Adjustment disorder is an excessive, prolonged reaction to a stressful event or situation. This reaction seriously impairs social and occupational functioning. Symptoms generally appear within three months of the stressor. In the case of an acute adjustment disorder, the symptoms resolve within about six months of onset. In the case of chronic adjustment disorder, the symptoms may linger beyond the six-month mark.
There are several subtypes of the disorder, including adjustment disorder with:
Causes
Adjustment disorders develop in reaction to stressful life events or major life changes. Relationship problems, financial difficulties, family conflict, school issues, work changes, major life changes, health problems,divorce, death of a close loved ones, moving, and sexuality issues are all common stressors. In some cases, ongoing problems (such as living in an unsafe, crime-ridden neighborhood) may cause the development of an adjustment disorder over a longer period of time.
Risk Factors
Adjustment disorders develop in reaction to stressors, and can affect individuals of all ages. Certain individuals may have a predisposition or vulnerability that can play a part in the risk of occurrence and how the disorder presents.
Factors such as genetics, flexibility, intelligence, social skills, and coping strategies can all affect how susceptible an individual is to stress. The stressor itself may also interfere with an individual’s support network. In children, boys and girls are at equal risk for adjustment disorders, while women are thought to be at higher risk than men. Certain early-childhood family history factors seem to contribute to the chance that an individual may suffer from an adjustment disorder in the future. These include:
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Frequent moves as a child
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Abusive family of origin
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Overprotective family of origin
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Coming from a disadvantaged background
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Prior exposure to extreme trauma (such as war) without having previously developed either an adjustment disorder or post-traumatic stress disorder (PTSD)
Individuals who are at higher risk for adjustment disorders also often have other conditions, such as a history of anxiety, depression, bipolar disorder, or eating disorders.
Symptoms
Symptoms may vary, but are similar in that the reaction is worse or more excessive than expected to the stressor. In order for a diagnosis of adjustment disorder to be made, symptoms must interfere with an individual’s social or work functioning.
Symptoms include:
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Depressed mood , sadness
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Difficulty breathing
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Chest pain
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Anxiety or worry
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Feeling of inability to cope
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Feeling of inability to plan ahead
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Feeling of inability to continue in present situation
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Some degree of disability in the performance of daily routine
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Conduct disorders
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Disturbance of other emotions and conduct
Diagnosis
Your doctor will perform an evaluation to assess whether your symptoms follow a recent stressful event, and if the symptoms are more severe than what is normal for you. You will also be evaluated to make sure there is no underlying disorders or disease, such as depression, an anxiety disorder, or post-traumatic stress disorder. Your doctor may refer you to a psychiatrist for diagnosis and treatment.
Treatment
The main goal of treatment is to resolve symptoms, and return the individual to his or her normal level of functioning. Treatment is important so that the disorder doesn’t become a larger illness, like major depression. Treatment options include the following:
Psychotherapy
Psychotherapy, or counseling, is the primary treatment for adjustment disorders. Therapy is used to help individuals understand why the stressful event caused the symptoms, and to develop coping mechanisms for future stressors. Therapy is generally short-term and can take any of the following forms: individual therapy, family therapy, behavior therapy, or group therapy.
Medications
Medications may be used in combination with therapy to alleviate common symptoms. Antidepressants or anti-anxiety medications may be prescribed on a short-term basis until the symptoms resolve.
Prevention
While there is no known way to prevent adjustment disorders, the prognosis is good. Adjustment disorders generally resolve with treatment and time without remaining symptoms.
RESOURCES:
National Institute of Mental Health
http://www.nimh.nih.gov
US Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
http://www.mentalhealth.org
CANADIAN RESOURCES:
Canadian Psychiatric Association
http://www.cpa-apc.org
Mental Health at Work
http://cgsst.fsa.ulaval.ca/sante/eng/default.asp
References:
Adjustment disorder. Medline Plus, National Library of Medicine website. Available at http://www.nlm.nih.gov/medlineplus/print/ency/article/000932.htm. Accessed July 4, 2005.
Adjustment disorders. PsychNet-UK website. Available at: http://www.psychnet-uk.com/dsm_iv/adjustment_disorder.htm. Accessed July 4, 2005.
Casey P. Adult adjustment disorder: a review of its current diagnostic status. Journal of Psychiatric Practice. 2001;7: 32-40.
Mental and behavioural disorders. International Classification of Diseases (ICD), Chapter V. World Health Organization website. Available at: http://www3.who.int/icd/vol1htm2003/gf40.htm. Accessed July 6, 2005.
