Adjustment Disorders

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Symptoms

Causes

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Adjustment Disorder refers to a reaction to one or more identifiable stressors that occurs within 3 months of when the stressors started. The reaction is excessive compared to a normal reaction to the stressors, and/or results in impaired functioning. The response might be to one stressor or many, and the stress may occur once (a flood or fire, marriage, divorce, going away to school, new job) or often (child witnessing parents constantly fighting) (Morrison, 1995).

Adjustment Disorder often occurs with one of the following: Depressed Mood (patient is tearful, sad, hopeless); Anxiety (patient is nervous, fearful, worried); Mixed Anxiety and Depressed Mood; Disturbance of Conduct (patient violates rules or rights of others); Mixed Disturbance of Emotions and Conduct; Unspecified (problems related to job, physical complaints, social isolation) (American Psychiatric Association, 1994; Morrison, 1995).

Adjustment Disorders are associated with higher risk of suicide and suicidal behavior; abuse of substances; prolonging of other medical disorders or interference with their treatment.

Symptoms

  • Hopelessness
  • Frequent crying
  • Depressed mood
  • Impaired occupational/social functioning
  • Agitation
  • Trembling or twitching
  • Palpitations
  • Conduct disturbances
  • Physical complaints
  • Withdrawal
  • Occupational functioning is decreased
  • Anxiety, stress, and tension

Note: Symptoms may vary widely, but duration is usually less than 6 months. The person may or may not be aware of the stressor causing the disturbance.

Diagnosis depends on the following:

  • Within 3 months of stressor, emotional and behavior symptoms develop in response to stressor
  • Symptoms seem excessive in relation to stressor OR symptoms significantly impair occupational, school or social functioning
  • Symptoms not explained by another diagnosis
  • Symptoms are not part of bereavement
  • Symptoms do not last longer than 6 months after end of stressor
  • The diagnosis may be Acute (symptoms lasting less than 6 months) or Chronic (symptoms lasting 6 months or longer as when stressors are chronic or have lasting effects)

(American Psychiatric Association, 1994; Morrison, 1995)

Causes

The cause is a life stress, but there is no way to predict which people are likely to get an adjustment disorder given the same stressor.

Adults usually develop adjustment disorders related to stressors such as marital discord, finances, or work. In adolescents, common stressors include school problems or parents' marital problems. Other stressors may include death of a loved one, life changes or unexpected catastrophes. Situational factors that influence how well a person reacts to stress may include economic conditions, availability of social supports, and occupational and recreational opportunities. Intrapersonal susceptibility to stress may include such factors as social skills, intelligence, and coping strategies.

The primary goals of treatment are to relieve symptoms and assist with achieving a level of adaptation that is comparable to the affected person's level of functioning before the stressful event. Most mental health professionals recommend a form of psychosocial treatment for this disorder. Treatments include individual psychotherapy, family therapy, behavior therapy, and self-help groups. Realistic short-term goals should be made at the start of therapy as the course of Adjustment Disorder is short-term in nature. Goals of therapy will often center around other supports available to the individual in his or her life in the form of family, friends and community. The individual's coping skills will be explored and developed. Relaxation techniques might be explored to help the individual deal with feelings of stress. More specific goals of treatment will include helping the individual understand his or her role in the stressors, teaching ways to avoid stressors in the future, helping the individual view stressors as chance for positive change or improvement, helping the individual to place stressors in perspective with relation to overall life, and helping the individual to understand his or her reactions to the stressors.

Family therapy might be recommended for cases in which the patient is younger (child, adolescent). When medications are used, they are usually in addition to other forms of treatment. Some prescription medication may be helpful in easing the depression or the anxiety associated with adjustment disorder. However, treatment of Adjustment Disorders usually excludes use of medication.

Most people recover in full from Adjustment Disorders if they have no previous history of mental illness and have access to a stable social support system.

It is important for these individuals to maintain and develop healthy diets and sleeping patterns as well as development and maintenance of social supports.

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Source: "Adjustment Disorder" - Psychology Today