Stendhal syndrome: causes, symptoms and treatment in an article by psychologist Isachenkov O. A.

Very often, people who, for one reason or another, are forced to visit a medical facility, ask specialists why blood pressure increases during a doctor’s appointment, is it dangerous, how to deal with this phenomenon, and does it need to be treated? As you know, an appointment with a doctor is usually associated with not entirely positive emotions, so most patients are very often worried and worried, which leads to an unexpected increase in blood levels.

Let’s take a closer look at whether this condition is dangerous, whether it is necessary to get rid of it, and what complications the fear of a doctor’s coat can lead to.

White coat syndrome: why it occurs and how to get rid of it

For many people, at rest and at home, when measuring blood pressure (BP), the tonometer shows values within the normal range. But as soon as you go to the clinic and enter the doctor’s office, your blood pressure jumps up. This condition is called white coat syndrome.

Hypertension today is considered the most pressing problem, due to which the number of deaths among the population increases annually in the world. High blood pressure is a major risk factor for heart disease, which in many cases is fatal.

At the same time, in Russia the percentage of hypertensive patients among women is slightly higher than among men. It is believed that the male population is more susceptible to this disease.

Prevention of white coat syndrome

Relaxation techniques such as breathing exercises and meditation can help calm people down. If you feel nervous when it's your turn to see the doctor, you can take a few deep breaths to calm yourself.

White coat syndrome can put you at risk for cardiovascular disease, and not all doctors believe the condition is harmless. Anyone who thinks they have white coat hypertension should see a doctor to get a proper diagnosis.

White coat syndrome when measuring blood pressure

Recently, such research as 24-hour blood pressure monitoring has been increasingly used in practice. This procedure shows that patients’ cardiovascular system indicators often begin to change for the better when they find themselves outside the walls of a medical institution.

In this case we are talking about the so-called syndrome or “white coat” effect (BC). When a doctor measures blood pressure, the tonometer shows higher numbers than those detected using 24-hour monitoring in people’s usual environment.

Features of the pathology
Who is more likely to show it?	during pregnancy, in smokers, alcoholics, children, impressionable people, psycho-emotional patients.
How to treat	lifestyle changes, work with a psychologist, herbal medicine, proper rest, consultations with a therapist.
How to pass a medical examination	Taking sedatives and breathing correctly when measuring blood pressure will help.

The term "white coat" hypertension means that a patient's blood pressure is measured only by a healthcare professional in a hospital or clinic setting.

In this situation, blood pressure levels increase significantly in some patients. Because of this, the doctor may mistakenly diagnose “arterial hypertension.” Increased blood pressure during the presence of a medical professional is largely due to the patient's anxiety and excitement.

During diagnosis at home, reactions of anxiety and excitement are less pronounced. Blood pressure readings are within the normal range.

Causes of pressure surges

This phenomenon has not yet been fully studied, but most scientists are confident that this is how the body reacts to a stressful situation.
A tendency to such a syndrome is usually observed in people with increased anxiety and suspiciousness.

They have instability of the vascular wall. The “white coat” effect is reminiscent of a fear of dentists or any other fears during which changes occur in the body. For example, sweating occurs, breathing is held, blood pressure rises, heart rate increases, etc.

In children susceptible to this symptom, the increase in blood pressure becomes more significant in the future! In some cases, the formation of hypertension is likely. The risk of developing cardiovascular diseases in the future is much higher in people who are prone to HD hypertension.

A study conducted by foreign scientists revealed that about 40% of the total population is susceptible to the classic syndrome of high blood pressure when visiting a doctor.

People who experience this condition frequently should take action and normalize their condition. This will reduce the risk of cardiovascular diseases in the future and save you from stroke.

Symptoms of pathology

During a diagnosis by a doctor, a person’s blood pressure often rises and their pulse often quickens. The patient's condition becomes anxious, distracted and agitated. After connecting ECG, tonometer or ultrasound suction cups to his body, his cheeks may turn red, he may begin to sweat excessively, and may develop a cough.

It is noteworthy that in this condition the patient’s only tonometer readings go off scale. The lower numbers usually remain within normal limits.

It has been noticed that patients experiencing fear, anxiety and similar sensations at a doctor’s appointment have indicators in the top numbers on the tonometer of 150 mm Hg. After the patient leaves the medical facility and finds himself in a familiar and calm environment, the pressure readings immediately stabilize.

The “white coat” effect affects mainly insecure, emotional and very impressionable people. In rare cases, these may be individuals with hidden mental disorders, drug addicts or experienced smokers.

Why is white coat syndrome dangerous?

How dangerous is high blood pressure due to doctor's coat syndrome? Doctors say that in stressful situations, blood levels rise in almost all people. For example, an unpleasant conversation with your superiors, sad news, a strong experience, etc. can lead to a jump. If such phenomena are episodic in nature, then they do not pose a clear threat to health.

A completely different situation is when blood pressure jumps in any negative situations. This can lead to the following complications:

Increasing the level of “bad” cholesterol.
Periodic increase in sugar levels with a tendency to diabetes.
The appearance of true hypertension.
In complicated cases, the situation is dangerous for a heart attack.
Sudden and frequent changes in blood pressure negatively affect the development of the fetus in pregnant women.

According to the latest research results, it has been established that in 75% of people, a regular rise in blood pressure due to psycho-emotional stress develops into real hypertension with all the ensuing pathological consequences, that is, the frequent occurrence of BCS can become a pre-hypertensive phase in the development of real hypertension.

According to Japanese doctors, in half of the observed volunteers, white coat syndrome increases the risk of stroke. The likelihood of such a severe complication increases with a history of other serious diseases.

In addition, the uncontrolled use of antihypertensive drugs in the syndrome, when the patient independently tries to normalize blood pressure without the doctor’s permission, can cause the development of severe complications, such as a sharp decrease in blood pressure and loss of consciousness.

How to fight: therapeutic therapy

Treatment of this syndrome should be carried out according to the instructions of the attending physician. In some cases, psychotropic medications, antidepressants, or herbs that lower blood pressure may be prescribed. It all depends on the age and condition of the patient.

In this case, auto-training techniques, conversations with a psychotherapist and similar methods of influencing the psyche are very helpful. Many cardiologists order their patients with HD syndrome to be examined by a psychologist. Classes with him help a person get rid of fears and become more self-confident.

There is no need to be afraid if your therapist refers you to a psychotherapist. This is a completely normal phenomenon and does not mean that everything is wrong with your psyche. It is conversations and trainings that will help prevent or reduce the possibility of further occurrence of hypertension and related diseases.

You can take mild medications (sedatives). For example, Valerian tincture, Zelenin drops or motherwort.

These products are safe and have no contraindications. They will help to temporarily calm and relax the patient.

Prevention methods

It is important for people with white coat syndrome to take care of their health as early as possible! Hypertension is easier to prevent than to treat. And since these patients are at risk of developing cardiovascular diseases, they should undergo daily prevention.

White coat syndrome: causes, symptoms, treatment, prevention

Up to 40% of people are susceptible to a condition called white coat syndrome, but many don't even know about it.

Manifestations of the syndrome

White coat syndrome has various manifestations. As a child, a child frightened by a painful injection or manipulation by a person in a white coat will become afraid of any person in such clothing.

But in most pathological cases, the white coat effect is associated precisely with an increase in blood pressure, while the person does not realize that he is afraid of doctors.

Outwardly, he is quite calm, but his pulse, rising due to white coat syndrome, gives him away.

When measuring blood pressure at home, such a person is completely relaxed, his pulse and blood pressure are normal. But as soon as you visit a medical facility, the indicators “jump” and show the presence of hypertension.

Moreover, they are consistently increased only in the doctor’s office, no matter how long the patient is in the hospital.

This leads to the prescription of specific drugs for hypertension, which does not exist, and the symptom is caused by white coat syndrome.

If the condition is not detected, and the patient begins to take serious medications for high blood pressure, this can lead to health problems, because he will actually be treating a non-existent disease.

Who is most susceptible to the syndrome?

In most cases, white coat syndrome always causes tension in suspicious, nervous patients who fear for their lives.

Stress stimulates an increase in blood pressure, which is perceived by doctors as symptoms of a disease. This further strengthens the confidence of a person with a labile psyche in the validity of their fears and “fuels” the fear of white medical coats.

Most often, women experiencing this condition suffer from this condition, especially if they previously had problems with conception or pregnancy, people who are facing a serious or unpleasant instrumental examination, for example, gastroscopy or colonoscopy, those who come for the first appointment with a new doctor

Office arterial hypertension is quite widespread, it is found in 15% of healthy people and in about 40% of those who suffer from high blood pressure.

Why is the syndrome dangerous?

White coat hypertension in some cases can lead to persistent negative changes in health status. In some patients who are predisposed to developing hypertension, this condition causes increasing symptoms of the disease, when the data will be increased not only in the doctor’s office, but also during home measurements.

The behavior of doctors also plays a big role in provoking the disease. A suspicious person suspects something is wrong even if the doctor simply shakes his head while reading his chart, or carelessly says something related to serious pathologies.

A nervous, sensitive person in a doctor's office in such a situation develops stress, which causes a steady increase in blood pressure.

And this, in turn, ricochets on such important organs as the kidneys, liver and cardiovascular system.

There is the opposite of the syndrome, which is called ambulatory (masked) hypertension. With it, high numbers when measured are obtained at home, and when visiting a doctor, the indicators are normalized. Since this condition is very difficult to diagnose, it can cause illness.

Is it possible to get rid of

It is difficult to treat white coat syndrome, because it is a manifestation of hidden pathologies in the patient’s psyche. It mainly helps to take mild sedatives before visiting medical facilities to alleviate fear and reduce stress levels.

If the patient already has a disease, it is necessary to normalize the blood pressure and reduce the level of anxiety, then visits to the doctor will not result in increased blood pressure. A specialized doctor is required to prescribe appropriate medications. Self-medication is very risky. It is recommended to undergo special training, and in severe cases, work with an experienced psychotherapist.

White coat hypertension

White coat hypertension (white coat syndrome) is a condition in which blood pressure measured in a medical facility increases. The main reason for this is the anxiety that people experience when visiting the doctor.

White coat hypertension is a phenomenon when readings increase above 140/90 mmHg. Art. only in the medical environment. In situations where values are measured by a person in a home environment, they are within the normal range. A person measuring blood pressure in a medical environment experiences a feeling of anxiety, fear, and tends to be afraid. The body responds to this condition by activating the sympathetic autonomic system, which, in states of psychological stress, increases blood pressure, heart rate, respiratory rate and other functions.

Often people suffering from white coat syndrome are ashamed of their fear and do not tell doctors and nurses about the problem. The effect of this behavior is predictable - the doctor measures the patient's high blood pressure, which does not reflect his true state of health. Temporary hypertension is just a natural reaction of the body to a stressful situation. If a person does not openly acknowledge their fear, they may be misdiagnosed as having hypertension.

Statistics show that up to ⅓ of “hypertensive patients” whose doctor has measured high levels actually suffer from white coat syndrome. Therefore, doctors diagnose hypertension after 3 measurements, when 2 of them exceed normal values.

Cause of white coat syndrome

Although the exact causes of high blood pressure are unknown, there are many factors that can increase the risk of hypertension, such as:

white coat syndrome during pregnancy;
obesity;
lack of physical activity;
smoking and drinking alcohol;
stress;
high salt intake;
a family history of high blood pressure;
elderly age;
thyroid diseases;
sleep apnea;
kidney disease;
genetics.

Managing these factors can help people keep their blood pressure in a healthy range. However, white coat hypertension is a condition in which blood pressure usually only rises in the doctor's office and may be related to nervousness and anxiety.

Manifestations of SBH

White coat syndrome manifests itself with the same symptoms as classic arterial hypertension: the patient’s pulse quickens, dizziness and headache appear, occasionally fainting, and the numbers on the tonometer increase, with the “upper” pressure readings being higher than the lower ones (not 120, and 140-150 mmHg).

In some cases, the disease occurs even in people who regularly use medications to lower blood pressure.

Diagnosing the pathology in question is very difficult, since it is not enough to measure blood pressure one or several times - a whole range of special examinations are needed that are aimed at tracking the dynamics of blood pressure and identifying hidden pathologies. A person needs to regularly monitor blood pressure under normal conditions (at home, at work) and write down the numbers, or undergo a daily blood pressure monitoring procedure. This procedure is performed in a medical facility or on an outpatient basis using a special tonometer that records blood pressure readings after a certain period of time.

In addition, the patient must undergo certain tests:

general blood and urine tests;
cholesterol and sugar levels;
lipid profile;
uric acid concentration.

Instrumental examination methods used to determine the diagnosis include:

ECG;
Ultrasound of the heart and kidneys;
duplex examination of the carotid arteries.

Some believe that a one-time increase in pressure is safe for humans, but in the end it was decided that this was a mistaken opinion. Regular surges in blood pressure associated with this disease can cause a hypertensive crisis, damage to internal organs, the development of “classical” arterial hypertension, and in elderly patients – stroke, as well as other cardiogenic disasters.

Upon extensive examination, patients are diagnosed with high cholesterol, coronary heart disease and primary diabetes mellitus. If a similar condition occurs in young people, then the risk of occurrence in adulthood almost doubles. In addition, surges in blood pressure that occur exclusively during a visit to a medical facility can lead to incorrect diagnosis and ineffective therapy, which will also not bring benefits to the patient’s health.

It is important! A strong argument in favor of the fact that white coat syndrome when measuring blood pressure is not considered a separate nosology (and it cannot be considered a disease) is the absence of a clause in the ICD-10 classification that would contain the coding of this condition. . But this does not mean that there is no need to fight it

This feature once again demonstrates that the condition in question should be gotten rid of by influencing the central nervous system and internal nervous system, and not the cardiovascular system, because this problem in hypertensive patients is caused by disorders of psychogenic origin. In addition, this feature of the adaptogenic mechanism should be taken into account when a person’s blood pressure is measured.

Stendhal syndrome - symptoms and treatment

Stendhal syndrome is a pathological condition that includes a complex of mental and somatovegetative symptoms, such as panic, confusion, fainting, tachycardia, shortness of breath, etc., that occur when a person comes into contact with famous works of painting, architecture and other cultural values, as well as impressive natural phenomena and outstanding people.

This syndrome is not a generally recognized disease in the medical community, and the question of adding the diagnosis “Stendhal Syndrome” to international classifications remains controversial.

The most common manifestations of the syndrome are observed in the Italian city of Florence, which is the largest tourist center. It contains cultural masterpieces of world art of the Italian Renaissance. In this regard, this syndrome has another name - “Florentine”. It is believed that the works of Michelangelo, Raphael, Caravaggio, Brunelleschi and others, located in the Uffizi Gallery and other museums in Italy, have the most powerful impact on a person’s mental state, including the development of negative consequences [4][6][18].

“Stendhal’s cider” got its name thanks to the great classic of French literature, Stendhal, who was distinguished by his impressionability and sensitivity to art. In 1817, while still a young writer, he visited Florence and was shocked by the cultural and historical heritage of the city. After visiting the Basilica of the Holy Cross, which is decorated with delightful frescoes by the Italian sculptor Giotto and where such great Italians as Galileo, Michelangelo, Machiavelli and others are buried, he felt the unusualness of his condition and almost lost consciousness. In his book “Rome, Naples and Florence “He described it this way: “When I left the Church of the Holy Cross, my heart began to beat, it seemed to me that the source of life had dried up, I walked afraid of collapsing to the ground... I saw masterpieces of art generated by the energy of passion - after which everything became meaningless, small, limited - so, when the wind of passions has ceased to inflate the sails that push the human soul forward, then it becomes devoid of passions, and therefore vices and virtues” [5][8].

More than a century and a half later, Italian psychiatrist Graziella Magherini, who worked in the psychiatric department of the Santa Maria Nova Hospital in Florence, studied more than a hundred patients with symptoms including panic, tachycardia, fainting, hallucinations, etc., which arose during a tourist trip, visiting a gallery Uffizi and other museums in Florence. Remembering that the famous French writer had similar symptoms, she called this pathological condition “Stendhal syndrome.”

In her book, published in 1989, Magherini summarized her observations and made a number of interesting conclusions regarding the occurrence of this syndrome. Thus, the absence of this disorder among tourists from North America and Asia was explained by the presence of other radically different cultural traditions. In turn, Italians, immersed in the atmosphere of this high art since childhood, according to the psychiatrist, have a kind of protection against the development of these disorders. The most vulnerable are educated, impressionable young people 25-40 years old with a rich imagination, interested in art, but who do not have wide access to artistic paintings in everyday life.

The so-called “expectation phenomenon” can also play a certain role in the development of Stendhal syndrome. The discrepancy between expected expectations and received impressions of a work of art in particularly sensitive individuals may be a trigger for the development of Stendhal syndrome [15][17].

Risk group

White coat hypertension is essentially a feeling of internal tension and fear of being examined by a doctor. We are talking not only about white clothes, which are a kind of medical symbol. Many people feel bad in ambulances, medical institutions, they may have unpleasant childhood memories, the smell of disinfection creates discomfort, fear of examination, pain, and a bad diagnosis. All these factors together constitute white coat syndrome—false hypertension.

The white coat syndrome does not bypass any segment of the population. In older people, the problem appears more often. Women are more likely than men to have high blood pressure in a health care setting, especially when it is measured by a doctor. Many patients exhibit elevated values only at the first measurements; some never get rid of the symptoms of white coat syndrome.

Possible consequences of the disease

When pressure begins to increase, it can be episodic in nature, and does not harm a person’s health. Blood tests of patients who suffer from white coat hypertension have determined a strong increase in cholesterol and sugar. Such symptoms occur when a person has diabetes. If the symptoms of a sudden and sharp increase in blood pressure are not treated, they will develop into pathology and can lead to consequences:

left ventricle enlargement;
the appearance of kidney diseases;
stroke due to stress;
When measuring pressure, the readings are high:
during pregnancy, this phenomenon has a bad effect on the unborn child;
for older people, the disease can become a serious threat to life;
People who do not lead a healthy lifestyle are often susceptible to mental disorders and can develop severe hypertension.

White coat hypertension can lead to serious heart disease White coat hypertension can lead to serious heart disease

Symptoms

This false hypertensive state is accompanied not only by an increase in systolic and diastolic parameters, but also by an accelerated pulse, nervousness, pallor, tremor, anxiety, tension, and sometimes increased sweating. Values usually rise above 140/90 mmHg. Art., which leads to incorrect diagnosis. However, unlike actual hypertension, the elevated blood pressure associated with white coat fear decreases to normal levels after leaving the medical facility. Therefore, correct diagnosis is important for hypertension. To get rid of white coat syndrome when measuring blood pressure, there is no need for specialized treatment with medications.

Necessary examinations for illness

To determine pathological changes in target organs from pressure surges and identify concomitant diseases, it is necessary to undergo laboratory tests and undergo instrumental examination:

biochemical blood test (cholesterol, lipid profile);
blood for sugar;
general urine analysis;
Ultrasound of the kidneys;
Ultrasound of the heart;
ECG;
duplex of vessels.

Be examined by a cardiologist and, if necessary, other specialists.

To determine the fear of a white coat when measuring blood pressure, you must undergo a medical examination, take special tests and undergo an instrumental examination:

donate blood for cholesterol and lipid profile;
check blood for sugar;
do an ultrasound of the kidneys and heart;
ECG;
duplex of vessels.

An examination by a cardiologist will help make the correct diagnosis.

Hypertension occurs in 15 percent of the population during a medical examination, namely during the process of measuring blood pressure. The patient cannot relax and control his own body, as a result of which the pressure increases significantly and the white coat syndrome manifests itself in all its glory when measuring indicators.

The effect of the body's inadequate response to consultation and the actions of the specialist can affect treatment, as the patient may be prescribed unnecessary medications due to symptoms of a serious illness. White coat syndrome does not occur when measuring blood pressure at home. When a person remains in a familiar environment, without the presence of a medical professional, he can calmly measure his blood pressure - and the readings will be normal.

Hypertension occurs in 15 percent of the population during a medical examination, namely during the process of measuring blood pressure. The patient cannot relax and control his own body, as a result of which the pressure increases significantly and the white coat syndrome manifests itself in all its glory when measuring indicators.

An examination by a cardiologist will help make the correct diagnosis.

White coat syndrome: how to deal with blood pressure measurements, how to pass the commission

Many people experience discomfort and anxiety while in medical institutions. Over time, these emotions result in white coat syndrome.

It is expressed in the fact that a person treats doctors with anxiety, as a result of which blood pressure rises and the pulse quickens. Scientists have confirmed that more than 15% of the population has this disease.

If you notice something similar in yourself that can be associated with this phobia, you should know what hypertension is and how to get rid of it.

White coat syndrome is manifested by increased blood pressure in the presence of a doctor

Description of the problem

White coat hypertension is an increase in systolic blood pressure when measured by a qualified professional. Often white coat syndrome manifests itself at the upper levels (140-160 mm Hg), the diastolic remains unchanged. The blood pressure index returns to normal after the person leaves the hospital. When measuring blood pressure in a home, familiar environment, it does not increase.

Increased blood pressure in the presence of doctors is the body's response to overexertion. In a similar way, overly susceptible people react to changes in the situation. It is necessary to realize that the term “white coat hypertension” refers to temporary surges in pressure when visiting doctors; hypertension as an obvious disease may not exist.

According to experts, white coat hypertension is a reflex acquired by a person; at the first appointment the person was under severe stress, the body remembered this reaction and now reproduces it on a subconscious level when it sees any doctor.

The second name is explained by the fact that people with the syndrome react with a surge of emotions and increased blood pressure not only to the appointment, but also to any other change in the situation.

Risk group

Most often, white coat hypertension is observed in impressionable individuals. What makes them nervous is that they take going to the doctor to heart. Also at risk are individuals who are weak in spirit. People with mental disorders also fall into this group; their fear of medical workers is more obvious and can lead to a panic attack.

In addition, people who lead an unhealthy lifestyle and have bad habits are at risk.

It is important to note that the syndrome can manifest itself in children one year old and older (children under one year old quickly forget everything) - this is most often associated with a child’s bad experience: without warning, blood was taken from a finger, and a painful injection was given.

These negative emotions are a source of anxiety.

Symptoms

Like any other disease, white coat syndrome has its symptoms. The symptomatic picture will allow you to determine whether it is simple anxiety or a problem that requires treatment. Let's move on to the symptoms:

increased blood pressure when measured in hospital;
Blood pressure normalizes after the end of the doctor’s appointment;
disjointed speech, panic attacks;
increased pulse and difficulty breathing when visiting a doctor; trembling in the arms and legs is also possible.

Diagnostics

In order to begin to treat a phobia, it is necessary to correctly diagnose the disease. If attacks of arterial hypertension are very rare and appear only after stressful situations, then there is no need for their treatment.

In order to record the exact number of pressure surges and their frequency, a person is recommended to measure blood pressure daily, in the morning and in the evening, and record the results in a special journal, which should be taken with you to subsequent visits to the doctor.

To detect the risk of cardiovascular diseases, it is important to determine whether there are disturbances in the functioning of target organs (these are the organs that suffer most from pressure changes: kidneys, heart, brain, eyes) and identify the diseases accompanying them. To do this, you should undergo diagnostics, including the following tests and examinations:

lipid profile;
blood sugar test;
analysis for the level of uric acid in the blood;
clinical laboratory tests;
electrocardiography (ECG);
echocardiography;
Ultrasound of the kidneys;
Ultrasound duplex scanning of the carotid arteries.

Fighting the syndrome

Some people are confident that such a psychological reaction is not a disease and does not require treatment, but experts believe that this problem cannot be neglected: against the background of constant stress, the syndrome can lead to an enlargement of the left ventricle of the heart or the development of kidney problems. The following are recommendations for the treatment and prevention of white coat hypertension.

All people who have discovered white coat syndrome need to stabilize their lifestyle. To do this, you need to quit smoking, not abuse alcohol, eliminate it if possible, switch to proper nutrition, and devote a sufficient amount of time to physical activity.
Various methods of autogenic training and sessions with a psychotherapist do an excellent job of combating this syndrome. If hypertension continues to develop and attacks in hospitals become more frequent, it is recommended to consult a specialist to obtain medications.
Some patients note significant improvements after taking sedatives, antidepressants, or traditional medicine that are aimed at stabilizing the nervous system.
It is also possible to use diuretics to reduce blood pressure by ridding the body of excess water and salts.

Diagnostics

Holter, a manometer that measures indicators repeatedly over a 24-hour period, will help in the correct diagnosis of the syndrome. Thanks to this reassessment, the doctor can easily know whether there is a real health problem or a psychological factor. You should know that white coat syndrome is not something special, it occurs in about ⅓ of people. Moreover, the highest systolic and diastolic indicators are measured for the first time.

Important! To definitively determine the diagnosis of high blood pressure or high blood pressure syndrome, measurements should be taken at least 3 times.

Manifestations of SBH

The problem with BHS is that the patient classifies his condition as “hypertensive disease” and can begin self-treatment. Long-term (24-hour) monitoring (ABPM) will help clarify individual blood pressure values.

The opposite phenomenon of SBH is considered to be “hidden” hypertensive patients. In this group of patients, normal blood pressure is measured in the clinic or in practice because the patient feels well and relaxes. A stress test or 24-hour measurement can rule out this condition.

How to distinguish care from codependency?

Codependents need to feel needed.

They are drawn to people they can care about: those suffering from alcoholism, drug addiction, serious mental and physical illnesses, as well as emotionally immature, infantile partners. The codependent takes on the role of helper, teacher and savior.

Caring nourishes the self-esteem of codependents, satisfies their need to be needed and gives their lives meaning. Deep down in their hearts, they are convinced that only as long as someone needs them, they will not be abandoned or rejected. Thus, caring for loved ones gives them a sense of security.

Codependents violate other people's boundaries

With clear boundaries, you can clearly see where your responsibility begins and ends. You separate your feelings from other people's emotions. You know what you like and what you don't. You understand what steps to take to meet your needs.

Codependent individuals have confusing boundaries. They try to solve other people's problems, offer unsolicited advice, impose their ideas and solutions without taking into account the wishes of loved ones. Their “concern” does not take into account the other person’s preferences, capabilities and right to live their own way. In fact, their behavior seems more like interference than genuine caring.

Codependents are obsessed with other people's problems

They act as if other people's problems are their own problems, and they are forced to solve them under the guise of help and care. Codependents spend a lot of time and energy worrying, trying to help loved ones, understand their difficulties, fix everything and save them from trouble. They are so focused on what is going on in other people's lives that it is difficult for them to step back and let their partner have their own way. They persistently try to help, even when it harms themselves and destroys relationships.

The art of separation - how to overcome codependency?

Poor boundaries and an obsessive desire to help others prevent them from taking care of themselves. They notice only what their loved ones need and do not pay attention to their own needs. Therefore, they are often left exhausted, exhausted and dissatisfied. And when codependents do not have hobbies or other interests, they become even more immersed in the problems of their loved ones.

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Codependents often feel resentful

Caring for loved ones increases self-esteem, however, for codependents it often becomes a source of resentment. The point is that they don't just want to help their partner. They want to change it. They give advice, impose their decisions and ideas, forcing others to act in accordance with their instructions. This rarely works, causing resistance - and so unsolicited "rescuers" risk being left disappointed and resentful, complaining that they are not appreciated.

How to get rid of the syndrome?

Since we are talking about a purely mental factor, psychological methods are also used in the question of how to deal with white coat syndrome when measuring blood pressure.

Learn to cope with the syndrome yourself:

Try to come to the doctor for the first time with an accompanying person - this will calm you down;
before visiting the doctor’s office, listen to relaxing music, do breathing exercises, take a walk in the fresh air;
grab something to read or watch in the doctor's office to distract your attention;
tell the doctor about your feelings and problems, don’t be shy - you are not alone;
if all else fails, measure your blood pressure at home, in a comfortable environment; take measurements 3 times, do not take into account the 1st value.

Try to honestly answer the following questions:

– Do I feel obligated to help or correct someone?

– Is it difficult for me to focus on my own needs?

– Do I worry a lot about my partner, dealing only with his problems?

– Do I feel empty inside, anxious, or feel like my life has no meaning when I'm not helping anyone?

– Do I give unsolicited advice or try to help, but my efforts are not appreciated and my recommendations are ignored?

– Do I feel guilty if I didn’t use every possible way to help someone?

– Do I feel more comfortable offering rather than accepting help? Am I avoiding asking for support?

- I believe that I have answers to all questions - if only my loved ones would listen to me!

– Do I just give and get very little in return?

Codependency: living in someone else's shadow

– Do I help because I want to, or because I feel like I have to?

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Psychological violence, recovery from abusers and narcissists, breaking up with an abuser, changing abusive behavior, self-esteem, relationships, loss of meaning, nice (comfortable) person syndrome, age-related crises, existential problems, loneliness, relationships “adult children - parents,” and more...

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– I ask my partner if he needs my help and what kind?

If you have come to the conclusion that your concern for others is based on codependency, the following steps will help restore balance:

Develop a sense of self and strong boundaries.
Don't get caught up in other people's lives.
Manage your anxiety.
Be mindful of your needs. Get ready to take care of yourself.
Practice the skills of “disconnecting” while maintaining love.
Get rid of the need to control everything.

This does not mean that you will stop caring for your partner or helping your loved ones. Breaking free from codependency creates a connection based on genuine affection. This will allow you to give your love and care from the bottom of your heart, without resentment or high expectations.

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Hello! This is a blog on psychology, in which significant attention is paid to the topics of psychological violence - abuse, narcissism, relationships, personal crises, taking responsibility for one's life, increasing self-esteem, existential problems. The cost of consulting a psychologist is 3000 rubles/hour, in person (Moscow, Maryina Roshcha metro station), or via Skype About us/Make an appointment

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Hypertension and pregnancy

In the process of bearing a child, a woman’s body experiences severe overloads, which affect her overall well-being. White coat syndrome is quite unpleasant for the expectant mother and dangerous for the fetus. This problem is especially relevant for pregnant women, since they have to undergo examinations by numerous doctors repeatedly.

It is believed that a single recorded increase in pressure does not pose any danger to a person and does not worsen the cardiovascular prognosis. But we cannot ignore the fact that the patient has a tendency to react in this way to an unpleasant situation. This may have negative consequences in the future.

As for young people and adolescents, this type of reaction is more often observed in patients with vegetative-vascular dystonia. If these are older or elderly people, we can talk about hypertension in half the cases. Pregnant women need to be very careful - pressure changes can have a negative impact on the development of the child.

Description of the problem

A person may not be aware of certain anxiety and fear. But even unconscious anxiety affects the body, it can cause an increase in heart rate (ECG shows a normal but accelerated rhythm) and, mainly, an increase in blood pressure. It is the incorrect diagnosis of hypertension that is the stumbling block. The person’s indicators are measured to be high, he is again invited for examination, the indicators are again higher than normal. The doctor prescribes medication for hypertension, which the patient takes. But, taking antihypertensive drugs with normal levels leads to hypotension, manifested by dizziness, headache, weakness, and fainting.

Passing a medical examination

What should you do if you need to undergo a medical examination, for example, when applying for a job or joining the army? Home measurements will not help; a doctor's examination is required. In some cases, a person can help himself on his own. Try the following tips:

talk to your doctor, ask not to wear a white coat during the examination (if possible);
Before entering the doctor’s office, take a deep breath and exhale several times; try to calm down, concentrate on pleasant things;
choose a day and time for the medical examination when there will be fewer people in the waiting room; if possible, make an appointment for a specific date;
keep in mind that the doctor will not harm you in any way, but, on the contrary, will help you;
If you are not satisfied with the doctor’s approach, try to see another specialist, ideally after recommendations from friends.

Does a doctor really need a white coat?

“Why isn’t the doctor wearing a coat?” - this is not an idle question. Very often we are faced with complete misunderstanding and rejection of the fact that the doctor is not wearing a gown at the appointment. After all, a robe, by definition, is cleaner and more sterile than ordinary clothing. In short, there are many myths surrounding this issue. The head of the field service, family doctor, cardiologist at GMS Clinic, Yuri Sergeevich Zamashkin, took it upon himself to debunk them.

Let's start with the experience of our American colleagues. Today, many Americans prefer to see their doctor in casual clothing. Perhaps this is due to a shift in values, when the perception of the doctor as an unconditional authority becomes a thing of the past and partnerships with him become preferable. Moreover, many patients today double-check the recommendations given to them, get a second opinion, and in certain situations this is very justified. Such patients come to us quite often.

A doctor today is not a deity who needs to be taken at his word and absolutely. A doctor is, first of all, a professional who has systemic knowledge and certain practical skills in his field.

Based on them, the doctor satisfies certain needs of members of society. But this does not require attributes such as a crown, mantle, scepter, or, if you like, a special uniform. For example, a robe.

By the way, about the uniform. The main task of the uniform, in our opinion, is, first of all, discipline and depersonalization, which makes it possible to effectively manage large teams, force them to carry out any tasks, often denying a critical attitude towards the task (order). And doctors, or rather good doctors, are not a mass phenomenon, but, so to speak, a piece product. And from this point of view, a special uniform, which pursues the goals of depersonalization and subordination, is completely useless here. We are not talking about clothing that is used in special situations, for example, in the operating room. These clothes serve a completely different purpose (preventing microorganisms from entering the wound, for example). But a doctor of a therapeutic specialty should not at all be packed in a gown in order to form an opinion about the patient’s health status and recommend treatment based on questioning, physical examination and studying data from laboratory and instrumental research methods. Anything that is not necessary in a given situation, in our opinion, may not be used.

One more thing. If a person comes for a preventive appointment (check-up), that is, when he is relatively healthy, the same white coats can cause a completely different reaction, namely a negative one. After all, they are associated with misfortune and pain, with ill health and treatment, which is rarely pleasant.

Now about what raises the most questions: cleanliness. Most people believe that a white coat carries fewer pathogenic microorganisms. Like Nosov, in the adventures of Dunno and his friends. Patchkulya Motley wore gray clothes because they get dirty less. Although in fact, gray clothes get dirty just like everything else, it’s just that the dirt is less noticeable on gray ones.

So, at the end of the twentieth century, in the 90s, British epidemiologists conducted a study. A UK hospital swabbed the sleeves, pockets and backs of hundreds of gowns worn by doctors and medical staff. At the same time, it was also found out that not all doctors are sensitive to the cleanliness of their uniforms: only 40% of respondents changed their gowns weekly. Most of the rest did this once every 2-3 weeks, and 5% even less often, once every 2 months.

Colonies of Staphylococcus aureus flourished on the sleeves and pockets of all gowns, and most often on the clothes of surgeons. Even if a clean robe was only received from the laundry in the morning after washing and disinfection, after 8 hours it was full of uninvited inhabitants from the world of bacteria.

It turns out that it's not about what clothes you wear to work, but how regularly you change them. That is why today, in our opinion, doctors of non-surgical specialties do not have to adhere to the rule of mandatory wearing of a uniform in the form of a gown. A doctor should work in what he is comfortable with.

Treatment of pathology

As mentioned above, in solving the question of how to get rid of the white coat syndrome when measuring blood pressure, psychological methods are used. The basis lies in a person’s awareness of his fear. There is nothing to be ashamed of; it is impossible to solve the problem without admitting fear. You can get rid of white coat syndrome by calming down and eliminating stress, for which discussing fear is important.

In less serious cases, it helps to have a loved one in the doctor's office, which will at least partially divert attention from the hospital and doctors. Reading a book, magazine, etc. can help.

In serious cases, contacting a specialist or psychologist will help. Together with him, you will determine the origin and cause of the syndrome, and gradually mitigate its manifestations. Since the causative factor of the syndrome is different for each person, an individual approach to therapy is desirable.

Important! Don't hesitate to contact a specialist! A psychologist will help you cope with the syndrome as soon as possible.

Preventive measures

The risk of white coat syndrome will be reduced if the patient knows the doctor well, there is mutual understanding between them, and the patient is not afraid of the specialist. However, for some people, some anxiety associated with the syndrome is intractable. Help in this case is simple - if you accidentally detect high blood pressure at the doctor, buy a tonometer, measure the readings several times at home, then report the results to the doctor. Although home electronic pressure gauges are not very accurate, they eliminate the syndrome. More accurate measurements can be taken by Holter, where a patient's blood pressure is taken regularly at home and the results are then assessed by a doctor.

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