Introduction
A crisis is a state of acute disequilibrium that occurs when a person faces a hazardous event and cannot cope with it using their usual methods. This topic covers the definition and phases of crisis, its types, the principles of crisis intervention, and the assessment of suicide risk, which is the most urgent task in many crisis presentations. Crisis work is brief and practical, and is part of the everyday role of every doctor.
Definition and mechanism
Caplan described a crisis as a response to a hazardous situation in which the person's problem-solving resources are overwhelmed. Three elements interact:
- Hazardous event: the precipitating event, such as a diagnosis, bereavement, violence or job loss.
- Vulnerability: the person's predisposition, previous crises, lack of support and current stress.
- Failed coping: the usual methods do not reduce the distress, so tension rises.
Phases of a crisis
- Rising tension: the person tries familiar solutions, which fail, and anxiety increases.
- Acute crisis: distress peaks, with confusion, fear, helplessness and sometimes impulsive or self-harming behaviour.
- Resolution: the person returns to a previous level of functioning, either adaptively or maladaptively, usually within a few weeks.