The psychological effect on patients has been described as an adjustment reaction in which the stress is severe enough to be considered catastrophic. Catastrophes often produce situational distress that elicits similar emotional responses in almost everyone subjected to the stress. In the initial crisis stage, there may be an acute response of denial alternating with periods of intense anxiety. Complicating this is the impact on supportive relationships and patients' difficulty in retaining information about their illness. The transitional state is characterized by alternating waves of anger, guilt, self-pity, and anxiety. Changes in self-esteem, identity and values, estrangement from families and community, the occurrence of more drug use, and consideration of suicide may occur. However, patients are especially accessible to psychosocial intervention at this time. The deficiency state is when the formation of a new, stable identity occurs upon reaching this stage of acceptance. Patients learn to accept the limitations imposed on them by AIDS, feel less victimized by life, and reach out to other patients who serve as role models. However, acceptance is not a permanent state and new crises may force renegotiation of transitional states to reach acceptance again. The fourth stage, the preparation of death, includes the fear of becoming totally dependent on others, as well as the fear of death, social prejudices, the lack of natural advocates for AIDS risk groups, and the resistance to change among nonpatient family members. 10 references.