“适应障碍”的访谈与诊治

Interview and treatment of adjustment disorder

咨客是一名24岁中专受教育程度的未婚女性,目前无业。她是家中的独生女,从小被忙于生计的父母所忽视,中专毕业走向社会开始出现一系列不适应,事业失败,情感不顺。近两年常有失眠、焦虑、烦躁、胃肠道不适,在压力下感到"心脏缺失了""头很僵",偶有时间感扭曲。被诊断为适应障碍伴焦虑,并出现了躯体化症状,采用生物、心理、社会的综合干预。具体做法是鼓励其进行运动并使用药物改善焦虑与睡眠情况,同时避免加重胃肠道反应;运用认知行为疗法(CBT)让咨客理解病因、调整认知、改善人际关系;学习应对策略,避免工作压力。

The patient was a twenty-four-year-old unmarried women with secondary school education who was currently unemployed.The girl was the only daughter in her family but she received less care since her parents were too busy with their work when she was young.After graduated,she faced several challenges such as career failure and relationship problems.Over the past two years,she frequently suffered from insomnia,anxiety,irritability and gastrointestinal discomfort.She sensed that her"heart was absent"and"head was inflexible"while under pressure.Further symptoms included a distorted sense of time on occasion.She was diagnosed with adjustment disorder with anxiety and developed somatic symptoms.To treat her condition,a bio-psycho-social integrated intervention was adopted.Biological treatments included encouraging exercise and using medication to reduce her anxious state while improving sleep and preventing gastrointestinal side-effects.Cognitive Behavioral Therapy(CBT)was used to assist the patient to understand the cause of her disorder and to adjust cognition in order to improve interpersonal relationships.Coping strategies were also taught to mitigate work pressure.