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Adjustment Reactions and the Surgical Intern

Theodore N. Pappas, MD
JAMA. 1982;248(1):31-32. doi:10.1001/jama.1982.03330010015016.
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To the Editor.—  The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) defines adjustment disorders as maladaptive reactions occurring within three months of an identifiable psychosocial stress. In addition, the disturbance may be expressed as an impairment of social or occupational functioning and should remit when a new level of adaption is achieved.Adjustment reactions occur frequently in patients and families after diagnosis and treatment of many medical and surgical illnesses. The literature is studded with examples of adjustment reactions to stressful conditions such as the post-myocardial infarction life-style,1 discovery of malignancy,2 or the sequelae in burn victims.3 This report suggests that maladaptive reactions can be observed during the early period of surgical internship.There have been frequent reports and editorials discussing the discomforts of internship,4 and the fact that only 20% of surgical internships supply social and emotional support organizations


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