Adjustment disorder

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Adjustment disorder
Other namesStress response syndrome
Specialty Psychiatry, clinical psychology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Anxiety, depression, and behavioral disturbances associated with a psychological stressor
Complications Suicide; [1] substance abuse, progression to more serious psychiatric disorders (e.g., post-traumatic stress disorder, major depressive disorder)
Usual onsetWithin one to three months after a stressful event
DurationUp to six months unless the stressor or its consequences continue
TypesMild, moderate, severe
Risk factors History of mental disorders; low social support
Differential diagnosis Post-traumatic stress disorder, mood disorders, anxiety disorders
TreatmentPsychotherapy; bibliotherapy; structured paraprofessional help
Prognosis Relatively good compared to many other mental disorders, but severity varies

Adjustment disorder is a mental and behavioral disorder defined by a maladaptive response to a psychosocial stressor. [2] The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual (considering contextual and cultural factors), causing marked distress, preoccupation with the stressor and its consequences, and functional impairment. [3] [4] [5] [6]

Contents

Diagnosis of adjustment disorder is common, with lifetime prevalence estimates for adults ranging from 5 to 21%. [7] Adult women are diagnosed twice as often as men. Among children and adolescents, girls and boys are equally likely to be diagnosed with an adjustment disorder. [8]

Adjustment disorder was introduced into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980. [9] [10]

Another name for adjustment disorder is stress response syndrome, as well as situational depression, since depression is one of the most common symptoms. [11]

Signs and symptoms

Signs of adjustment disorder include sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, desperation, feeling overwhelmed and thoughts of suicide, performing poorly in school or work, among others. [12]

Common characteristics of adjustment disorder include mild depressive symptoms, anxiety, and traumatic stress symptoms or a combination of the three. According to the DSM-5, there are six types of adjustment disorder, which are characterized by the following predominant symptoms: depressed mood, anxiety, mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct, and unspecified. However, the criteria for these symptoms are not specified in greater detail. [8] Adjustment disorder may be acute or chronic, depending on whether it lasts more or less than six months. According to the DSM-5, if the adjustment disorder lasts less than six months, then it may be considered acute. If it lasts more than six months, it may be considered chronic. [8] [13] Moreover, the symptoms cannot last longer than six months after the stressor(s), or its consequences, have terminated. [2] : 679  However, the stress-related disturbance does not only exist as an exacerbation of a pre-existing mental disorder. [6]

Unlike major depressive disorder, adjustment disorder is caused by an outside stressor and generally resolves once the individual is able to adapt to the situation. The condition is different from anxiety disorder, which lacks the presence of a stressor, or post-traumatic stress disorder and acute stress disorder, which usually are associated with a more intense stressor.

Suicidal behavior is prominent among people with adjustment disorder of all ages, and up to one-fifth of adolescent suicide victims may have an adjustment disorder. Bronish and Hecht (1989) found that 70% of a series of patients with adjustment disorder attempted suicide immediately before their index admission and they remitted faster than a comparison group with major depression. [5] Asnis et al. (1993) found that adjustment disorder patients report persistent ideation or suicide attempts less frequently than those diagnosed with major depression. [4] According to a study on 82 adjustment disorder patients at a clinic, Bolu et al. (2012) found that 22 (26.8%) of these patients were admitted due to suicide attempt, consistent with previous findings. In addition, it was found that 15 of these 22 patients chose suicide methods that involved high chances of being saved. [3] Henriksson et al. (2005) states statistically that the stressors are of one-half related to parental issues and one-third in peer issues. [14]

One hypothesis about adjustment disorder is that it may represent a sub-threshold clinical syndrome. [6]

The syndrome of occupational burnout is considered to be adjustment disorder by some national health authorities. [15] [16] [17]

Subtypes

Adjustment disorder has six different subtypes, all of which are based on what the main symptoms are. [18] [19]

The subtypes are as follows: [18]

Risk factors

Those exposed to repeated trauma are at greater risk, even if that trauma is in the past. Age can be a factor due to young children having fewer coping resources and because they are less likely to realize the consequences of a potential stressor. [8]

A stressor is generally an event of a serious, unusual nature that an individual or group of individuals experience. [20] Adjustment disorders can come from a wide range of stressors that can be traumatic or relatively minor, like the loss of a girlfriend/boyfriend, a poor report card, or moving to a new neighborhood. It is thought that the more often the stressor occurs, the more likely it is to produce adjustment disorder. The objective nature of the stressor is of secondary importance. A stressor gains its pathogenic potential when the patient perceives it as stressful. The identification of a causal stressor is necessary if a diagnosis of adjustment disorder is to be made. [21]

There are certain stressors that are more common in different age groups: [22]

Adulthood:

Adolescence and childhood:

In a study conducted from 1990 to 1994 on 89 psychiatric outpatient adolescents, 25% had attempted suicide in which 37.5% had misused alcohol, 87.5% displayed aggressive behaviour, 12.5% had learning difficulties, and 87.5% had anxiety symptoms. [14]

Diagnosis

DSM-5 classification

The basis of the 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 adjustment disorder. In addition, the diagnosis of adjustment disorder is less clear when patients are exposed to stressors long-term, because this type of exposure is associated with adjustment disorder and major depressive disorder (MDD) and generalized anxiety disorder (GAD). [23]

Some signs and criteria used to establish a diagnosis are important. First, the symptoms must clearly follow a stressor. The symptoms should be more severe than would be expected. There should not appear to be other underlying disorders. The symptoms that are present are not part of a normal grieving for the death of family member or other loved one. [21]

Adjustment disorders have the ability to be self-limiting. Within five years of when they are originally diagnosed, approximately 20–50% go on to be diagnosed with psychiatric disorders that are considered as more serious. [6]

Treatment

Individuals with an adjustment disorder and depressive or anxiety symptoms may benefit from treatments usually used for depressive or anxiety disorders. The use of different therapies can be beneficial for any age group. There is also a list of medications that can be used to help people with adjustment disorder whose symptoms are too severe for therapy alone. If a person is considering taking medication, they should talk to their doctor. [18] Specific treatment is based on factors of each individual separately. These factors include but are not limited to age, severity of symptoms, type of adjustment disorder, and personal preference. [18] [19]

Different ways to help with the disorder include:

In addition to professional help, parents and caregivers can help their children with their difficulty adjusting by:

Criticism

It has been criticized for its lack of specificity of symptoms, behavioral parameters, and close links with environmental factors has been criticized from a minority of the professional community as well as those in semi-related professions outside the healthcare field. Relatively little research has been done on this condition. [24]

An editorial in the British Journal of Psychiatry described adjustment disorder as being so "vague and all-encompassing… as to be useless," [25] [26] but it has been retained in the DSM-5 because of the belief that it serves a useful clinical purpose for clinicians seeking a temporary, mild, non-stigmatizing label, particularly for patients who need a diagnosis for insurance coverage of therapy. [27]

In the US military, there has been concern about its diagnosis in active duty military personnel. [28]

In relation to the COVID-19 pandemic

A study was conducted in Poland during the first phase of the pandemic. The study used self-report surveys to measure the prevalence and severity of symptoms of adjustment disorder compared to PTSD, depression, and anxiety. The data was collected in the first quarantine period between March 25 to April 27, 2020. [29]

Results from the study: [29]

Related Research Articles

Bipolar I disorder is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features. Most people also, at other times, have one or more depressive episodes. Typically, these manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks.

<span class="mw-page-title-main">Major depressive disorder</span> Mood disorder

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability, after lower back pain.

<span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

<span class="mw-page-title-main">Borderline personality disorder</span> Medical condition

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. People diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

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<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

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<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

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<span class="mw-page-title-main">Bipolar disorder in children</span>

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<span class="mw-page-title-main">DSM-5</span> 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders

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References

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  2. 1 2 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). pp. 271–281.
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  19. 1 2 "Adjustment Disorder: All You Need to Know". Psych Central. 2021-08-27. Retrieved 2022-04-10.
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  27. ↑ Baumeister H, Kufner K (July 2009). "It is time to adjust the adjustment disorder category". Current Opinion in Psychiatry. 22 (4): 409–12. doi:10.1097/YCO.0b013e32832cae5e. PMID   19436201. S2CID   8610912.
  28. ↑ "Discharges for adjustment disorder soar". 29 March 2013. Retrieved 31 July 2018.
  29. 1 2 Dragan M, Grajewski P, Shevlin M (2021-01-01). "Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic". European Journal of Psychotraumatology. 12 (1): 1860356. doi:10.1080/20008198.2020.1860356. PMC   8725738 . PMID   34992743.

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