The impact of the value system on decision-making
The thought process aimed at choosing the optimal course of action relies heavily on a person's internal benchmarks. If a patient exhibits an unformed (so-called loose) value system, the decision-making process becomes critically impaired.
In clinical practice, such individuals display characteristic manifestations. They remain in a state of permanent internal conflict and constantly experience uncertainty regarding their own correctness. Having made a choice, they tend to ruminate painfully and regret that the decision made may have been wrong. This creates fertile ground for the development of anxiety.
Classification of personal needs
Human needs act as the primary driver of thoughts and actions. Two key categories of motivational factors are distinguished:
- Dominant needs. These represent a crucial characteristic of the personality, as they determine the vast majority of actions. The individual spends the maximum amount of time satisfying them. Externally, they manifest as prevailing inclinations and stable interests, forming the general personal orientation.
- Actual (actualized) needs. These are the needs that a person experiences so acutely at a specific moment in life that absolutely all other motives temporarily recede into the background.
Significance in medical practice: It is extremely important for a physician to identify both the dominant and actual needs of the patient in order to achieve full mutual understanding. If obstacles arise on the path to satisfying these needs, the person experiences intense distress. Such stress inevitably leads to severe suffering, deterioration of somatic (physical) health, and provokes interpersonal conflicts.
The concept of stress (by Hans Selye)
The physiologist Hans Selye initially defined stress as the universal physiological response of any living organism to the impact of extreme loads.
Pathophysiology of the process: The organism reacts in a stereotyped manner, triggering uniform compensatory-protective mechanisms. The nature of the stressor is irrelevant in this regard—whether it is hypothermia, critical physical overload, or a direct threat to life. Key changes include:
- Massive release of hormones from the adrenal medulla and cortex.
- A sharp increase in plasma glucose levels.
- Development of arterial hypertension.
It is important to understand that stress performs a protective-adaptive function and is not always a pathology. Tension can be beneficial (during athletic training or hardening) or even pleasurable (staying in a hot sauna, sexual intimacy, riding extreme amusement park attractions).
However, with a prolonged, chronic course, physiological tension turns into distress. It is distress that becomes the cause of numerous organic and functional diseases.
Assessment of the stressfulness of life events
Physiological shifts during stress are practically identical regardless of whether the state is caused by a pleasant surprise or a severe loss. To quantify the impact of various situations, psychologists T. Holmes and R. Rahe developed the Social Readjustment Rating Scale in 1967.
Despite the popularity of such scales, they have two significant limitations in clinical practice:
- Subjectivity of perception. The exact same event can be evaluated by patients in diametrically opposite ways. A classic example: a long-awaited pregnancy causes joyful excitement, whereas an unwanted one becomes a source of severe stress.
- Focus exclusively on the past. Questionnaires measure the impact of already accomplished facts. However, in the real work of a psychiatrist and psychologist, the main trigger for disorders is anticipatory anxiety—exhausting thoughts about possible, expected, but not yet occurred contingencies.
Excerpt from the Social Readjustment Rating Scale (Holmes T., Rahe R.)
| Life event | Score |
|---|---|
| Death of a spouse | 100 |
| Divorce | 73 |
| Imprisonment | 63 |
| Marriage | 50 |
| Pregnancy | 40 |
| Change of residence | 20 |
| Vacation | 13 |
| Minor violation of the law | 11 |
Emotional tension and frustration
To more accurately characterize the degree of emotional tension in psychology and psychiatry, the concept of frustration is used (derived from the Latin word frustratio, which translates as "deception" or "vain expectation").
Frustration is traditionally understood as an extremely unpleasant psychological state that arises in situations when a person encounters insurmountable (or subjectively perceived as insurmountable) obstacles on the path to achieving significant goals or satisfying current needs.
Briefly: answers to topical questions
What stages of the general adaptation syndrome (stress) did Hans Selye distinguish?
Hans Selye distinguished three stages of the general adaptation syndrome (stress).
- Alarm stage — resources are mobilized, while excessively pronounced or prolonged anxiety can cause the development of pathology.
- Stage of resistance — stable adaptation to the acting factor is formed.
- Stage of exhaustion — the third stage, characterized by a disorder of nervous and humoral regulation mechanisms, dominance of catabolic processes, and impaired functioning of organs and systems.
What specific hormones of the adrenal medulla and cortex are released into the blood during stress?
During stress, hormones of the adrenal medulla and cortex are released into the blood.
- Hormones of the adrenal medulla — catecholamines, specifically adrenaline.
- Hormones of the adrenal cortex — primarily glucocorticoids, mainly cortisol.
Induced hyperproduction of glucocorticoids and catecholamines is part of the stress response.
What thinking disorders in form (disturbances of the associative process) are distinguished?
Disturbances of the associative process include the following pathological conditions:
- Reasoning (Querulanz / circumstantiality) — non-goal-directed thinking in which speech becomes complex, ornate, and scholarly, and the patient is prone to fruitless "philosophizing".
- Loosening of associations (Thought derailment) — thinking devoid of meaning and purpose, in which the grammatical structure of speech is preserved, but random associations are used.
- Pathological viscosity (circumstantiality) — slow, viscous speech abounding with digressions and non-essential details.
What types of pathology of thinking by content exist?
Disorders of the content of thinking (pathology of judgments and inferences) include three main types:
- Delusions — false judgments and inferences arising as a result of a pathological process, taking over the patient's consciousness and resistant to correction.
- Overvalued ideas — thoughts arising in connection with actual facts, but acquiring special significance and determining all human behavior.
- Obsessions — intrusive phenomena, among which the most common are intrusive fears (phobias).
To remember Selye's phases, use this association: Stress is Strength (mobilization, training), while Distress is Destruction (breakdown from chronic overstrain).
Class and exam questions
Why does an unformed value system harm health?
It deprives a person of clear guidelines when making decisions, leading to chronic doubts, internal conflicts, and persistent regret over choices made, thereby exhausting the psyche.
What is the difference between actual and dominant needs?
Dominant needs determine a person's long-term interests and character, whereas actual needs are acute "here and now" urgencies that temporarily eclipse all other motives.
Can a pleasant event cause stress?
Yes, the body's physiological reaction (adrenal hormone release, spikes in glucose and blood pressure) is triggered in response to any overwhelmingly strong stimuli, including extremely positive emotions.
Why is the Holmes-Rahe Scale not always accurate in psychiatry?
It only evaluates past events without accounting for their subjective significance, whereas most patients suffer from anticipatory anxiety—fear of future problems that have not yet occurred.
What else to study on this topic
- Pathophysiology of distress: adrenal cortex exhaustion
- Anticipatory anxiety: cognitive mechanisms of formation
- Psychosomatic consequences of unmet actual needs
- Psychological defense mechanisms in frustration
Master the entire topic in the "Psychiatry" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Thinking" and 499 more pages on the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 7 video lessons on the subject
Other topics in "Chapter 2. Psychological mechanisms of human behavior"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.