The chronic stress it is a type of adjustment disorder characterized by an unhealthy emotional and behavioral reaction to an identifiable and prolonged stress situation. It differs from anxiety in that in this the stressful stimulus is not identifiable.
Stress is an adaptive response of our body to an excessive demand from the environment or to a situation with a high emotional charge. Stressful situations can be both negative and positive, for example they can cause us the same stress to show up for an important exam and get married.
This ability allows us to prepare to respond to stressful stimuli. To do this, you must first become aware of the situation. If we identify the stimulus as stressful, the neuroendocrine system will be activated and a neurophysiological response will be emitted, characterized by a rise in activation levels.
When intermediate stress levels are reached, our performance in the face of the stressful situation will be optimal, but if the stressful situation continues to occur for a long time, our neuroendocrine system is depleted, stress is no longer adaptive and chronic stress appears (see Figure 1).
The levels of stress necessary to reach the optimum level and to reach chronic stress depend on many variables (context, personality, type of stimulus); therefore it varies from person to person.
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The emotional and behavioral reaction to chronic stress must occur within 3 months after the stressful situation has occurred and must be of great intensity.
This disorder includes the following symptoms (according to DSM-V):
To speak of chronic stress, the above symptoms must persist for more than 6 months. It is important to clarify that these symptoms should not respond to a grieving reaction, since in that case it would be a normal response, not a maladaptive one..
People who suffer from chronic stress may experience the following symptoms:
Most symptoms diminish and often disappear as time passes and stressors are eliminated, without the need for any type of treatment..
However, when stress becomes chronic it is more difficult for this to occur, since it can facilitate the appearance of other disorders such as depression or anxiety, or even promote the use of psychoactive substances.
It is estimated that between 5-20% of the population that has been assisted by psychological problems suffer from an adjustment disorder (which includes chronic stress). In children and adolescents this percentage increases, reaching between 25-60%.
Chronic stress can be suffered at any age, although it is especially common in children and adolescents, and affects women and men indifferently.
Cases of chronic stress occur throughout the world, but the way in which these cases manifest themselves and the way of studying them varies markedly depending on the culture.
Furthermore, cases of chronic stress are more numerous in disadvantaged cultures or in developing countries. Likewise, they tend to be more frequent in populations with low socioeconomic levels..
There are many factors or variables that can increase or decrease the probability of suffering from an adjustment disorder, although no variable is known that by itself determines the appearance of this disorder..
The variables can be:
The individual variables that can influence the development of an adjustment disorder are those that influence the way in which the person perceives and copes (coping) with stressful situations. These variables include:
The social environment is very important both as a risk factor and as a protector, since it can be another tool to cope with stress but it can also lead to the appearance of certain stressors (divorce, abuse, bullying). The main social variables are:
The design of the treatment will depend on multiple factors, among which it is worth highlighting:
It is recommended to use multimodal holistic treatments that include the important areas of the patient's life, for example, psychotherapy, family therapy, behavior modification, cognitive restructuring and group therapy could be combined.
All treatments pursue the same objectives:
Regarding the nature of the treatment, psychological or psychopharmacological, it is recommended to start with psychotherapy and start with psychoactive drugs only if necessary, but always continuing with psychotherapy.
There are very diverse treatments but we will focus on cognitive-behavioral and systemic therapy as they are the most used.
This approach is aimed at teaching the patient to develop their own tools to solve problems, to improve communication and to manage impulses, anger and stress..
The intervention focuses on modifying thoughts and behaviors in order to improve coping strategies. This approach includes a wide variety of techniques, such as biofeedback, problem solving, cognitive restructuring, relaxation techniques, among others..
Of the systemic therapies the most common are:
Psychotropic drugs are only indicated in cases that are particularly resistant to psychotherapy and in severe cases (such as the subtypes of adjustment disorder with anxiety or depression), but they should always be accompanied by psychotherapy.
It is important to take the drug only when the doctor prescribes it and in the doses indicated by the doctor, since the choice of the psychoactive drug to take depends on multiple factors. For example, not all antidepressants have the same effects, and it can be very dangerous to take the wrong psychoactive drug (or in the wrong dose) and can even cause other disorders.
In the case of chronic stress, anxiolytics or antidepressants are usually pre-registered depending on the patient's symptoms. Only if anxiety is very intense, low-dose antipsychotics can be indicated. In specific cases where there is significant inhibition or isolation, psychostimulants (for example amphetamines) can also be pre-registered.
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