Previous Psychiatric Illness or Personality Disorder

For many people, there is little correlation between a previous psychiatric illness or personality disorder and their capacity to cope or adapt to an acute crisis or trauma. A person with schizophrenia may be just as capable of handling an acute crisis as others who do not have psychiatric disorders. How well a person handles an acute crisis or trauma depends primarily on the variables discussed earlier, including the precipitant, the meaning of the events, the crisis situation itself, the patient's coping skills and styles, and the effectiveness of the patient's support network.

However, there are many cases in which a preexisting psychiatric disorder or an unresolved trauma or crisis may influence the development of a new crisis. Consider the case of a mentally retarded boy who becomes severely violent because his mother ran out of his favorite breakfast cereal. This change would be a minor stressor for most people, but for this boy, disruption of his daily breakfast food and routine are perceived as catastrophic. His low IQ and lack of verbal skills, related to his mental retardation, predispose him to a crisis involving violence because he lacks the ability to consider other options. Patients with severe psychiatric illness or personality disorders, those with trauma-related disorders (see Table 45-1), and those who have rigid coping styles or poor adaptation skills all are at greater risk for future crisis.

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