A short document outlining some facts I've learned about Adjustment Disorders.

1. #14 Adjustment Disorders
Adjustmentdisorderdevelopsasareactionto a stressful life eventoramajor life change. Itisa stress-
related,short-term,nonpsychoticdisturbance. The symptomsoccurbecause youare havinga hard time
coping.
An AdjustmentDisorderisanabnormal andexcessivereactiontoanidentifiable life stressor.The
reactionismore severe thanwouldnormallybe expected,andcanresultinsignificantimpairmentin
social,occupational oracademicfunctioning.
Since people withthisdisordernormallyhave symptomsthatdepressedpeople do,suchasgeneral loss
of interest,feelingsof hopelessnessandcrying,thisdisorderissometimesknownassituational
depression.Unlike majordepressionthe disorderiscausedbyanoutside stressorandgenerallyresolves
once the individual isable toadaptto the situation.
Adjustmentdisordersare associatedwithhigherriskof suicideandsuicidal behavior;substance abuse;
prolongingof othermedical disordersorinterferencewiththeirtreatment.Adjustmentdisorderthat
persistsmayprogresstobecome a more seriousmental disorder(majordepressive disorder).
Presentation
Commoncharacteristicsof adjustmentdisorderinclude milddepressive symptoms,anxietysymptoms,
and traumaticstresssymptomsora combinationof the three. Adjustmentdisordermaybe acute or
chronic,dependingonwhetheritlastsmore orlessthan six months. However,the symptomscannot
lastlongerthan six monthsafterthe stressor(s),oritsconsequences,have terminated.
The type of stressthat can triggeran adjustmentdisordervariesdependingonthe person,butcan
include:
 Endingof a relationshipormarriage
 Losingor changingjob
 Deathof a lovedone
 Developingaseriousillness(yourself oralovedone)
 Beinga victimof a crime
 Havingan accident
 Undergoinga majorlife change (suchasgettingmarried, havingababy,or retiringfroma job)
 Livingthrougha disaster,suchas a fire,flood,orhurricane
Accordingto DSM-5, diagnosticcriteriaforAdjustmentdisorders are:
A. The developmentof emotional orbehavioralsymptomsinresponse toanidentifiable stressor(s)
occurringwithin3 monthsof the onsetof the stressor(s).

2. B. These symptomsorbehaviorsare clinicallysignificant,asevidencedbyone orbothof the
following:
1. Marked distressthatisout of proportiontothe severityorintensityof the stressor,taking
intoaccount the external contextandthe cultural factorsthatmightinfluence symptomseverity
and presentation.
2. Significantimpairmentinsocial,occupational,orotherimportantareasof functioning.
C. The stress-relateddisturbancedoesnotmeetthe criteriaforanothermental disorderisnot
merelyanexacerbationof apreexistingmentaldisorder.
D. The symptomsdonot represent normal bereavement.
E. Once the stressoror its consequenceshave terminated,the symptomsdonotpersistformore
than an additional 6months.
Diagnosisof adjustmentdisorderisquite common;there isanestimatedincidence of 5%–21% among
Americanpsychiatricconsultationservicesforadults.Adultwomenare diagnosedtwice asoftenasare
adultmen.Amongchildrenandadolescents,girlsandboysare equallylikelytoreceivethisdiagnosis.
Some emotional signsof AdjustmentDisorderare
 Sadness
 Hopelessness
 Lack of enjoyment
 Cryingspells
 Nervousness
 Anxiety
 Worry
 Desperation
 Trouble sleeping
 Difficultyconcentrating
 Feelingoverwhelmedandthoughtsof suicide
Some behavioral signsof AdjustmentDisorderare
 Fighting
 Recklessdriving
 Ignoringimportant taskssuchas billsorhomework
 Seekingapproval fromothersbyanywaypossible (cheating/lying/escapingreality)
 Avoidingfamilyorfriends
 Performingpoorlyinschool
 Skippingschool
 Vandalizingproperty
Whois at risk of developingAdjustmentDisorder?
Researchislimitedonhowoftenadjustmentdisorderoccurs,althoughitisthoughttobe a common
condition.Childrenandadultsof bothsexessufferfromit butthere isno wayto determine whowill
developadjustmentdisorderinresponse toastressor. Certainfactorsincrease yoursusceptibilityto
developingthe disorder.Riskfactorsinclude:

3.  age (adolescentsmaynotbe able tocope withstressorsaswell asadults)
 a lack of emotional development
 a lack of flexibilityforlife changes
 a lack of good copingskills
 a lack of social skills
 a lack of a supportsystem
 past experiences
 othermental healthproblems
 geneticfactors
 intelligence
Management
Selectionof treatmentsforadjustmentdisorderisa clinical decision.Atpresent,noofficial consensus
identifiesanoptimal therapy.Bothpsychological therapyandpharmacotherapymaybe considered.
Because adjustmentdisordertendstobe time-limited,brief ratherthanlong-termpsychotherapyis
generallypreferred.Goalsshouldinclude the following:
 To analyze the stressorsaffectingthe patientanddetermine whethertheycanbe eliminatedor
minimized(problemsolving)
 To clarifyandinterpretthe meaningof the stressorforthe patient
 To reframe the meaningof the stressor
 To illuminatethe concernsandconflictsthe patientexperiences
 To identifyameansof reducingthe stressor
 To maximize the patient’scopingskills(emotionalself-regulation,avoidance of maladaptive
coping,especiallysubstancemisuse)
 To helppatientsgainperspective onthe stressor,establishrelationships,mobilize support,and
manage themselvesandthe stressor
Approachesthatmay be helpful include:
 Psychotherapy
 Crisisintervention
 Familyandgrouptherapies
 Supportgroupsspecifictothe stressor
 Cognitive-behavioral therapy(CBT)
 Interpersonal psychotherapy
Pharmacotherapymayhelp,particularlywiththe taskof improvingcopingbymoderatingsymptoms
such as insomnia,anxiety,ordysphoria. Some typesof medicationsthatmaybe usedinclude:
 antianxietymedicines
 antidepressantmedicines
 antipsychoticmedicines(uncommon)
 stimulants(if youare withdrawn)
Agentsthathave beenusedinclude the following:

4.  Benzodiazepines(eg,lorazepamandclorazepate)
 SSRIor SNRI(sertaline,venlafaxine)
 Plantextracts(eg, kava-kavaandvalerian)
Furtherstudiesare requiredtoinvestigate the effectivenessof theseagentsandadditionalnovelagents
intreatingadjustmentdisorder.
Outlook (Prognosis)
Withthe righthelpandsupport,youshouldgetbetterquickly.The problemusuallydoesnotlastlonger
than 6 months,unlessthe stressorcontinuestobe present.
Most adultsrespondwell totreatmentforadjustmentdisorderandhave a goodlong-termprognosis,
while adolescentsmaynotrespondaswell totreatmentandmaydevelopmajorpsychiatricillnesses.
Most people withadjustmentdisorderrecovercompletely.Infact,a personwhoistreatedfor
adjustmentdisordermaylearnnewskillsthatactuallyallowhimorherto functionbetterthanbefore
the symptomsbegan.
Prevention
There isno knownguaranteedwaytopreventadjustmentdisorder.Youmaybe able toreduce yourrisk
of developingthe disorderbydoingthe following:
 seeksupportfromfamilyandfriends
 talkto a healthcare professional if youstartto feel stressed
 try to have a flexible attitude regardingwhere yourlife will lead
 thinkpositively
 live ahealthylifestyle (healthydietandexercise)

5. SOURCES
DSM-5, AmericanPsychiatricPublishing(2013)
AdjustmentDisorders
http://emedicine.medscape.com/article/2192631-overview
Adjustmentdisorder
https://en.wikipedia.org/wiki/Adjustment_disorder
AdjustmentDisorder
http://www.healthline.com/health/adjustment-disorder#ReadThisNext0
DiseasesandConditions:Adjustmentdisorders
http://www.mayoclinic.org/diseases-conditions/adjustment-disorders/basics/causes/con-20031704
Adjustmentdisorder
http://www.nlm.nih.gov/medlineplus/ency/article/000932.htm
AdjustmentDisorder
https://www.psychologytoday.com/conditions/adjustment-disorder
Mental Healthand AdjustmentDisorder
http://www.webmd.com/mental-health/mental-health-adjustment-disorder