headaches and insomnia.

There are changes in self-esteem. It is rapidly declining.

Often the patient looks older than his age. Skin turgor is significantly reduced, early wrinkles and gray hair are observed.

In some cases, abuse of alcohol, nicotine or drugs begins. Joining sects is common.

The melancholy is clearly expressed. It is very painful. It is against this background that the patient often experiences suicidal thoughts. Fortunately, they are not persistent; the patient retains critical thinking, and timely psychotherapeutic assistance eliminates this threat.

Diagnostics

Adaptation disorder must be differentiated from other pathological conditions that are not related to mental disorder. These are severe depressive disorders in the form of somatization, substance abuse disorders, and behavioral pathologies.


The main diagnostic criteria for adjustment disorder are as follows:

1. Pathological condition is a consequence of a stress response that manifests itself during the first 3 months after a particular incident.
2. Relationships with others, the learning process or professional work activity are carried out by the patient with great difficulties.
3. Clinical signs inherently go beyond the normal range of conventional reactions. The patient overdramatizes the event, exaggerates its hopelessness, and such a reaction is greatly delayed.

Treatment

The basis of treatment, in addition to psychosocial factors, must necessarily include biological ones. Depending on the predominance of specific manifestations, treatment is differentiated, step-by-step and comprehensive.

The basic component in this case is psychotherapy. It is necessary to change the patient's attitude towards what happened and convince him to accept the situation as part of the necessary life experience. Reassess the patient’s role in the current situation and form an active position in him in relation to overcoming the current circumstances.

It is often particularly effective group psychotherapy , the techniques of which allow you to openly express your anger, anxiety, fears and the subjective feeling of complete hopelessness of the situation.

The attitude of specialists towards drug treatment in the case of adjustment disorder remains ambiguous. But best results However, patients with a competent combination of medications and cognitive behavioral therapy achieve faster results.

In the case of a short-term disorder with mild or moderate anxiety and asthenic symptoms, taking anxiolytics is often quite sufficient. Wherein the dynamics of the patient's condition requires careful monitoring. If hypochondriacal and depressive reactions worsen, an antidepressant should be added. In terms of effectiveness, Paroxetine, Sertraline, Citalopram, Fluoxetine and Fluvoxamine are among the first.

Phenazepam, Clonazepam, Alprazolam and Tofisopam help relieve acute anxiety. Slightly less often drugs with barbiturates are used: Valocordin, Valoserdin, Corvalol.

Attention. Uncontrolled and prolonged use of barbiturates, even after 1 month of use, leads to the formation of persistent psychological and physical dependence.

Adjustment disorder in the army

The diagnosis of adaptation disorder for military service is a serious problem that gives every reason for a commission. A strict regime, heavy physical activity, distance from home and the inability to communicate with loved ones create enormous psychological stress.

Not everyone can cope with this. Open access to weapons creates completely real threat for the lives of others on the part of the sick soldier.

The risk group consists of conscripts who have poor relationships with their parents, who do not know how to stand up for themselves, systematically feel their own inferiority and react sharply to failures.

The test results of soldiers with the identified disorder show 3 main root causes for the rapid development of the pathology:

1. Separation from loved ones. 88% of respondents admit that they begin to suffer from this issue from the first day of service.
2. Inability to cope with the difficulties of preparation. In particular, categorically abandon your taste habits, follow a difficult daily routine and endure excessive physical exertion.
3. Hazing. Ridicule and humiliation from the command and comrades.

The following manifestations can be considered obvious signs of adaptation disorder in a conscript in the army:

• lack of interest in any activity, reluctance to achieve any results;
• general loss of strength and lack of faith in one’s own capabilities;
• lack of appetite, insomnia, blood pressure fluctuations, unusual sweating, frequent headaches;
• open anger, conflict, irritability mixed with excessive vulnerability;
• memory impairments, basic errors in simple tasks, state of prostration;
• aggressive opposition to discipline, attempts at communication from colleagues, isolation.

To be classified, the disorder requires an official opinion from a psychiatrist. This can be either a civilian specialist, or an examination by specialists from a military medical commission.


Due to the potential for symptoms of the disorder to manifest in the future, despite the treatment received, the soldier is registered with a psychiatrist. This is a precaution against possible violence towards strangers, causing intentional harm to both oneself and others, which is typical for such a diagnosis.

Adjustment disorder is a pathological condition characterized by emotional disorders, impaired social adaptation, decreased performance and the inability to adapt to significant life changes. Adaptation disorder is registered in 2–8% of the population, regardless of age and gender.

Causes

Adjustment disorder is caused by emotional and stress factors. These factors do not threaten the physical and mental health of a person, but cause a negative emotional pathological state that disrupts the adaptation response.

• emotional and psychological: lack of sleep, divorce, sudden change social status, prolonged neuropsychic stress, death of a loved one;
• physiological: malnutrition, injuries, somatic diseases, disorders of the central nervous system.

Most often those affected by adaptation disorder are: students, military, police, medical staff, migrants, lonely elderly people, journalists.

Symptoms

The clinical picture is varied and nonspecific: each person has different symptoms and signs. The prevalence of specific symptoms depends on its “vulnerabilities”: people prone to anxiety will suffer from anxiety.

There are two types based on duration:

1. Short-term adjustment disorder. Lasts up to 1 month. It is mild and often goes away without treatment.
2. Prolonged adjustment disorder. Lasts from 1 month to 2-3 years. It occurs in different clinical types, most often with a predominance of anxiety-depressive symptoms and behavioral disorders.

The clinical picture includes the following syndromes and symptoms:

• Asthenic. It manifests itself as rapid fatigue, exhaustion, irritability and anger, impaired concentration, and sleep disturbance.
• Anxious. It manifests itself as a feeling of internal discomfort, psychomotor agitation, anxiety, and sleep disturbance. Accompanied by autonomic reactions: nausea, loss of appetite, diarrhea or constipation, sweating, shortness of breath or dizziness.
• Depressive. It manifests itself as decreased mood, slowed thinking and attention, low motor activity, apathy, and anhedonia. Depressive syndrome is often combined with anxiety.
• Inappropriate emotional reactions: aggressiveness, outbursts of rage and anger, emotional coldness, excitement, gloomy and melancholy mood with a tendency to an angry outburst.
• Behavioral reactions: withdrawal from alcoholism, gambling, drug addiction, smoking, dismissal from work.
• Cognitive: decreased intellectual productivity, absent-mindedness, decreased short- and long-term memory, flattened imagination and fantasies.
• Vegetative syndrome: dizziness, flushing of the face, frequent urination, trembling, rapid heartbeat, shortness of breath, excessive sweating, muscle twitching.

Severe adjustment disorder is accompanied by suicidal behavior and suicidal thoughts. People harm themselves: most often, scars from cuts can be found on the hands.

Diagnosis and treatment

Diagnostic criteria for adjustment disorder International classification diseases of the 10th revision (disease code – F43.2):

1. excessive preoccupation with a problematic situation;
2. constant and obsessive thoughts about the stress factor;
3. inability to adapt to changes;
4. symptoms interfere with daily activities;
5. difficulty concentrating or sleeping;
6. loss of interest in work, hobbies, social life;
7. reduction of professional duties: a person performs less and worse job responsibilities, wants to leave work as quickly as possible, often asks for time off.

Diagnosis and treatment are carried out by a medical psychologist and psychiatrist. They conduct a clinical interview and psychometric study. By using psychological tests emotional and adaptation disorders are established.

Treatment objectives:

• increasing stress resistance;
• elimination of symptoms of adaptation disorder;
• activation of the body's compensatory capabilities.

Adaptation disorder is treated with biological methods and psychotherapy. TO biological methods refers to the pharmacological approach - taking medications. The most commonly prescribed groups of drugs are:

1. Anxiolytics. They reduce anxiety, calm you down and improve sleep. Representatives: Diazepam, Phenazepam, Gidazepam. May cause addiction and side effects such as depression. Prescribed if the clinical picture includes symptoms of psychomotor agitation, severe anxiety and restlessness.
2. Antidepressants. Normalizes mood and motor activity. Representatives: Fluoxetine, Sertraline, Paroxetine. Heavy antidepressants (Amitriptyline, Nortriptyline) are not prescribed.

Adaptation disorder is often treated with the common drug Adaptol. It is not recommended to buy or take it: Adaptol does not have an evidence base and proven clinical effectiveness.

Psychotherapy – cognitive behavioral approach, autogenic training, hypnotherapy.

Adaptation disorder (disorder of adaptive reactions) occurs as a result of significant changes in the way of life caused by the emergency. According to the Diagnostic and Statistical Manual of Mental Disorders, adjustment disorder, which can be triggered by stressors of varying intensity, has different manifestations.

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

Externally, the victims look older than their age. A decrease in skin turgor, early appearance of wrinkles and graying of hair are noted. They do not actively engage in conversation, have difficulty maintaining a conversation, speak in a low voice, and the pace of speech is slow. The victims note that it is difficult for them to gather their thoughts, any undertaking seems impossible, and it takes a strong-willed effort to do anything. They note difficulty concentrating on one issue, difficulty in making decisions, and then in putting it into practice. Victims, as a rule, are aware of their inadequacy, but try to hide it, coming up with various reasons to justify their inaction.

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

They observe fluctuations in blood pressure that appear before a change of weather, previously not typical attacks of tachycardia, sweating, coldness of the extremities and a feeling of tingling in the palms, abnormalities in the functioning of the digestive system (decreased appetite, a feeling of discomfort in the abdominal area, constipation). In some cases, in people who suffer from adaptation disorder, a feeling of anxiety comes to the fore, along with a subjectively little-perceived decrease in mood.

Outwardly, the victims look tense, and during a conversation they sit in a “closed position”: leaning slightly forward, crossing their legs and crossing their arms over their chest. They enter into conversation reluctantly and warily. At first, no complaints are expressed, but after the conversation begins to touch on a “hot topic,” the pace of speech accelerates, and a “metallic tint” appears in the voice. During a conversation, they have difficulty following the flow of the conversation, cannot wait for the interlocutor to express his opinion, and constantly interrupt him. Answers to questions are often superficial and ill-considered. Easily suggestible and quickly amenable to persuasion. They take on the assigned task with great responsibility, but subsequently, due to difficulty concentrating, they cannot track the sequence of execution of assignments, make serious mistakes and either do not complete the task or complete it very late.

There is also sleep disturbance, however, unlike the representatives of the previous group, difficulty falling asleep in these cases is primarily expressed in the fact that before going to bed, “various disturbing thoughts come to mind” regarding significant issues. On the part of the cardiovascular system, just 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 functioning of the digestive system (decreased appetite, moving with the appearance of a feeling of hunger, often accompanied by absorption large quantity food).

Some people with adjustment disorder develop anxiety along with a subjectively felt decrease in mood. Moreover, in the early morning hours, immediately after waking up, an anxious mood prevails, which “does not allow you to lie in bed.” Then within 1-2 hours it decreases, and melancholy begins to predominate in the clinical picture,

During the day, victims of this group are inactive. By own initiative they don't ask for help. During the conversation they express complaints about low mood and apathy. Representatives of this group complain of anxiety only when examined in the evening or if 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 and realize that during this period of the day it is necessary to rest, but they begin to do household chores or watch an “interesting movie” on TV, and only go to bed well after midnight.

In some cases, adaptation disorder manifests itself in changes in lifestyle. Sometimes a person subconsciously abdicates 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. They often 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 their family and join an environment with lower social demands and needs. Sometimes, having subconsciously abdicated 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 you forget old grief.”

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

Adjustment disorder and grief reaction

Adaptation disorders include a pathological grief reaction.

Before describing the clinical picture of the pathological grief reaction, it is advisable to outline how the uncomplicated grief reaction associated with loss occurs (the body’s emotional and behavioral response to an irreparable loss).

Initially, the word “loss” was understood as a personal experience associated with the loss of a loved one. Somewhat later, divorce and other types of breakup with a loved one began to be considered loss. In addition, loss includes loss of ideals and previous way of life, as well as amputation of a body part and loss important function organism caused by somatic disease. There is a particular form of loss seen in individuals who have suffered from a chronic illness. For example, with chronic diseases of the cardiovascular system, a person is forced to lead the life of a semi-invalid person, to which he gradually adapts, and subsequently gets used to it. After carrying out the necessary surgery and restoration of function, a reaction of grief 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, job, housing. A special place among losses (mainly among lonely people) is the loss of beloved pets.

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

The grief reaction is to some extent a natural reaction to loss. According to the opinion of S.T. Wolff and R.C. Simons, the “purpose” of the grief reaction is the liberation of the individual from ties with an individual who no longer exists.

The intensity of the grief reaction is more pronounced with sudden loss. However, the degree of severity of the grief reaction is influenced by family relationships with the deceased. As is known, in 75% of cases, couples who have lost children cease to function as a single family for a certain time, and subsequently the family often breaks up. Among these married couples, there are frequent cases of depression, suicide attempts, alcoholism and sexual problems.

When a person dies, it is not only the parents who suffer. Surviving siblings not only feel guilty for being alive, but also perceive the parents' torment as confirmation that the dead children were loved more.

The external expression of the grief reaction (mourning) is largely determined by cultural affiliation. Ethnocultural traditions (rituals) either help to weaken the grief reaction or prohibit its display.

The grief reaction is conventionally divided into three phases. 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 “I don’t believe this happened.” Some individuals cannot accept what happened and continue to behave as if nothing happened. Sometimes protest manifests itself in a subjective feeling of dullness of all senses (they hear nothing, see nothing and feel nothing). As some authors point out, such blocking surrounding reality at the very beginning of the protest phase, it represents a type of massive defense against the perception of loss. Sometimes, realizing that an individual has died, close relatives strive to bring him back in an unrealistic way, for example, a wife, hugging 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. In this case, quite often there is pronounced hostility and anger, often directed at doctors. The protest phase can last from a few minutes to several months. Then it gradually gives way to the disorganization phase (phase of awareness of the loss). In this phase, there is a realization that the loved one is no longer there. The emotions are very intense and painful. The main mood is deep sadness with the experience of loss. The individual may also experience anger and guilt, but the predominant affect remains deep sadness. It is important to note that. Unlike depression, during the grief reaction, a person’s self-esteem does not decrease.

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

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

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

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

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

In general, in this phase of the grief reaction, the patient experiences disorganization, aimlessness, and restlessness. 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 acknowledge the loss. He remembers more and more often about the deceased, about his last days and minutes. Many people try to avoid these memories because they are very painful: the individual understands that this connection no longer exists.

Many individuals dream of seeing the deceased in a dream. Some people quite often see the dead alive in their dreams. For them, waking up (returning to reality) is often extremely painful. Sometimes in daytime individuals experience auditory hallucinations: “someone tiptoed along the corridor and slammed the window”, “the deceased is calling out by name.” These hallucinations often cause significant fear and force one to seek help from specialists for fear of “going crazy.” It should be noted that, as some researchers believe, the fear of going crazy in individuals with adaptation disorder does not relate to adaptation disorders and does not entail the development of serious diseases.

The disorganization phase is followed by a reorganization phase, lasting from several 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 visible 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 the memory.

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

Despite the fact that a lot changes, most people with adjustment disorder still have some common patterns of attitude towards the deceased:

• memories of the deceased;
• internal maintenance of fantasies of 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 activities, for example, a wife begins to continue her husband’s business in the same way, 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 has adequately survived the grief reaction 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 do not experience any heartache, no melancholy, no memories of the deceased. They 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, with pathological adjustment disorder, 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 as this moment individual reached

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

The resulting deep sadness and survivor's guilt can gradually develop into clinical depression with feelings of self-hatred. Often, at the same time, hostile feelings arise towards the deceased, which are unacceptable both for the individual himself and for the surrounding microsocial environment. Rarely, 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 from loss of a significant other during the first year of mourning are increased compared to the general population.

In some cases, persons with adaptation 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 understand that their loved one is no longer alive.

Currently, there is no unified classification of adaptation disorders associated with emergencies. In different classifications, the concepts of the type of course (acute and chronic) are interpreted differently and the duration of a particular syndrome is defined differently.

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

When it is possible to eliminate a stressful situation, the duration of acute adaptation disorder does not exceed several hours. In cases where stress continues or by its nature cannot stop, symptoms begin to disappear after 24-48 hours and are minimized within three days. At the same time, according to diagnostic criteria for adjustment disorder, the response of an individual exposed to a 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 feelings of numbness, alienation, or lack of emotional resonance;
• reduction of perception of the surrounding reality (state of “stunned” or “dazed”);
• derealization;
• depersonalization;
• dissociative amnesia (inability to remember important aspects injuries).

The person constantly re-experiences the traumatic event in at least one of the following ways:

• recurrent ideas, thoughts, dreams, illusions, flashback episodes; o feeling of revival of the lived experience;
• distress when exposed to reminders of the traumatic event.

Avoidance of stimuli that evoke memories of the traumatic event is observed: thoughts, feelings, conversation, activity, location of the event, people involved. Significant symptoms are detected that cause anxiety and increase arousal: difficulty sleeping, irritability, difficulty concentrating, hypervigilance, 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 ICD-10. First, acute stress adjustment disorder includes some of the symptoms that, according to ICD-10, are included in the diagnostic criteria for PSD. Secondly, the duration of the acute stress reaction, according to ICD-10, “is reduced to a minimum within three days, even in cases where the stress continues or by its nature cannot stop.” According to ICD-10, “if symptoms persist, then the question arises of changing the diagnosis.” Third, according to OBM-GU-TI, if symptoms consistent with acute stress disorder last more than 30 days, the diagnosis of acute stress adjustment disorder should be replaced with the diagnosis of ASD. Therefore, according to OBM-GU-TI, PSD as a diagnosis can only be made within the first 30 days after the traumatic event.

The diagnosis “transitional period” does not exist in any classification. Nevertheless, we singled it out for the following reasons:

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

Adaptation disorder is a mental illness of a person that is provoked by various stresses.

A person’s life is inextricably linked with stress, which can adversely affect his health.

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The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any drugs have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! .

Types of disorder

There are several types of this disorder, which have the following characteristics:

• The patient is in a state of anxiety;
• The patient has a depressed mood;
• The presence of disturbances in the psycho-emotional state;
• The patient is in a state of chronic depression.

What can you tell us about prolonged depressive reaction?

Prolonged depressive reaction is a mild depressive illness in response to long-term stress. The patient's stay in this state should not exceed 2 years.

Symptoms of this disease include:

• Feeling depressed;
• The presence of a tearful state (crying);
• A look at the future without rainbow colors;
• Confidence in negative developments.

Causes of this condition

For the manifestation of this disease, the following stress is sufficient:

• Personal problems;
• Conflicts in the workplace;
• Problems with material well-being;
• Conflict relationships at school;
• Frequent change of place of residence;
• Accommodation in places of hostilities;
• Features of the family’s social status (either severe poverty or great wealth);
• Misunderstanding in the family, often leading to quarrels;
• Severing a relationship with a loved one (both male and female parts of the population may suffer);
• Health problems (presence of serious illnesses);
• Sexual inferiority (more common in men);
• Situations related to the death of loved ones.

Some situations may not immediately trigger this mental disorder. If several of the above list occur at once, severe harm to the human psyche is possible.

Risk categories

In addition to the reasons listed, you may be at risk of developing this mental disorder.

1. Genetic predisposition.
2. Gender.
3. Features of individual adaptability to certain life situations.
4. The inability to eliminate the situation causing stress in the body.
5. Experienced abortions in women.
6. The presence of serious illnesses.

Sometimes the occurrence of maladaptation in adult life can be caused by situations experienced in childhood, for example, parental alcoholism, fights in the family, separation from parents (due to deprivation parental rights), living in a combat zone, conflicts with classmates.

Finding a person in a risk category can provoke more serious mental disorders than maladjustment. This is, for example, prolonged depression or bipolar disorder.

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Symptoms and signs of the disease

Any disease is accompanied by a number of symptoms that signal that the body needs help. This disorder can develop within six months after the stress has occurred, and in chronic cases, even longer.

The most characteristic symptoms of adjustment disorder:

• The patient is characterized by a depressed state;
• The patient may experience anxiety;
• Presence of chest pain;
• Early gray hair and the appearance of wrinkles on the face;
• Difficulty breathing (the patient may often take deep breaths);
• The presence of a factor of irritability over trifles;
• Lack of joyful thoughts;
• To start doing something, the patient makes a lot of volitional efforts;
• Lack of plans for the near future;
• Decreased or increased appetite, which leads to either weight loss or weight gain;
• Reluctance to make contact with the interlocutor;
• Loss of healthy sleep.

Signs of this disorder are:

• It is difficult for the patient to remember these new facts and interesting events;
• The circle of interests is greatly narrowed;
• The patient is unable to make quick decisions;
• It is difficult for the patient to draw conclusions from current situations;
• Mental and physical exhaustion of the body occurs.

Diagnosis of this mental disorder

When a patient consults a doctor with these symptoms, he should ask about the presence of stress. You need to tell the doctor everything without hiding.

Because the He must assess the risk factor for the effects of stress on your body.

And rule out the possibility of prolonged depression or post-traumatic disorder. The patient may be referred for consultation to a psychotherapist to clarify the diagnosis and prescribe a course of treatment.

Important! Be sure to check out this material! If after reading you still have any questions, we strongly recommend that you consult with a specialist by phone:

The location of our clinic in the park has a beneficial effect on the state of mind and promotes recovery:

Treatment of adaptation disorders. Symptoms of adjustment disorder

Adjustment disorder is an intermediate state between a person’s normal reaction to misfortune and a mental illness. The complexity of the pathology lies in its intermediateness, since the person himself and those around him often cannot determine it. The prognosis depends on the timeliness of diagnosis and timely provision of assistance.

Causes

Most often observed adjustment disorder in children and adolescents, which is explained by the instability of their psyche. But, with prolonged experience of stressful situations, it is diagnosed in people of working age and elderly patients. The pathological condition appears when:

• Stress;
• Neuroses;
• Psychosis.

With these diseases, patients complain of insomnia and worsening general condition person, which leads to adaptation disorder. Personality adjustment disorder has varying degrees of severity, depending on the severity of the stress.

The onset of the disease can be observed during a serious single stress, for example, the loss of a prestigious job, the death of a loved one, etc. Pathology develops with periodic stress that occurs against the background of poverty or chronic diseases.

People with a genetic predisposition are at risk of developing pathology. If a person has problems with intimacy or conflicts in the family, this leads to maladjustment. It appears when there are material difficulties or difficulties in relationships with others. If the traditional way of life changes dramatically, this leads to a pathological process.

Signs of pathology

Symptoms of adjustment disorder are not always clearly expressed and may differ in each individual case, which complicates the diagnosis process. The main symptoms are of an anxious and depressive nature. Maladjustment is accompanied by a feeling of inability to cope with the troubles that appear in life. With pathology, the patient becomes suspicious and irritable. Most people note the appearance of a feeling of internal tension. Psychiatry adjustment disorders has information that it is accompanied by:

• Anxiety;
• Persistent anxiety;
• Internal discomfort;
• Violations in normal behavior.

In patients with pathology, the mood worsens. In particular severe cases a sad state appears. A person becomes uninterested in his usual activities. A person becomes physically and mentally exhausted, so he cannot make informed decisions. He does not analyze the situation and is not responsible for the decisions made.

Disadaptation has a vague clinical picture, so when the first suspicious symptoms appear, it is recommended to seek help from a specialist who will correctly diagnose and prescribe effective treatment.

Types of pathology

In accordance with the causes and characteristics of its course, maladjustment is divided into several types:

• Social adjustment disorder. With pathology, the patient cannot communicate with his usual circle of friends and acquaintances. He gradually moves away from them and retires. If the pathology is severe, the patient cannot be in society at all. He may not leave the apartment for months.
• Depressive adjustment disorder. The disease develops against the background of depression. A person is constantly depressed. They have no desire to communicate and gradually lose their usual interests.
• Mental adjustment disorder. Arises pathological process in the form of an acute reaction to stress, which develops in the form of psychological shock. It is accompanied by various mental disorders.
• Prolonged adjustment disorder. The pathological process is characterized by a long course. The situation is aggravated when a stressful situation of varying severity appears.
• Anxious adjustment disorder. With this type of pathology, patients experience alarming symptoms under any circumstances.
• Mixed adjustment disorder. This form of pathology combines several of the above.

There are several types of pathology that are recommended to be determined in order to assign the correct diagnosis of adjustment disorder.

Diagnostic measures

Only a qualified specialist can determine maladjustment. It determines the development of somatic symptoms in children and adolescents and warning signs in older people who indicate the progression of pathology. The diagnosis is made in accordance with the diagnostic criteria of DSM-III-R:

• Reactions to overt psychosocial stresses that occur within three months.
• The nature of maladjustment. At this stage of diagnosis, the presence of impairments in school or work and symptoms that should not be present during stress are determined.
• The duration of the maladjustment reaction is more than 6 months.

In case of maladaptation, differential diagnosis is recommended. Pathology must be distinguished from conditions such as disorders that appear due to the use of psychoactive drugs, post-traumatic disorders that occur due to stress, and aromatization.

Treatment of the disease

requires the use of psychotherapy. It is recommended to conduct group therapy for patients who experience the same stress, for example, retirees or people with the same chronic illness. Individual psychotherapy is aimed at ensuring that a person begins to understand that the onset of the disease is observed under stress. This is the main cause of the pathology. If treatment methods are selected correctly, the patient gains strength and endurance with which to combat stress.

To avoid secondary gain, it is recommended correct execution psychiatric decision. Treatment of the disease will be successful if the doctor has an attentive and caring attitude towards the patient. When symptoms of secondary gain appear, the treatment process becomes more complicated.

If diagnosed anxiety depressive disorders, then this requires drug therapy. Patients are recommended to take anti-anxiety medications and tricyclic agents, which help relieve depression.

With maladjustment, the patient may become overly aggressive, which leads to conflicts at work or school, committing crimes, etc. Doctors should not justify these actions of patients and try to justify them to law enforcement agencies. With this line of behavior of the doctor, the person’s emotional state does not improve. In addition, he does not criticize himself, and such socially unacceptable behavior becomes the norm for him.

Disadaptation is a dangerous pathological process that has a blurred clinical picture. That is why pathology is often diagnosed untimely. The choice of treatment method should be made by a doctor, which will ensure its effectiveness.

The private clinic “Salvation” has been providing effective treatment for various psychiatric diseases and disorders for 19 years. Psychiatry is a complex field of medicine that requires maximum knowledge and skills from doctors. Therefore, all employees of our clinic are highly professional, qualified and experienced specialists.

When to ask for help?

Have you noticed that your relative (grandmother, grandfather, mother or father) does not remember basic things, forgets dates, names of objects, or does not even recognize people? This clearly indicates some kind of mental disorder or mental illness. Self-medication in this case is not effective and even dangerous. Tablets and medications taken independently, without a doctor’s prescription, will, at best, temporarily alleviate the patient’s condition and relieve symptoms. At worst, they will cause irreparable harm to human health and lead to irreversible consequences. Traditional treatment at home is also not able to bring the desired results, not a single folk remedy will not help with mental illness. By resorting to them, you will only waste precious time, which is so important when a person has a mental disorder.

If your relative bad memory, complete loss of memory, other signs clearly indicating a mental disorder or serious illness - do not hesitate, contact the private psychiatric clinic “Salvation”.

Why choose us?

The Salvation clinic successfully treats fears, phobias, stress, memory disorders, and psychopathy. We provide assistance with oncology, care for patients after a stroke, inpatient treatment for elderly and geriatric patients, and cancer treatment. We do not refuse the patient, even if he has the last stage of the disease.

Many government agencies they do not want to take on patients over 50-60 years of age. We help everyone who applies and willingly provide treatment after 50-60-70 years. For this we have everything you need:

• pension;
• nursing home;
• bed-ridden hospice;
• professional caregivers;
• sanatorium.

Old age is not a reason to let the disease take its course! Complex therapy and rehabilitation gives every chance of restoring basic physical and mental functions in the vast majority of patients and significantly increases life expectancy.

Our specialists use in their work modern methods diagnostics and treatment, the most effective and safe medications, hypnosis. If necessary, a home visit is carried out, where doctors:

• an initial examination is carried out;
• the causes of mental disorder are determined;
• a preliminary diagnosis is made;
• an acute attack or hangover syndrome is relieved;
• in severe cases, it is possible to force the patient into a hospital - rehabilitation center closed type.

Treatment in our clinic is inexpensive. The first consultation is free. Prices for all services are completely open, they include the cost of all procedures in advance.

Relatives of patients often ask questions: “Tell me what a mental disorder is?”, “Advice how to help a person with a serious illness?”, “How long do they live with it and how to extend the allotted time?” You will receive a detailed consultation at the private clinic “Salvation”!

We provide real help and successfully treat any mental illness!

Consult a specialist!

We will be happy to answer all your questions!