Adjustment Disorder

Adjustment disorder is a transient maladaptive reaction to an identifiable psychosocial stressor or changes in life circumstances (Maercker et al. 2008 ).3

When the stressor is not a traumatic event, the diagnosis of adjustment disorder is used rather than that of posttraumatic stress disorder (PTSD). 2

CLINICAL FEATURES:

Symptoms of adjustment disorder are regarded as clinically significant and do not represent an adaptive response to a stressor1

Psychiatric classificatory systems require that symptoms occur within 1–3 months of an identified stressor. Symptoms can include:

● anxiety
● depressed mood
● disturbance of conduct
● physical complaints
● withdrawal, or academic inhibition.

The disorder’s duration is typically brief, less than 6 months. If it lasts longer than that, the diagnosis is re-evaluated 2

DIAGNOSTIC CRITERIA

According to DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDITION (DSM-5)

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:

1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.

2. Significant impairment in social, occupational, or other important areas of functioning.

C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder.

D. The symptoms do not represent normal bereavement.

E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

TREATMENT

● Adjustment disorder resolves over time when the stressor is removed or when the person’s own adaptive skills and resilience enable this.

● Also, removing an individual from the stress-inducing situation facilitates improvement

● Pharmacological: There is no evidence that antidepressants have any effect on mood changes associated with adjustment disorder, but pharmacological treatments may help alleviate sleep and anxiety symptoms1

Main therapeutic goals in the treatment of adjustment disorder are (Strain and Diefenbacher HYPERLINK “http://link.springer.com/article/10.1007/s10879-012-9208-6” 2008).

Restoring mental balance, exposing the concerns and conflicts that the patient is experiencing, identifying means of reducing stressors, enhancing the patient’s coping skills, helping the patient regain perspective on the adversity, and establishing relationships to assist the management of the stressors and the self

● Non-pharmacological:

Psychotherapy: timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known.3

A study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1 year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder.3

Brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up.3

Another study found client centered psychotherapy in patients suffering adjustment disorder to be superior to untreated controls (Altenhofer et al. HYPERLINK “http://link.springer.com/article/10.1007/s10879-012-9208-6” 2007).3

PROGNOSIS

The person diagnosed with adjustment disorder can be reassured that his or her psychological prognosis is very good.

REFERENCES:

  1. When Somebody Has an Adjustment Disorder Patricia Casey, M.D., James Strain, M.D. Published online: January 04, 2016
  1. Adjustment Disorder Roger J. R. Levesque Affiliated with Indiana Encyclopedia of adolescence
  1. Ben-Itzhak, S., Bluvstein, I., Schreiber, S. et al. J Contemp Psychother (2012) 42: 249. doi:10.1007/s10879-012-9208-6