Acute Crisis Resolution and Adaptation to the Crisis Within 6 Weeks

For many patients, the acute nature of the crisis is often resolved within 6 weeks as the patient learns to cope or adapt to the acute stress. The DSM-IV-TR (APA, 2000) has classified the initial 1 -month period of a crisis marked by impaired functioning as an "acute stress disorder." DSM IV-TR specifies that the acute symptom picture must last more than 2 days and no more than 4 weeks and must cause significant distress or impairment in social or occupational functioning. The result of the acute stages of the crisis is one of four possible outcomes specified in Figure 45-1. Successful coping and adaptation to a crisis can lead to crisis resolution that ultimately promotes growth and can even lead to improved functioning. For most patients, however, crisis resolution means a return to a previous level of baseline functioning. Still other patients only partially resolve the crisis and instead "seal over" and deny the significance of their feelings or recent events, setting the stage for a future crisis. Those with the worst prognosis typically have poor adaptation skills and, at best, stabilize at a lower level of daily functioning. For example, a patient who swallowed many pills after being left by her boyfriend may in retrospect deny any suicidal intent and instead say, "I just had a headache." This patient has sealed over her crisis. Denial of her suicidal intent and anger with her boyfriend will probably lead to poor adaptation and latent weakness, called a missed or unresolved crisis. The patient may continue to use unsuccessful coping strategies, such as drinking or repeated suicide gestures, as a way to deal with her feelings. Unresolved crises predispose the patient to future episodes that may be caused by even less stressful precipitants. For example, this same patient may once again become suicidal after a minor argument with a male friend. Fortunately, future crises can afford new opportunities to rework past unresolved crisis, with better adaptation and coping.

The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

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