Editorial

Stressors and the Fine Line Between Normal and Psychopathology

Authors: M C. Davila, MD, R G. Bota, MD

Abstract

The terrorist attacks of September 11, 2001, were a sudden and extreme stressor that affected many people.1,2 We all responded to this high level of trauma in different ways. In extreme circumstances, the otherwise adaptive defenses that we use no longer provide us the means to “make sense” of our experiences. As a result, more primitive defenses (eg, denial, projection identification) are used as “failsafe” mechanisms to allow the necessary time for adjustments to a defamiliarized world. Even when gathering all the pertinent information about an individual, it is difficult to accurately predict the impact of stressors on that person's psychopathology.3 It is also known that the presence of emerging psychiatric illness leads to impaired tolerance to even normal stress.4 Therefore, a comprehensive psychiatric history, with emphasis on dynamics of commonly-used defenses, is essential to understand the development of emerging delusional systems.

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References

1. Hoven CW, Duarte CS, Lucas CP, et al. Psychopathology among New York City public school children 6 months after September 11. Arch Gen Psychiatry 2005;62:545–552.
 
2. Nandi A, Galea S, Tracy M, et al. Job loss, unemployment, work stress, job satisfaction, and the persistence of posttraumatic stress disorder one year after the September 11 attacks. J Occup Environ Med 2004;46:1057–1064.
 
3. Pine DS, Costello J. Trauma, proximity, and develop mental psychopathology; the effects of war and terrorism on children. Neuropsychopharmacology 2005;30:1781–1792.
 
4. Klosterkotter J, Ebel H, Schultze-Lutter F, Steinmeyer EM. Diagnostic validity of basic symptoms.Eur Arch Psychiatry Clin Neurosci 1996;246:147–154.
 
5. Reeves RR, Beddington JJ. Persistent paranoid delusions following the September 11 terrorist attacks in a man with no preexisting mental illness. South Med J 2006;99:303–305.
 
6. Lopez-Ibor JJ. Psychopathology of disasters. An R Acad Nac Med (Madr) 2002;119:489–505.
 
7. Bracha HS, Yoshioka DT, Masukawa NK, Stockman DJ. Evolution of the human fear-circuitry and acute sociogenic pseudoneurological symptoms: the Neolithic balanced-polymorphism hypothesis. J Affect Disord 2005;88:119–129.
 
8. Polatin PB, Young M, Mayer M, et al. Bioterrorism, stress, and pain: the importance of an anticipatory community preparedness interventions. J Psychosom Res 2005;58:311–316.