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Coping with the Long Haul: Understanding and Managing Chronic Adjustment Disorder in War-Torn Israel

As Israel endures coming four months of war, the psychological toll on its residents evolves. Initially, many experienced acute stress disorder, a natural response to the sudden and overwhelming stress of conflict. But now, as the war persists, a more prolonged and insidious form of psychological distress is emerging: chronic adjustment disorder.

Acute Stress Disorder: The Initial Shock

Acute stress disorder (ASD) is a psychiatric condition that can develop rapidly after exposure to a traumatic event. In the context of war, such as the ongoing conflict in Israel, the prevalence and intensity of ASD can be notably high. This condition typically manifests within minutes to hours after the trauma, and its symptoms can last up to one month.

Characteristics of Acute Stress Disorder in a War Zone

  1. Intense Anxiety and Panic Attacks: Individuals may experience overwhelming feelings of anxiety and panic. These reactions are the body's immediate response to a perceived threat, leading to symptoms like rapid heartbeat, sweating, and trembling.

  2. Intrusive Memories and Flashbacks: Those affected might have recurrent, involuntary, and distressing memories of the event. Flashbacks can occur, where the individual feels or acts as if the traumatic event is happening again.

  3. Numbness and Dissociation: A sense of numbness or emotional detachment is common. Dissociation, a mental escape from the reality of the war, can manifest as feeling disconnected from oneself, having a sense of unreality, or experiencing time and surroundings as distorted.

  4. Sleep Disturbances: Insomnia and nightmares related to the traumatic event are frequent symptoms. The constant stress and fear can disrupt normal sleep patterns, leading to difficulty falling or staying asleep.

  5. Hypervigilance and Startle Response: Individuals may be excessively vigilant about their safety, constantly on the lookout for danger. This state of heightened awareness often accompanies an exaggerated startle response to loud noises or sudden movements, common in war zones.

  6. Avoidance Behaviors: There's a strong desire to avoid anything that might remind them of the trauma. This includes avoiding talking about the event, staying away from places related to the war, or avoiding activities once enjoyed.

Acute Stress Disorder vs. PTSD

It's important to distinguish ASD from post-traumatic stress disorder (PTSD). While both conditions arise in response to trauma, ASD is immediate and short-term, typically resolving within a month. If symptoms persist beyond this duration, the diagnosis might evolve into PTSD, a more chronic condition.

The Immediate Impact on Daily Life

During the initial phase of war, the impact of ASD on daily life can be profound. Individuals may find it difficult to carry out routine activities, maintain relationships, or perform work responsibilities. The constant state of stress and anxiety can lead to physical health problems, such as headaches, gastrointestinal issues, and a weakened immune system.

From Acute to Chronic: A Gradual Transition

Chronic adjustment disorder is a psychological response to ongoing stress that persists over an extended period. This condition often develops as a progression from acute stress disorder, especially in contexts like prolonged warfare. The transition from acute to chronic adjustment disorder is a gradual process, marked by the individual's struggle to adapt to continuous stress and upheaval.

Characteristics of Chronic Adjustment Disorder in Prolonged Conflict

  1. Long-Term Emotional and Behavioral Symptoms:

  2. Emotional Symptoms: Individuals may experience persistent feelings of sadness, hopelessness, and chronic anxiety. Unlike the immediate and intense reactions seen in acute stress disorder, these emotions tend to be constant and less intense but more enduring.

  3. Behavioral Symptoms: There may be noticeable changes in behavior, such as withdrawal from social activities, decreased performance at work or school, and difficulty in maintaining personal relationships.

  4. Physical Health Impacts:

  5. Cognitive and Perceptual Changes:

  6. Altered Coping Mechanisms:

Factors Contributing to the Transition

  1. Duration and Intensity of Stressor:

  2. Individual Vulnerability:

  3. Lack of Resolution:

Impact on Daily Life and Functioning

The prolonged nature of chronic adjustment disorder can lead to significant impairments in daily functioning. Individuals may find it challenging to perform regular tasks, engage socially, or maintain a normal routine. This can lead to deterioration in professional and personal relationships, reduced quality of life, and increased risk of other mental health disorders.

The Reality of Chronic Adjustment Disorder During War

Living through an ongoing war can profoundly exacerbate the symptoms of chronic adjustment disorder, a condition that emerges in response to prolonged stress. The realities of this disorder in a war-torn environment are multifaceted, deeply affecting individuals’ emotional, cognitive, and physical well-being.

  1. Persistent Emotional Turmoil:

  2. Pervasive Sadness and Hopelessness: The continuous nature of conflict can instill a deep sense of despair. Individuals may feel a relentless sadness and a pervasive sense of hopelessness about the future, which can be difficult to alleviate.

  3. Heightened Anxiety and Fear: Constant anxiety and fear become a part of everyday life. The unpredictability and danger associated with war can lead to a perpetual state of worry, exacerbating feelings of nervousness and tension.

  4. Cognitive Impairments:

  5. Concentration Difficulties: The ongoing stress can severely impact cognitive functions. Individuals may find it challenging to focus on tasks, make decisions, or remember important information. This can affect their performance at work or their ability to manage day-to-day responsibilities.

  6. Mental Exhaustion: The mental strain of living in a constant state of alertness can lead to mental fatigue, making it difficult to think clearly or engage in problem-solving.

  7. Physical Symptoms:

  8. Sleep Disturbances: Chronic anxiety and stress often disrupt normal sleep patterns. This can manifest as insomnia, restless sleep, or nightmares related to the war, leading to chronic fatigue and decreased physical health.

  9. Stress-Related Physical Complaints: Chronic adjustment disorder can also manifest physically, leading to headaches, gastrointestinal issues, and other stress-related ailments.

  10. Overwhelmed by Daily Life:

  11. Amplified by the War Environment:

  12. Constant Reminders of Conflict: In a war zone, the ever-present reminders of conflict – such as sounds of sirens, military presence, and media reports – can continuously trigger stress responses.

  13. Uncertainty About the Future: The unpredictability of war creates a sense of uncertainty about the future, further complicating the ability to plan ahead or maintain hope.

  14. Social and Relationship Impact:

  15. Strained Relationships: The emotional burden of chronic adjustment disorder can strain personal relationships. Individuals might withdraw socially, struggle to communicate their feelings, or find it hard to participate in family or community activities.

  16. Community Impact: The pervasive nature of war can lead to a collective experience of chronic adjustment disorder, affecting the overall morale and cohesiveness of communities.

Strategies for Coping with Chronic Adjustment Disorder During War

In the midst of the ongoing conflict, individuals dealing with chronic adjustment disorder need effective coping strategies to manage their symptoms and maintain their well-being. Here are some practical approaches:

  1. Self-Care and Routine:

  2. Establishing a Routine: Creating and maintaining a daily routine provides a sense of normalcy and control amidst chaos. Simple activities like regular meal times, sleep schedules, and designated work or relaxation periods can be grounding.

  3. Physical Self-Care: Regular physical activity, even mild exercise like walking or stretching, can significantly alleviate stress. Proper nutrition and adequate sleep are also crucial.

  4. Enroll in Resilience Rising online course at no cost to improve resilience during challenging times.

  5. Mindfulness and Relaxation Techniques:

  6. Deep Breathing Exercises: Practicing deep breathing can help calm the nervous system and reduce anxiety. Techniques like diaphragmatic breathing are simple yet effective.

  7. Mindfulness and Meditation: Engaging in mindfulness practices or meditation can aid in managing stress and improving mental clarity. These practices help in staying present and reducing negative thought patterns.

  8. Staying Connected with Loved Ones:

  9. Engaging with Nature:

  10. Creative and Expressive Outlets:

Recognizing the Need for Professional Help

Acknowledging the need for professional assistance is a crucial step in managing chronic adjustment disorder effectively:

  1. Recognizing the Signs:

  2. Seeking Therapy and Counseling:

  3. The Role of Support Groups:

  4. Medication:

  5. Continued Self-Monitoring:

Conclusion: Embracing Resilience in Times of Prolonged Conflict

As Israel confronts the realities of an enduring war, the evolving psychological landscape among its residents cannot be overlooked. The journey from the initial shock of acute stress disorder to the more persistent challenges of chronic adjustment disorder is a testament to the profound impact prolonged conflict has on mental health. However, amidst these struggles lies a remarkable capacity for resilience.

The resilience of the Israeli people is rooted in a deep understanding of survival and adaptation in the face of adversity. It's a resilience born not just from enduring hardships but also from the collective spirit of supporting one another through difficult times. This resilience is further strengthened by acknowledging the psychological toll of war and taking proactive steps to address it.

Prioritizing mental health becomes not just a necessity but a powerful act of self-preservation and communal solidarity. It involves recognizing the signs of distress and understanding when to seek help. It's about building and maintaining a support system that includes family, friends, and mental health professionals. It's about using strategies like self-care routines, mindfulness, and creative expression to navigate the complexities of living in a conflict zone.

As the war continues, it's essential to remember that seeking help is a sign of strength. Professional therapy, counseling, and support groups offer a safe space to process emotions and learn coping strategies. These resources are not just for immediate relief but are instrumental in building long-term resilience.

In conclusion, the people of Israel, while facing the unrelenting challenges of war, also hold the power to adapt, overcome, and emerge stronger. By embracing resilience and prioritizing mental health, they can continue to navigate the uncertainties of the present while laying the groundwork for a more hopeful and stable future. Remember, in the realm of mental health, every step taken towards self-care and seeking support is a step towards collective strength and resilience.

Israeli Government Resources:

In light of the ongoing conflict, it's crucial to highlight the invaluable support available through Resilience Centers across the country. These centers are a beacon of hope and assistance, providing essential therapeutic services at no cost to those affected by the stress and anxiety stemming from the war. Here's a breakdown of what these centers offer and how you can access their services

Resilience Centers

Resilience centers provide therapeutic services for free to stress (anxiety) victims against the backdrop of the war, through licensed professions who specialize in trauma-focused treatment. The centers provide individual, group or family treatments, either by phone, by Zoom or in-person in treatment centers across the country.

To whom is the treatment at the resilience centers intended for?

Treatment is intended for anyone who was traumatized by a war incident who feels stressed and difficulty functioning.

Who is eligible to receive treatment at the resilience centers?

The resilience centers provide their services according to your permanent place of residence. Therefore, you should contact the resilience center affiliated with the address registered in the Ministry of the Interior.

  • Residents of the southern district from the following localities: Sderot, Ashkelon, Netivot, Ofakim, Merhavim, Bnei Shimon, Hof Ashkelon, Shaar HaNegev, Eshkol, Sdot Negev and all Bedouin localities, including unincorporated ones, may receive emotional support at their local resilience centers.

  • Residents of the northern district may receive emotional support in the Eastern Galilee and Western Galilee resilience centers.

  • Residents from other localities may receive emotional support from the national resilience center.

Anyone who is not a resident of these localities is welcomed to contact the national resilience center at *5486.

Resilience centers in the southern district

Resilience centers in the northern district

Eastern Galilee

  • Cities: Kiryat Shmona, Safed, Katzrin

  • Locaoul cncils: Metula, Yesod HaMaale, Hazor HaGalilit, Rosh Pina, Gush Halab, Tuba Zangaria, Majdal Shams, Massadeh, Ein Kiniya, Bukatha, Rajar

  • Regional councils: Upper Galilee, Hermon entrances, Golan, Marom HaGilil

Western Galilee

Cities: Ma'alot Tarshiha, Nahariya, Acre

Local councils: Shlomi, Kfar Vardim, Fasuta, Meylia, Beit Jan, Horfish, Mazraa, Jit-Yanouch, Tefen, Abu Snan, Julis, Yarka, Jadeida-Macher, Kfar Yassif

Regional councils: Ma'ale Yosef, Mateh Asher

Judea and Samaria resilience centers

Emotional support by the HMOs

In order to provide task-specific emotional support during the emergency situation, all HMOs provide emotional support in the form of three therapeutic sessions with professionals.HMOs' hotlines:

YAHEL centers

Emotional support hotlines for all Israeli residents


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