[Allostatic load stress state: a novel framework for early identification, prevention, and stratified intervention of stress-related disorders].

内容摘要

Stress is a series of non-specific, adaptive physiological and psychological response processes generated by the body when challenged, burdened, or threatened by internal or external environments (e.g., social pressure), with the aim of maintaining homeostasis. Currently, stress-related disorders have become a major public health issue affecting national health. Daily persistent micro-stressors are widely prevalent, and in some individuals, the cumulative effects may lead to decompensation of the regulatory system, manifesting as a subclinical state. However, current diagnostic systems mainly rely on adjustment disorder and posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, text revision (DSM-5-TR) and the International Classification of Diseases, Eleventh Edition (ICD-11), both of which have significant limitations: adjustment disorder is a diagnosis of exclusion, while PTSD only covers major traumatic events. Neither DSM-5-TR nor ICD-11 adequately identifies subclinical populations who, under the cumulative effect of daily persistent micro-stressors, have developed mild symptoms and functional decline but do not meet the diagnostic criteria. To address this gap, this paper systematically proposes the concept of "allostatic load stress state" (ALSS), defined as "a transitional clinical state arising from decompensation of the individual's regulatory system under the cumulative effect of daily persistent micro-stressors, characterized by persistent stress-related symptoms with mild functional decline, but falling below the threshold of existing diagnostic criteria". ALSS integrates the previously indistinguishable core features of "allostatic load" (physiological wear and tear) and "allostatic overload" (clinical distress), filling the gap between normal stress and clinical disorders, and for the first time provides a structured identification criterion for this subclinical population. On this basis, this paper constructs a three-stage continuous spectrum theoretical framework-"normal stress (healthy population)-allostatic load stress (subclinical population)-persistent excessive stress (clinical disorder population)"-clarifying the clinical features, prevention and intervention principles for each stage; establishes a three-dimensional integrated assessment system centered on "stressor-symptom-function" to enable early identification of ALSS; and proposes a non-pharmacological, stratified, stepwise early intervention strategy aimed at providing actionable pathways for subclinical populations and promoting a forward shift in the prevention and management of stress-related disorders. 应激是指机体在受到内外环境（如社会压力）的挑战、负担或威胁时所产生的一系列非特异性、适应性生理心理反应过程，其目的是维持内稳态。目前，应激相关障碍已成为影响国民健康的重要公共卫生问题。日常持续性微小应激源暴露广泛，部分个体在累积作用下调节系统失代偿，呈现亚临床状态。然而，当前诊断体系主要依据《精神障碍诊断与统计手册（第五版-修订版）》（DSM-5-TR）和《国际疾病分类（第十一版）》（ICD-11）中的适应障碍与创伤后应激障碍（PTSD），二者存在明显局限：适应障碍为排除性诊断，PTSD仅覆盖重大创伤事件。DSM-5-TR和ICD-11对日常持续性微小应激源累积作用下已出现症状与功能轻度下降，但未达诊断标准的亚临床人群缺乏识别能力。为此，该文系统提出“稳态负荷应激状态”（ALSS）概念，将其定义为“在日常持续性微小应激源累积作用下，个体调节系统失代偿而出现的过渡性临床状态，表现为持续性应激相关症状伴轻度功能下降，但未达到现有诊断标准的亚临床阶段”。ALSS整合了既往难以区分“稳态负荷”（生理磨损）与“稳态负荷超载”（临床痛苦）的核心特征，填补了正常应激与临床障碍之间的空白，首次为该亚临床人群提供结构化识别标准。在此基础上，该文构建了“正常应激（健康人群）-稳态负荷应激（亚临床人群）-持久过度应激（临床障碍人群）”三阶段连续谱理论框架，明确各阶段的临床特征、预防与干预原则；建立了以“应激源-症状-功能”为核心的三维整合评估体系，实现ALSS的早期识别；同时提出以非药物为主、分层递进的早期干预策略，旨在为亚临床人群提供可操作的干预路径，推动应激相关障碍防治关口前移。.