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Chapter: Medical Surgical Nursing: Homeostasis, Stress, and Adaptation

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Maladaptive Responses to Stress

The stress response, which, as indicated earlier facilitates adapta-tion to threatening situations, has been retained from our evolu-tionary past.

MALADAPTIVE RESPONSES TO STRESS

 

The stress response, which, as indicated earlier facilitates adapta-tion to threatening situations, has been retained from our evolu-tionary past. The “fight-or-flight” response, for example, is an anticipatory response that mobilized the bodily resources of our ancestors to deal with predators and other harsh factors in their environment. This same mobilization comes into play in re-sponse to emotional stimuli unrelated to danger. For example, a person may get an “adrenaline rush” when competing over a de-cisive point in a ball game, or when excited about attending a party.

When the responses to stress are ineffective, they are referred to as maladaptive. Maladaptive responses are chronic, recurrent responses or patterns of response over time that do not promote the goals of adaptation. The goals of adaptation are somatic or physical health (optimal wellness); psychological health or hav-ing a sense of well-being (happiness, satisfaction with life, morale); and enhanced social functioning, which includes work, social life, and family (positive relationships). Maladaptive re-sponses that threaten these goals include faulty appraisals and in-appropriate coping (Lazarus, 1991a).

 

The frequency, intensity, and duration of stressful situations contribute to the development of negative emotions and sub-sequent patterns of neurochemical discharge. By appraising sit-uations more adequately and coping more appropriately, it is possible to anticipate and defuse some of these situations. For example, frequent potentially stressful encounters (eg, marital discord) might be avoided with better communication and prob-lem solving, or a pattern of procrastination (eg, delaying work on tasks) could be corrected to reduce stress when deadlines approach.

 

Coping processes that include the use of alcohol or drugs to reduce stress increase the risk of illness. Other inappropriate cop-ing patterns may increase the risk of illness less directly. For ex-ample, people who demonstrate “type A” personality behaviors such as impatience, competitiveness, and achievement orienta-tion and have an underlying hostile approach to life are more prone than others to develop stress-related illnesses. Type A be-haviors increase the output of catecholamines, the adrenal-medullary hormones, with their attendant effects on the body.

 

Other forms of inappropriate coping include denial, avoid-ance, and distancing. Denial may be illustrated by the woman who feels a lump in her breast but downplays its seriousness and delays seeking medical attention. The intent of denial is to con-trol the threat, but it may also endanger life.

 

Models of illness frequently cite stress and maladaptation as precursors to disease. A general model of illness, based on Selye’s theory, suggests that any stressor elicits a state of disturbed phys-iologic equilibrium. If this state is prolonged or the response is ex-cessive, it will increase the susceptibility of the person to illness. This susceptibility, coupled with a predisposition in the person (whether from genetic traits, health, or age), leads to illness. If the sympathetic adrenal-medullary response is prolonged or exces-sive, a state of chronic arousal develops that may lead to high blood pressure, arteriosclerotic changes, and cardiovascular dis-ease. If the production of the ACTH is prolonged or excessive, behavior patterns of withdrawal and depression are seen. In ad-dition, the immune response is decreased, and infections and tu-mors may develop.

 

Selye (1976) proposed a list of disorders that he called diseases of maladaptation: high blood pressure, diseases of the heart and blood vessels, diseases of the kidney, hypertension of pregnancy, rheumatic and rheumatoid arthritis, inflammatory diseases of the skin and eyes, infections, allergic and hypersensitivity diseases, ner-vous and mental diseases, sexual derangements, digestive diseases, metabolic diseases, and cancer.

 

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