The term nervous breakdown is the colloquial name for an acute reaction of the body to extreme psychological stress, characterized by sudden physical and emotional overreactions of the affected person. The causes of a nervous breakdown can vary. If the condition persists, professional help in the form of talk and behavioral therapy, which is not infrequently also supported by medication, usually becomes necessary.
What is a nervous breakdown?
The everyday hectic, tension and inner turmoil, can lead to a nervous breakdown in the long term. A nervous breakdown is triggered by a situation that is extremely psychologically stressful for the affected person. Such situations can be events such as accidents, experiences of violence, the loss of a loved one, or ongoing stress in the private or professional environment. These events, also known as traumas, represent an acute or latent situation for the affected person in which he is completely overwhelmed and unable to cope. The continuation of the situation leads to an overload of the body and finally to a breakdown. Depending on the occurrence of the nervous breakdown and the persistence of its symptoms, a distinction is made between acute stress disorder (nervous breakdown occurring in the short term and lasting several hours to a few weeks immediately after an event) and post-traumatic stress disorder (psychological or social impairment lasting longer than four weeks). The acute nervous breakdown is not considered a disorder, but counts as a normal psychological reaction to an extraordinary experience. If a post-traumatic nervous breakdown is present, it is referred to as an illness that must be treated. If there is no significant improvement even after three months, the illness becomes chronic post-traumatic stress disorder.
Causes
In general, stress can be cited as the cause of all stress disorders. The different types of stress cause enormous psychological strain and can be triggered by acute or chronic events. Acute events can be, for example, an accident or a violent crime. Natural disasters and wars also represent an acute stress situation. In this case, the event can become a trauma and thus a stress trigger not only for those directly involved, but also for witnesses or helpers. The loss of a loved one can also be traumatic. Examples of stress that is not acute, but rather constant, can be persistent psychological pressure in a private or professional environment or persistent anxiety disorders (phobias). In each case, the persistent stress prevents sufficient physical and psychological recovery of the organism. Whether someone suffers a nervous breakdown as a result of such events depends to a large extent on which personal coping strategies they can fall back on. For example, psychologically vulnerable people who have little social support are more prone to develop a stress disorder or are less able to recover from this disorder.
Symptoms, complaints, and signs
Symptoms during the acute phase of a nervous breakdown differ from symptoms and complaints during the subsequent processing phase. A nervous breakdown may be heralded, for example, by nausea, profuse sweating, trembling, or palpitations, and sometimes by perceptual disturbances. It is not uncommon for those affected to have the feeling of being beside themselves and no longer in control of their emotional overreactions and irrational actions. Aggressive or apathetic behavior, as in shock, can also be observed. Immediately after the acute phase, many affected persons suffer from an extreme feeling of helplessness and emptiness. For them, there seems to be no way out of the situation at this moment. This phase is often characterized by listlessness, despair and physical and mental exhaustion. In the processing phase that follows, nightmares or flashbacks may occur more frequently, and there may be depressive moods, sleep disturbances, digestive problems, panic attacks or even repeated crying fits. The symptoms usually decrease during the processing phase and, in the best case, disappear completely.If the stress disorder develops into a post-traumatic or chronic phase, serious mental disorders may result if it is not treated or if it is treated incorrectly. Thus, it is not uncommon for those affected to develop a personality disorder with depression, sometimes aggressive behavior, the inability to form personal bonds, and even an increased susceptibility to suicide.
Complications
It is the latter complaints that also represent the most dangerous complications associated with nervous breakdowns. Treatment of these concomitant disorders first requires careful and targeted management of the triggering trauma as part of professional therapy. If this therapy is not carried out or is carried out in the wrong way, or if repression and a general defensive attitude on the part of the affected person prevent the treatment, which is sometimes necessary for a longer period of time, a chronic manifestation and worsening of the symptomatology is to be expected, which sometimes makes it impossible for the patient to continue to lead a self-determined life.
When should you see a doctor?
As described earlier, an acute stress reaction can last anywhere from a few hours to a few weeks. If the affected person has sufficient and appropriate strategies to cope with the situation independently with some rest, time off is often sufficient to get over the trauma. The first port of call for complaints of all kinds is the family doctor, who will initially issue a sick bill on the basis of the symptoms. However, if the symptoms persist for more than three to four weeks, a specialist or psychologist should be consulted in consultation with the family doctor. In general and as a preventive measure, this should also be considered without an actual nervous breakdown in the case of regularly occurring exhaustion and depressive moods.
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Diagnosis
The appointment with psychologists or psychotherapists is unfortunately, depending on the region, comparatively difficult. For acute cases, however, there are emergency numbers where trained specialists can listen and at least give initial clues on how to proceed to the point of overcoming the situation. In many cases, therefore, it will initially be the family doctor who conducts the initial interview with a person affected. A detailed history of the patient’s medical history, symptoms and risk factors is an essential part of the examination. If necessary, a referral to a specialist is arranged. Often, it may be advisable to also perform an examination of physical symptoms. The diagnosis of acute stress disorder resulting from trauma is usually then made by a specialist if the following conditions are present: The affected person has recently been confronted with an event that, due to its severity, represents an extraordinary stress. Such events can be, for example, the direct or indirect (as an eyewitness or helper) experience of death or a threatened or actual serious injury. Since then, various physical and psychological symptoms and complaints attributable to the event occur and massively affect the person concerned. If these or other complaints, which may include difficulty falling asleep or staying asleep, difficulty concentrating, or increased irritability and aggressiveness, continue to occur within six months of the event, the diagnosis shifts toward post-traumatic stress disorder. The diagnosis can be complicated by the fact that symptoms can occur both immediately after experiencing a trauma and with a delay of many years to decades. In extreme cases and a chronic course over several years, an ongoing personality change after extreme stress can be diagnosed.
Treatment and therapy
Acute nervous breakdown:
Depending on the affected person and the extent to which he or she can individually and independently retrieve or develop strategies to cope with the exceptionally stressful situation, acute stress disorder often requires no further therapeutic measures. Ideally, the symptoms and complaints should subside on their own after a relatively short time.Post-traumatic stress disorder:
If the symptoms do not subside and there is a risk of serious mental illness, the physician and patient should jointly agree on further treatment steps. In extreme cases, the first step is to prevent the patient from committing suicide by admitting him to hospital. Subsequently, and also in the case of outpatient therapies, various approaches are usually mixed in order to provide the best possible support for the affected person in coping with the traumatic events through comprehensive and complex treatment. Thus, in many cases, cognitive behavioral therapy is used, in which confrontation with the traumatic experience takes place in individual or group sessions. A result-oriented reorientation and reconsideration of the situation are sought. This approach can be accompanied by drug therapy, which can either reduce accompanying symptoms such as insomnia and headaches or have a general mood-lifting effect. Herbal preparations such as valerian and hops for calming or homeopathic products can sometimes also achieve rapid success. Movement and relaxation techniques often play a significant role in the therapy. Physical exercise, meditation or autogenic training help both body and mind to better reduce the stress. At the same time, a regulated and balanced daily routine, a healthy diet and fixed periods of rest also help to steer everyday life in a harmonious direction.
Outlook and prognosis
The prognosis after the onset of an acute stress reaction is very good. Usually, the symptoms disappear on their own within a few days to weeks. However, if symptoms persist and progress to posttraumatic stress disorder, the chances of rapid recovery decrease depending on the persistence of nontreatment. Thus, if a persistent stress reaction threatens, professional help should be sought as soon as possible. Because nervous breakdowns have a very individual course, depending on the history, the event at hand, and the coping strategies that can be retrieved, consistent self-motivation, sustained daily adjustment, and behavioral modification are the best prerequisites for complete recovery.
Prevention
Because traumatic events usually happen unprepared, they are difficult or impossible to influence and thus to prevent. Prevention here is only possible to a limited extent by avoiding certain situations from the outset or by taking special care to avoid them. The situation is different in the case of persistent stress or anxiety disorders. If this danger exists, preventive action can be taken through targeted behavioral training or a change in life circumstances.
Aftercare
Nervous breakdown requires consistent aftercare to create the optimal conditions to prevent relapse. This can be designed in collaboration with a psychologist, but also the family doctor. In this context, it is important to know how intense the nervous breakdown was, whether it can be linked to a specific experience or is an expression of a permanent stress, and whether it is the first time or has occurred more frequently. These are all factors that are taken into account in an individualized aftercare concept. In the case of a specific triggering event for the nervous breakdown, discussions with friends and family often help with regard to sustainable processing. If the cause is, for example, permanent stress at work or in everyday life, aftercare includes reducing these stress factors as best as possible. Aftercare should also provide the necessary rest for regeneration and gradually restore the patient’s ability to cope with stress. Relaxation exercises and sports are often very helpful. In the sporting field, gentle endurance training without any overload is possible, but games without any competitive character are also ideal. In the relaxation area, PMR (progressive muscle relaxation) is recommended, as is autogenic training. Problems falling asleep can be reduced with fantasy journeys or soothing music. Yoga also rebalances the mind, spirit and body through physical and breathing exercises, relaxation and meditation.
Here’s what you can do yourself
Listening into your own psyche and paying attention to physical reactions and moods is especially important when there is a threat of overwork due to professional or personal stress.If it is foreseeable that a stressful situation will last longer, one should try to avoid this situation, create retreat points or at least allow oneself sufficient rest. It is very important to get enough sleep; going to bed early and relaxing by reading offer significant improvement with comparatively little effort. A short time out often significantly reduces stress and helps to find new ways and new strength. Therefore, planned relaxation breaks through sports or a hobby are very important for a positive general condition. In the case of acute stress reactions, herbal sedatives from the pharmacy can also be used. Among others, remedies with valerian or hops are well suited. In more severe cases, a prescription sedative with a relaxing and calming effect can also help in the short term. Since the active ingredients produce a dependence in the long term, this measure should only be resorted to in individual and absolute emergencies.