Stress and adjustment disorders are reactions to severe stress and trauma. A distinction is made between acute stress reaction, adjustment disorder, and post-traumatic stress disorder. Long-lasting personality changes can also occur following extreme stress.
Below you will find further information as well as a selection of specialists for the treatment of stress-related and adjustment disorders.
Stress disorders are directly caused by a single severe stressful event (trauma) such as
or by prolonged severe stress (e.g., prolonged sexual abuse). The symptoms of such excessive reactions to stress can vary widely.
In general, it is normal for trauma or severe life events to cause sadness, fear, shock, sleep disturbances, etc. Such reactions are only classified as a mental disorder when
An acute stress reaction refers to symptoms that occur in the hours immediately following a stressful event. They subside after a maximum of 48 hours (“nervous breakdown,” psychological shock).
These symptoms include feelings of inner emptiness, despair, and anxiety, and in some cases, suicidal thoughts. It is important not to leave those affected alone and to support them in stabilizing their condition (“crisis intervention”).
Adjustment disorders are characterized by various symptoms such as anxiety, worry, and tension. These symptoms cause the affected person significant distress. Adjustment disorders begin within one month of the triggering event and last for a maximum of several months.
Triggering events can include acute events such as the death or serious illness of a loved one. However, they can also involve prolonged stressors, such as marital problems or difficulties at work.
Adjustment disorders are primarily treated on an outpatient basis through psychotherapy. In addition to necessary crisis intervention, support in processing the triggering event may also be helpful. In some cases, a short-term prescription for a sedative may also be considered.
Case Study: Adjustment Disorder
A 34-year-old married mother of two young children visits a psychotherapist on the advice of her primary care physician. She explains that things had actually been going quite well for her in recent years until, three weeks ago, her husband told her that he had met another woman online and wanted to separate from her. They are currently still living in the same apartment but in separate rooms; he is looking for a new place to live.
Since this happened, she has felt desperate, is often irritable, has intense fears about the future, has trouble sleeping, and finds herself crying frequently. She is still able to work her part-time job. This even provides her with some variety and distracts her, as do get-togethers with friends. However, as soon as she is back in the apartment, all her symptoms return, and she doesn’t know how to move forward.
Post-traumatic stress disorder (PTSD) occurs after extremely severe, catastrophic traumatic events such as assaults, rapes, or torture. Symptoms include
Many people affected feel ashamed of what they have experienced and of the disorder itself. As a result, they often seek psychiatric or psychotherapeutic treatment only late in the course of the illness—or not at all. It is also common for people to abuse alcohol or sedatives in an attempt to manage their symptoms on their own. This can lead to complex addiction issues.
About 60 percent of all people experience trauma at some point in their lives. However, only 5 to 10 percent develop PTSD. Women are affected about twice as often as men. Depending on the type of trauma, the likelihood of developing post-traumatic stress disorder varies greatly:
Treatment for PTSD should primarily consist of psychotherapy. However, the first step is stabilization, e.g., through
is important.
Afterward, it is often helpful to confront the traumatic situation rather than constantly avoiding it. This can be done by mentally replaying the experience, but also by visiting the site of the traumatic event. Psychotherapy may be supplemented, if necessary, with medication such as antidepressants.
Case Study: Post-Traumatic Stress Disorder (PTSD)
A 24-year-old female student sought help at the outpatient clinic of a specialized psychosomatic clinic due to severe anxiety, sleep disturbances, irritability, and low mood. These symptoms had persisted since she was attacked by a stranger outside her apartment four months ago while returning home late at night. While locking her bicycle, she was struck hard on the head. After that, she could not remember anything until 25 minutes later, when she regained consciousness. Her purse was gone. She sustained significant injuries from the blow and the subsequent fall.
Since then, she has not touched her bicycle, cannot go out alone after dusk, and has constant nightmares. Even during the day, the event replays in her mind over and over, as if in a movie.
Particularly severe, prolonged, and repeated traumas can also lead to lasting personality changes. Such events include, for example,
Even after the danger has passed, those affected fear that the events could recur. They are extremely distrustful of their surroundings. Chronic sleep disturbances and other physical symptoms are common complaints. As a result, some individuals are completely cut off from their previous social circles.
