Crisis State

The crisis state can b e defined as a brief psychological upheaval, precipitated by a stressor, that produces an intense state of inner turmoil or disorganization that overwhelms a person's ability to cope and adapt. As with Melinda, the crisis state can be experienced as panic, disbelief, fear, confusion, sudden awareness of vulnerability, initial elation at having survived, or beginning of a grief reaction. For some, the crisis state may be denied or experienced as psychological numbing.

Often, patients in a crisis or suffering from a trauma present to their family physician with a confusing array of physical complaints. Patients like Melinda, who seek help while in an acute crisis, are typically impaired in some aspect of their daily interpersonal, work, social, or family life. Patients may have obvious psychological symptoms, unconscious psychological distress and pain associated with substance abuse, or physical symptoms. Four clusters of symptoms are typically experienced by patients during a crisis or secondary to a trauma (Box 45-1).

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