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Adjustment Disorder

Adjustment disorder occurs when someone can’t adjust to, or deal with, a particular stressor. A major life event, for example.

There are a handful of different types of adjustment disorders. They are characterized by the following predominant symptoms: depressed state, anxiety, mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct, and other unspecified symptoms. The criteria for these symptoms are not specified in greater detail. AD may be acute or chronic, depending on the disorder’s duration.  If AD lasts for less than 6 months, then it may be categorized as acute. If adjustment disorder lasts for six months or more, then it may be classified as chronic. Symptoms can’t last longer than six months after the stressor(s), or its consequences, are terminated.  

Causes of Adjustment Disorder

AD is caused by an outside stressor. It generally resolves once the individual is able to adapt to the situation they’ve been trying to deal with. There are emotional signs of adjustment disorder: sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, worry, desperation, difficulty sleeping, difficulty concentrating, feeling overwhelmed, and suicidal thoughts. There are also behavioral signs of AD: fighting, reckless driving, ignoring priorities (bills, homework, etc), avoiding family/friends, performing poorly in school, not attending school, or destroying property. Suicidal behavior is prominent among people with adjustment disorder of all ages, and up to 1/5 of adolescent suicide victims may have AD.

Adjustment Disorder Diagnostic Guidelines

Since people with AD normally show the same symptoms as depressed people, the disorder is sometimes referred to as “situational depression.” Unlike major depression, AD is caused by an outside stressor and generally resolves once the individual is able to adapt to the situation. One hypothesis for adjustment disorder is that it may represent a sub-threshold clinical syndrome. It’s common characteristics include: mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms, or a combination of the three.

The basis of diagnosis is the presence of a precipitating stressor and a clinical evaluation of the possibility of symptom resolution on removal of the stressor, due to the limitations in the criteria for diagnosing AD. Additionally, diagnosis is less clear when patients are exposed to stressors long-term. This type of exposure is associated with AD, major depressive disorder (MDD), and generalized anxiety disorder (GAD). Some signs and criteria used to establish a diagnosis are important. Firstly,  a stressor must be clearly followed by symptoms. The symptoms should be more severe than what would be expected. Other underlying disorders shouldn’t appear. Present symptoms aren’t part of a normal grieving for the death of family member or other loved one.

Adjustment disorders have the ability to be self-limiting. Within 5 years of original diagnosis, approximately 20%-50% of those with AD go on to being diagnosed with psychiatric disorders which are more serious. Adult women are diagnosed twice as often as adult men. Girls and Boys are also likely to receive this diagnosis.

Treatment for Adjustment Disorder

Psychotherapy is often recommended to treat AD.  This form of treatment aims at symptom relief and behavior change. Psychotherapy allows the patient to put their distress or rage into words rather than actions. Individual therapy can help a person gain the support they need, identify abnormal responses, and maximize the use of the individual’s strengths. Counseling (self-help groups , crisis intervention, etc), family therapy and behavioral therapy are often used to encourage the verbalization of fears, anxiety, rage, helplessness, and hopelessness. Sometimes, small doses of antidepressants and anxiolytics are used in junction with other forms of treatment. Benzodiazepines are recommended for those with severe life stresses and a significant anxious component. Although non-addictive alternatives have been recommended for patients with current or past heavy alcohol use because of the greater risk of dependence. Tianeptine, alprazolam, and mianserin were found to be equally effective on patients with AD and anxiety accompanying it.

Additionally, antidepressants, antipsychotics (rarely used) and stimulants have been incorporated and enforced in treatment plans. There has been little systematic research regarding the best way to manage individuals with adjustment disorder. It’s been brought forth that there is no need to intervene  due to natural recovery, unless levels of risk or distress are high. However, treatment may be beneficial for some, of course. AD victims with depressive and/or anxiety symptoms may benefit from treatments that are usually used for depressive and/or anxiety disorders.

One study found that AD sufferers received similar interventions to those with other psychiatric diagnoses, including psychological therapy and medication. Another study found that AD responded better than major depression to antidepressants. The absence of meaningful evidence for AD treatment calls for watchful waiting, which should be considered initially if symptoms are not improving or causing marked distress. Treatment should then be directed at the predominating symptoms. Parents and caregivers can also play a role and help their children by:

  • encouraging to talk about their emotions
  • offering support and understanding
  • reassuring the child that their reactions are normal
  • getting teachers involved (check on their progress in school)
  • allowing the child to make simple decisions at home (choosing meals, shows or movies to watch, etc)
  • having the child partake in a preferred hobby or activity
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