Adjustment Disorder is an abnormal and excessive reaction to an identifiable life stressor. The reaction is severe compared with what would normally be expected, and can result in significant impairment in social, occupational or academic functioning. The response may be linked to a single event (a flood or fire, marriage, divorce, starting school, new job) or multiple events (marital problems or severe business difficulties). Stressors may be recurrent events (child witnessing parents constantly fighting, chemotherapy, financial difficulties) or continuous (living in a crime-ridden neighborhood).
Adjustment Disorder often occurs with one of the following: depressed mood (patient is tearful, sad, hopeless); anxiety (patient is nervous, fearful, worried); mixed anxiety and depressed mood; disturbance of conduct in which the patient violates rights of others or major age-appropriate societal norms or rules (e.g. truancy, vandalism, reckless driving or fighting); mixed disturbance of emotions and conduct; maladaptive reactions (problems related to job or school, physical complaints, social isolation). Adjustment disorders are associated with higher risk of suicide and suicidal behavior; substance abuse; prolonging of other medical disorders or interference with their treatment. Adjustment disorder that persists may progress to become a more serious mental disorder (major depressive disorder).
Impaired occupational/social functioning
Trembling or twitching
Physical complaints (e.g. general aches and pains, stomachache, headache, chest pain)
Anxiety, worry, stress and tension
Note: Symptoms may vary widely. The person may or may not be aware of the stressor causing the disturbance.
Diagnosis depends on the following:
The reaction clearly follows a life stressor. Within three months of stressor onset, emotional and behavioral symptoms develop in response to stressor
Symptoms seem excessive compared to what would normally be expected in relation to stressor and/or, symptoms significantly impair occupational, school or social functioning
Symptoms are not explained by another diagnosis
Symptoms are not part of bereavement
Symptoms do not last longer than six months after end of stressor
The diagnosis may be acute (symptoms last less than six months) or chronic (symptoms last six months or longer as when stressors are chronic or have lasting effects)
The cause is a life stressor. Adults usually develop adjustment disorders to stressors related to marital discord, finances, or work. In adolescents, common stressors include school problems, family or parents' marital problems, or sexuality issues. Other types of stressors include death of a loved one, life changes, unexpected catastrophes, medical conditions such as cancer and subsequent treatments.
There is no way to predict which people are likely to develop adjustment disorder, given the same stressor. Factors that influence how well a person reacts to stress may include economic conditions, availability of social supports, and occupational and recreational opportunities. Intrapersonal susceptibility to stress may include such factors as social skills, intelligence, genetics and coping strategies.
The primary goal of treatment is to relieve symptoms and help the person achieve a level of functioning comparable to that 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. Realistic short-term goals should be made at the start of therapy, as the course of adjustment disorder is short-term in nature. Goals of therapy will often center around social supports available to the individual in his or her life in the form of family, friends and community. The individual's coping and problem solving skills will be explored and developed. Relaxation techniques might be explored to help the individual deal with feelings of stress. More specific goals of treatment will include eliciting the patient's concern and helping the individual understand his or her role in the stressors; reviewing and reinforcing positive steps the patient has taken to deal with the stress; teaching ways to cope or avoid stressors in the future; helping the individual to place stressors in perspective with relation to overall life; helping the individual to understand his reaction to the stressors; and helping the individual view stressors as chance for positive change or improvement.
Family therapy as well as effective communication and coping-with-stress skills may be recommended for cases in which the patient is younger (child, adolescent). When medications are used, it is in addition to psychosocial treatment. Prescription medication may be helpful in easing the depression or the anxiety associated with adjustment disorder. However, treatment of adjustment disorders usually excludes use of medication.