adjustment disorders


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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.

ad·just·ment dis·or·ders

1. a group of mental and behavioral disorders in which the development of symptoms is related to the presence of some environmental stressor or life event and is expected to remit when the stress ceases;
2. a disorder the essential feature of which is a maladaptive reaction to an identifiable psychological stress, or stressors, that occurs within weeks of the onset of the stressors and persists for as long as 6 months; the maladaptive nature of the reaction is indicated by impairment in occupational (including school) functioning, or in usual social activities or relationships with others, or with symptoms that are in excess of a normal or expectable reaction to the stressor.

ad·just·ment dis·or·ders

(ă-jŭstmĕnt dis-ōrdĕrz)
A group of mental and behavioral disorders in which the development of symptoms is related to the presence of some environmental stressor or life event and is expected to remit when the stress ceases.
References in periodicals archive ?
Immediate help through group therapy for patients with somatic diseases and depressive or adjustment disorders in outpatient care: study protocol for a randomized controlled trial.
Adjustment disorders were second most common (26%) psychiatric morbidity in current study.
No drug has demonstrated superiority to placebo for alleviating symptoms of an adjustment disorder, but some clinicians nonetheless sometimes feel compelled to "up-code" the diagnosis of an adjustment disorder to the status of a major affective disorder, even when syndromal criteria for major depressive disorder (MDD) or dysthymia are absent.
Finally, they addressed the prevalence of mood and adjustment disorders among the cohort.
Cognitive skills were used more for adjustment disorders than for either mood or anxiety disorders
2%) of chronic pain were diagnosed with anxiety disorders, 28 patients (11%) with adjustment disorder and 1.
Other areas covered included post traumatic disorders and adjustment disorders which are very relevant to the region.
It found that counselors disproportionately diagnosed males as having psychotic, childhood, and substance-related disorders and females as having major depressive and adjustment disorders.
Most of those affected develop acute stress, depression or adjustment disorders - a short-term abnormal or excessive reaction to an event.
It only adds to the mental shock for troops who live under the constant threat of death or maiming, and helps account for the rise in adjustment disorders they suffer.
Among the disorders listed are adjustment disorders, alcohol abuse, anxiety disorders, ADHD, sleep disorders, and suicide.