Adjustment Disorders

An adjustment disorder is a debilitating reaction, usually lasting less than six months, to a stressful event or situation. 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).

These symptoms or behaviors are clinically significant as evidenced by either of the following:

Distress that is in excess of what would be expected from exposure to the stressor.

Significant impairment in social, occupational or educational functioning.

The symptoms are not caused by Bereavement.

The stress-related disturbance does not meet the criteria for another specific disorder. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.

Adjustment Disorders Subtypes:

With Depressed Mood
With Anxiety
With Mixed Anxiety and Depressed Mood
With Disturbance of Conduct
With Mixed Disturbance of Emotions and Conduct
Unspecified

Associated Features:

Depressed Mood
Somatic/Sexual Dysfunction
Guilt/Obsession

Differential Diagnosis: 

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.

Personality Disorders;
Not Otherwise Specified Disorders (e.g., Anxiety Disorder Not Otherwise Specified);
Posttraumatic Stress Disorder, and Acute Stress Disorder;
Psychological Factors Affecting Medical Condition; Bereavement;
Nonpathological Reactions to Stress.

Cause:

Many people have difficulties adjusting to stressful events. Stressful events include starting a new job, ending an important relationship, or conflicts with work colleagues. As a result, the individual may have difficulty with his or her mood and behavior several months after the event. There are as many different responses to stressful events as there are stressful events. Some who have recently experienced a stressor may be more sad or irritable than usual and feeling somewhat hopeless. Others become more nervous and worried. And other individuals combine these two emotional patterns. The symptoms associated with adjustment difficulties usually subside within about 6 months after the stressful event.

Treatment:

Counseling and Psychotherapy

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.

Pharmacotherapy

Mental health professionals generally do not use medication to treat this disorder. When medications are used, they are usually in addition to other forms of treatment.

Expectations:

Adjustment disorders are less severe than other disorders. People with behavior disorders are more likely to later develop antisocial personality disorder. People with multiple psychiatric disorders are less likely to return to a previous level of functioning.

Complications:

Major Depression may develop if help is not obtained.