Adjustment Disorders

Adjustment Disorders 

Definition

An adjustment disorder is a debilitating reaction, usually lasting less than six months, to a stressful event or situation. It is not the same thing as post-traumatic stress disorder (PTSD), which usually occurs in reaction to a life-threatening event and can be longer lasting.

Description

An adjustment disorder usually begins within three months of a stressful event, and ends within six months after the stressor stops. There are many different subtypes of adjustment disorders, including adjustment disorder with:

• depression
• anxiety
• mixed anxiety and depression
• conduct disturbances
• mixed disturbance of emotions and conduct
• unspecified

Adjustment disorders are very common and can affect anyone, regardless of gender, age, race, or life-style. By definition, an adjustment disorder is short-lived, unless a person is faced with a chronic recurring crisis (such as a child who is repeatedly abused). In such cases, the adjustment disorder may last more than six months.

Causes and symptoms

An adjustment disorder occurs when a person can't cope with a stressful event and develops emotional or behavioral symptoms. The stressful event can be anything: it might be just one isolated incident, or a string of problems that wears the person down. The stress might be anything from a car accident or illness, to a divorce, or even a certain time of year (such as Christmas or summer).

People with adjustment disorder may have a wide variety of symptoms. How those symptoms combine depend on the particular subtype of adjustment disorder and on the individual's personality and psychological defenses. Symptoms normally include some (but not all) of the following:

• hopelessness
• sadness
• crying
• anxiety
• worry
• headaches or stomachaches
• withdrawal
• inhibition
• truancy
• vandalism
• reckless driving
• fighting
• other destructive acts

Diagnosis

It is extremely important that a thorough evaluation rule out other more serious mental disorders, since the treatment for adjustment disorder may be very different than for other mental problems.

In order to be diagnosed as a true adjustment disorder, the level of distress must be more severe than what would normally be expected in response to the stressor, or the symptoms must significantly interfere with a person's social, job, or school functioning. Normal expression of grief, in bereavement for instance, is not considered an adjustment disorder.

Key terms

Multiple sclerosis — A progressive disorder of the central nervous system in which scattered patches of the protective sheath covering the nerves is destroyed. The disease, which causes progressive paralysis, is marked by periods of exacerbation and remission. There is no cure.

Post-traumatic stress disorder (PTSD) — A specific form of anxiety that begins after a life-threatening event, such as rape, a natural disaster, or combat-related trauma.

Treatment

Psychotherapy (counseling) is the treatment of choice for adjustment disorders, since the symptoms are an understandable reaction to a specific stress. The type of therapy depends on the mental health expert, but it usually is short-term treatment that focuses on resolving the immediate problem.

Therapy usually will help clients:

• develop coping skills
• understand how the stressor has affected their lives
• develop alternate social or recreational activities

Family or couples therapy may be helpful in some cases. Medications are not usually used to treat adjustment disorders, although sometimes a few days or weeks of an anti-anxiety drug can control anxiety or sleeping problems.

Self-help groups aimed at a specific problem (such as recovering from divorce or job loss) can be extremely helpful to people suffering from an adjustment disorder. Social support, which is usually an important part of self-help groups, can lead to a quicker recovery.

Prognosis

Most people recover completely from adjustment disorders, especially if they had no previous history of mental problems, and have a stable home life with strong social support. People with progressive or cyclic disorders (such as multiple sclerosis) may experience an adjustment disorder with each exacerbation period.

Resources

Books

Luther, Suniya G., Jacob A. Burack, and Dante Cicchetti. Developmental Psychopathology: Perspectives on Adjustment, Risk, and Disorder. London: Cambridge University Press, 1997.