adjustment disorder
Introduction
Introduction to adaptation disorders Adaptation disorder (adjustmentdisorder) is due to the long-term existence of stressors or difficult situations, plus the patient's personality defects, causing emotional disorders such as troubles and depression, as well as maladaptive behaviors (such as withdrawal, inattention to hygiene, irregular life, etc.) and physiology Dysfunction (such as poor sleep, lack of appetite, etc.), and a chronic psychic disorder that impairs social function. The occurrence of adaptive disorder is the result of the interaction of psychosocial stress factors and individual quality. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: Hypertension Diabetes Headaches Stomach Ulcer Stroke
Cause
Adaptation disorder
(1) Causes of the disease
This disorder is an abnormal state in which an individual is unable to adapt to changes in life or stressful events (such as widowhood, going abroad, immigration, participation in the military, retirement, etc.), and continues to be in an emotional disorder and poorly adaptive behavior, due to the same stressors. Many people can handle it smoothly without any abnormal reaction, but the patient has mental disorders, indicating that personal susceptibility plays an important role in the occurrence of adaptation disorders. However, it is still necessary to be sure that if there is no stress source, it will not happen. This is the case.
Psychosocial factor
Changes in living environment and family, deteriorating interpersonal relationships, frustration in work and school, death of relatives and friends, etc. Some factors also have specific periods such as new marriage, graduates seeking employment, and adapting to new life rules after retirement.
2. Personality factors
Many people can deal with the same stress source without any abnormal reaction, but the patient has mental disorder, indicating that the individual's susceptibility plays an important role in the occurrence of the adaptation disorder, but it should be certain that if there is no stress source, There is no adaptation disorder, and the social adaptability is not good. The coping style is blunt and monotonous, and the physiological condition of the individual under stress is relatively weak, and it is easy to produce adaptive obstacles.
(two) pathogenesis
Stress source
The stressors that cause adaptation disorders can be one, such as widowed; or multiple, such as career failures and loved ones, the stressors can come suddenly, such as natural disasters; or they can be slower For example, if the relationship between family members is not harmonious, some stressors also have specific periods, such as the wedding period, the graduates seeking employment, leaving, adapting to new life rules after retirement, etc., the severity of the stressors. It is impossible to predict the severity of the adaptation disorder, but also the nature of the stressor, the duration of the stress, the reversibility, the situation and the characteristics of the individual's personality (Gelder M, 1996), such as the significant stress in the face of significant effects. Sources, like being taken hostage, suffer from bad inhuman treatment. At this time, emotional or behavioral obstacles are difficult to avoid, as well as the vulnerability of adolescents, the experience of stressors is deep, and it is also one of the risk factors. It can also happen in a group, such as schools, people with natural disasters, etc.
2. Personal psychological characteristics
Under the same stress source, some people adapt well, while others are maladaptive. Not all people show adaptive obstacles. It is reasonable to infer that the patient's pre-patient personality psychological characteristics (ie personality) can not be ignored. The role of the individual, such as the vulnerability of the individual, the strength of the stressor is not very large, and may cause adaptation disorders. The different vulnerabilities of the individual may be related to the previous life experience (Gelder M, 1996), therefore, Whether the adaptation disorder occurs or not, we must weigh the two factors of stress intensity and personality psychological characteristics.
Prevention
Adaptive disorder prevention
The body has no disease, no mental illness, and social adaptability is recognized as the "comprehensive health" three elements at home and abroad. Mental health and social adaptability are important indicators of people's intellectual development and brain function health. They are establishing a concept of life, a world view, and training. The basis of good psychological quality, social adaptation refers to the ability to coordinate interpersonal relationships, to cope with various interpersonal relationships in a criss-crossed human group, and to have the ability to deal with and adapt to family, school and social life to students. Take social adaptation as an example, and the countermeasures for prevention are:
Persuasion education law
The formation of psychological quality is based on moral understanding. Therefore, in order to shape positive psychological quality, it is necessary to improve moral understanding, judgment and evaluation level as a breakthrough. For example, students often have poor learning consciousness, and their root causes First, the purpose of learning is unknown. Whether it is at school or at home, as long as you mention learning and doing homework, you will have an inertia in your mind. In action, you will be afraid of learning, do not want to do homework, and are easily attracted by other things. Therefore, we apply the method of persuasion education to the psychological state and characteristics of different types of students, and make sense to educate students to form correct understanding, overcome errors or vague understandings in the mind, and achieve intensive learning purpose education. the goal of.
2. Situational edification
The harmonious or democratic education or teaching situation is an important method to cultivate the health and psychological quality of the educated. In the education and teaching activities, we must systematically create harmonious and democratic educational situations in various ways, such as creating a united and tense, serious and lively situation. The joy, success, knowledge, diligence, and democratic atmosphere in teaching; individual respects, expectations, encouragement, strict requirements, etc., so that educators can enjoy the education in a harmonious educational and teaching situation. Express your own thinking and feelings, overcome timidity, worry, fear of unnecessary psychological pressures such as criticism, enhance self-confidence, and cultivate the courage to courage and solve problems independently.
3. Situational infection method
Emotions and emotions are always infected with each other. In a specific school environment, emotional communication often occurs between the educator and the educated, intentionally and unintentionally infected with emotions, and the educator seeks to make himself healthy, happy, and vivid. Emotions, words and deeds to infect their own educational objects, so that they produce a strong and positive inner experience, such as a praise; a successful individual conversation; a clear-cut event, etc., will enable the educated to have a pleasant emotional experience. Resonating emotionally, the educational method of "moving emotions" is not only conducive to fostering positive attitudes such as hobbies and curiosity, but also helps to shorten the psychological distance between each other, so that it can maintain stable and lasting emotions. Be focused, active, active, and conscientious.
4. Willing method
The cultivation of various psychological qualities is the result of consciously participating in social practice and is also tempered in the struggle against difficulties. Therefore, it is extremely important to temper the quality of the will. First, it is necessary to cultivate confidence and courage to overcome difficulties. Instinct in front of them, self-control, self-discipline, second, to participate in group activities, enhance collective ideas, obey the collective will, gradually develop self-control, strong, resolute, decisive will quality in the activities, correct hesitation, blindness, stubbornness, recklessness , stubborn bad quality, improve their level of will
5. Psychological Education Law
This is the basic form of improving psychological quality. The ultimate goal is to protect and promote people's physical and mental health. The content is not only to popularize mental health knowledge, but also to correct the cognitive structure of psychological confusion. It is necessary to understand the mastery of mental health care through discussion. Requirements and problems, through survey and test, analyze the psychological barriers of the subjects, the biased situation, then talk about knowledge, talk about health care, jointly analyze and exchange psychological issues, special discussions, to connect with the actual education of mental health and self-cultivation.
6. Psychological counseling
This is to help the respondents overcome the psychological obstacles they may encounter on the road of life, so that they can adapt to social life, handle interpersonal relationships, and smoothly complete the transfer of social roles. The key to achieving good results in psychological counseling is to give trust. Give understanding, give transposition (ie, put yourself in the heart, compare your heart), but also move with emotion, follow listening (let the respondent vent), confidentiality (some deep content must be absolutely confidential), and groom (for special issues raised by him) Face-to-face guidance) Mutual trust is the basis for successful consultation. The consultation process is the process of emotional and psychological communication between the two sides. Only in this way can we achieve the effect of eliminating mental stress and achieving psychological transformation.
Complication
Adaptation disorder complications Complications, hypertension, diabetes, headache, stomach ulcer, stroke
Chronic frequent stress response, so that the spirit is in a state of tension for a long time, easy to induce high blood pressure, diabetes, neuropathic headache, gastric ulcer and other chronic diseases, and excessive emotional stress, such as overjoyed, too sad is very easy to cause brain Stroke, muscle infarction and other "white heads", "laughing dead" situation, due to increased stress and glucocorticoid secretion, significantly inhibiting the body's immunity, so stress can increase the incidence of infectious diseases Susceptibility.
Symptom
Symptoms of Adaptation Disorders Common Symptoms Useless Trembling for Life Loss Interests Widowed After Adaptation Disorder Violent Impulsive Behavior Weight Loss Depression Anxiety Irritating Back Pain
The incidence of this disease is more than 1 to 3 months after the onset of stress events, the clinical symptoms of patients vary greatly, mainly characterized by emotional and behavioral abnormalities; common anxiety, anxiety, depression, inability Feeling, timid fear, difficulty concentrating, confusing and irritating, etc., can also be accompanied by physical symptoms such as palpitation and tremor, and at the same time, maladaptive behavior can affect the daily activities, and the patient can feel irritated. Attention to maladaptive behavior or violent impulsive behavior, but in fact rarely occurs, sometimes patients have alcohol or drug abuse, other more serious symptoms, such as interest, no motivation, lack of pleasure (anhedonia) and lack of appetite Etc. It is rare, there are reports that there is a certain relationship between clinical manifestations and age: physical symptoms can be associated with the elderly; adults often have symptoms of depression or anxiety, and conduct disorder in adolescents (ie, attack or hostile social behavior) Common; in children can be characterized by degeneration, such as bedwetting, childish speech or squatting thumb.
The patient's clinical phase may have a predominant symptom group or a mixed symptom group. The following types are available for clinical work (American Psychiatric Association, 1994):
1. Adaptation disorder of anxiety
With neurosis, upset, palpitations, nervousness, agitation, etc. as the main symptoms, there are few reports of anxiety disorder with anxiety, mainly manifested as nervousness, fear, nervousness, trembling, and Have a heart, suffocation or breathing, feel a little comfortable, restless, sweating and so on.
2.Adjustment disorder with depressed mood
The more common adaptation disorders for adults are mainly characterized by bad mood, loss of interest in life, self-blame, despair, crying, tears, depression, suicidal behavior in severe cases, but the proportion of depression is light, often accompanied by Sleep disorders, loss of appetite, weight loss.
3.Adjustment disorder with conduct disturbance
More common in adolescents, mainly manifested in violations of the rights of others or violent acts against social norms and regulations, abnormal performance of non-compliance with legal responsibilities, such as: truancy, miners, fights, fights, destruction of public property, rude People are rude, driving cars, stealing, running away from home, premature sex, fighting and drinking too much.
4. adjustment disorder with mixed disturbance of emotion and conduct
Clinical manifestations include both emotional abnormalities and performance of conduct disorders, and caution should be exercised in the diagnosis of such patients.
5.Adjustment disorder with mixed emotional features
Described as a mixed syndrome of depression and anxiety mood and other emotional abnormalities. From the point of view of the severity of symptoms, the proportion of depression and anxiety is mild. If some young people enlisted in school or left school after leaving school, they will have depression, conflict, and anger. And obviously dependent on performance.
6. Unadjusted adaptation disorder (adjustment disorder unspecified)
This is an atypical adaptation disorder, such as a social withdrawal without anxiety or depression.
(1) Adaptation disorder of physical complaints: mainly manifested as physical complaints, such as fatigue, headache, back pain, loss of appetite, chronic diarrhea or other physical discomfort, etc., patients do not seek medical diagnosis or compliance with treatment; physical examination Corresponding positive signs, other tests are normal.
(2) Adaptation barriers to job inhibition: mainly manifested as sudden difficulty in daily work and study, reduced work efficiency, poor academic performance, weak work and study ability, serious daily work, or even learning or reading materials. For the ability to weaken.
(3) Retraction-type adaptation disorder: manifested as loneliness, out-of-group, not participating in social activities, not paying attention to personal hygiene, life is irregular, in children in the form of bedwetting, childish language or squatting thumb, patients generally have no anxiety and depression, There are no symptoms of horror.
Symptoms of adaptation disorders are diverse. Onset usually occurs within 1 month after the occurrence of stress events or life changes. In addition to long-term depressive reactions, after the stressors and difficult situations are eliminated, the duration of symptoms is generally not More than 6 months.
Adjustment disorder A state of subjective pain and emotional disorder that often impedes social functioning, occurring during an apparent adaptation of life or stress events (stressors), including major personal developmental aspects. Change (school, first parent, failure to achieve personal ideals, retirement, etc.), or events that may affect the integrity of an individual's social relationship (habitation, parting experience), or events affecting social support systems and value systems (immigration or Refugee status), but it should be pointed out that personal quality or susceptibility also plays an important role in the risk and manifestation of this disease. The symptoms of this disease are diverse, including depression, anxiety or trouble, and it is impossible to plan for the current situation. Can not cope, is difficult to adhere to, dealing with daily affairs are also flawed, often accompanied by emotional and conduct disorders (especially adolescents), the course of disease for at least 1 month, the longest does not exceed 6 months.
Examine
Adaptation disorder check
There is currently no specific laboratory test for this disease. When other conditions, such as infection, occur, laboratory tests show positive results from other conditions.
Diagnosis
Diagnosis and identification of adaptive disorders
diagnosis
Diagnostic adaptation disorders should pay attention to the following relationships: the form, content, severity of symptoms; past medical history and personality traits; stressful events, situation or life crisis; strong evidence that there is no barrier if there is no stress However, many mental disorders may have stress incentives, so the existence of stress cannot be considered as a basis for diagnosis. If the patient is treated due to normal frustration, and the response is appropriate in the culture of the individual, and the duration does not exceed 6 In the month, the adaptation disorder is not diagnosed, and the diagnosis is mainly based on clinical manifestations:
1. There are obvious sources of stress as incentives, especially changes in living environment or social status, and abnormal mood and behavior occur within 3 months after the occurrence of stressors.
2. The stressor and the patient's personality play the same role, that is, the patient has been mentally normal when there is no stress source, and the same stress event can successfully handle the same kind of events, indicating that the patient's social adaptability is not strong.
3. Emotional disorders are dominant, with obvious distress and maladaptive behavior and physiological dysfunction.
4. Mental disorders hinder the influence of social function.
5. After the stressor disappears, the symptoms should not persist for more than 6 months, and the long-term depression response does not exceed 2 years.
6. Except for emotional abnormalities caused by lovelorn or depression, this is a normal psychological reaction.
7. Symptoms are not sufficient to diagnose other types of mental disorders. It should be noted that when adolescents are diagnosed, they should be considered and analyzed.
Differential diagnosis
Acute stress disorder
Adaptation disorder and acute stress disorder are both post-traumatic stress disorder. It is difficult to explain the severity of the disease in the etiology. The main difference lies in clinical manifestations and disease processes. Acute stress disorder has unusual stress events and rapid onset. Symptoms are fully developed within a few minutes to a few hours, with psychomotor excitement or psychomotor inhibition as a prominent manifestation, rather than emotional and behavioral abnormalities, and may be accompanied by a certain degree of disturbance of consciousness. Completely recalled, the entire course of the disease is also relieved, usually within a few hours to a week.
2. Post-traumatic stress disorder
Although the disease and adaptation disorder are not acute, but there are identifiable points in clinical symptoms. Post-traumatic stress disorder is characterized by repeated recurrence of traumatic experience, accompanied by illusions or hallucinations, and may have sleep disorders. Symptoms such as irritating or shocking reactions can continue to be avoided, and try to avoid recalling or participating in painful experiences or memories, or even contact with people.
3. Major depression
The identification of disability and depression is sometimes difficult to distinguish in terms of emotions. This requires clinical practical experience. There is no absolute standard of discrimination. Generally speaking, the emotional abnormalities of depression are severe, and there are often negative thoughts and even suicide. In the attempt and behavior, the whole clinical phase changes sooner or later, and it can be recurrent from the course of the disease. Many patients also have manic episodes.
4. Anxiety disorder
Mainly related to the identification of generalized anxiety disorder, this disease is not only a long course of disease, but also often accompanied by obvious symptoms of autonomic nervous system disorders, sleep disorders are also very prominent, often there is no strong stress source worthy of attention before the disease can be found .
5. Personality disorder
Personality disorder can not be ignored in the pathogenesis of adaptive disorders. Personality disorder is an important factor in the pathogenesis of adaptive disorders, but it is not a significant manifestation of clinical phase. In practice, personality disorder can be aggravated by stressors, but personality disorder is obvious as early as in childhood. The stressor is not the dominant factor in the formation of personality disorder. The patient is not distressed by personality abnormalities, but basically continues to adulthood or even life. It should also be pointed out that when patients with personality disorder develop new symptoms and meet the diagnostic criteria for adaptation disorders, Both diagnoses should be juxtaposed at the same time, such as paranoid personality disorder and depression in mood settings.
6. Emotional disorders caused by physical illness
It is characterized by a long-lasting concern or belief in various physical symptoms. Patients often seek medical treatment for these symptoms such as cardiovascular disease and cerebrovascular disease. Various medical examinations and doctors' explanations cannot dispel their doubts. When the patient may have an anxiety and depression state, it is necessary to identify with the adaptation disorder.
7. Neurosis
It is characterized by anxiety, depression, coercion, horror, etc., accompanied by obvious autonomic symptoms, sleep disorders are also prominent, and the course of disease is long, often without strong sources of stress.
