“适应障碍”的访谈与诊疗

The interview and treatment of adjustment disorder

咨客是一名30岁左右的已婚女性,研究生学历。两年前第一次怀孕,孕8周时发生胎停育。一年前再次怀孕,但孕9周时再次胎停育。在此期间,咨客对怀孕的事情感到非常焦虑,反复去医院检查,几乎每日以泪洗面。两次怀孕失败后,咨客非常消沉,有自杀观念,睡眠质量也很差。她的丈夫在这段时间被查出心脏有问题。经过家人和病友开导,半年后逐渐好转。两个多月前,咨客第三次怀孕,孕9周时再次发生胎停育。咨客重新陷入之前的焦虑和抑郁状态,同时,她也开始隐隐地担心丈夫的健康状况。虽然她知道心脏疾病与怀孕之间并无明确联系,但仍然难以控制自己的情绪。经过治疗,她被诊断为适应障碍伴焦虑和抑郁心境,并给予认知行为治疗和焦点解决短程治疗。值得一提的是,医生将这件事重新定义,告知咨客并非"运气不好"或者自身有过错,这使得咨客感觉好多了。根据咨客的病史,医生建议她在尝试再次怀孕之前先明确是否有其他医学原因导致流产。咨客逐渐认识到,她对丈夫的担心以及自责感都是毫无根据的,因为丈夫目前的情况不会威胁生命,也并非她怀孕所致。

A married woman in her thirties is a graduate student,who first became pregnant two years ago but miscarried within eight weeks. One year later, she became pregnant for the second time but again miscarried within nine weeks. During this time period, she felt enormously anxious about the pregnancy, constantly worrying, crying every day, and visiting the hospital frequently. After two miscarriages, she was overwhelmed by depressed feelings, suicidal ideation, and poor sleep hygiene. Her husband at this time discovered an unspecified heart condition. Her family and friends eventually intervened before her condition deteriorated, and she gradually recovered within half a year. Two months ago,she became pregnant for the third time, and miscarried within nine weeks. She relapsed into her former depressed and anxious state, this time also harboring fears about her husband＇s health. Although she is consciously aware that there is no connection between the heart ailment and her pregnancies, she is unable to dissociate the two in her mind or control her emotions. After therapy, she was diagnosed with adjustment disorder with anxiety and depression and recommended cognitive behavior therapy and solution focused brief therapy. In particular,reframing the issue so it’ s not ＂bad luck＂ or her fault has helped her to feel better. Given her medical history, she was advised to determine if there is a medical reason for the miscarriages before trying again. Over time, she has become receptive to the idea that her fears about her husband and feelings of guilt are unfounded as his condition is neither life - threatening nor brought on by her pregnancy.