Adjustment disorders

Depressive Reaction (Brief and Chronic), Adjustment Reaction, Grief Reaction, Stress

Basic Information

What is Adjustment disorder?

Adjustment disorder with depressed mood refers to the development of depressed psychological symptoms in response to one or more stressful events. The symptoms are similar to those seen in an episode of major depression but are not as severe. Unlike a major depression, there is always a key event or events that causes the symptoms. When the cause is removed, the symptoms resolve within six months. An example of such might be following a divorce or severe financial setbacks. In response, there may be disturbance in sleep or a profound sense of hopelessness such that the individual's level of functioning is impaired.

Adjustment disorder signs and symptoms

  • There must be an identifiable stressor. It may seem minor, or even positive, such as a job promotion, or negative, as with a small financial loss.
  • The symptoms or behavior changes occur within 3 months of onset of the stressor and last no more than 6 months after the end of the stressor.
  • Other psychological disorders are not present (e.g., major depression, anxiety disorder, personality disorder, etc.).
  • Symptoms vary from person to person (often more severe in adolescents and the elderly) and include sleeping problems, restlessness, irritability, loss of concentration, fatigue, increased startle reaction, tension, depression, anxiety, withdrawal and inhibition. There can be feelings of fear, rage, guilt and shame, and denial of the stressful event (acting as if it never occurred).

Causes

A disruption in the normal process of adapting to a stressful event.

Risk increases with

  • The degree of undesirable change a stressor causes.
  • Whether the stressor was sudden or expected.
  • The unique importance of the stressor in the individual's life.
  • Lack of support systems (e.g., family, friends, religious, cultural and social ties).
  • The degree of vulnerability of the individual to stressful life experiences.

How is it diagnosed?

Diagnosis is usually based on exclusion. In other words, the set of symptoms do not qualify for a major psychiatric disorder such as depression, nor are they pervasive and chronic as would be the case in a personality disorder such as borderline personality disorder.

  • History: In this case, the diagnosis is strongly suggested by the onset of symptoms in response to a stress or stresses. By definition, the symptoms must appear within three months of the stressful event, do not meet criteria for another psychiatric illness, and do not represent a worsening of a preexisting psychiatric illness. The presence of another psychiatric illness does not prevent the diagnosis of an adjustment disorder with depressed mood being made, but only if the symptoms are not better accounted for by this other illness. Also, a physical illness may be the stressful event, but the symptoms seen should be a psychological reaction and not a direct result of the illness. Bereavement is specifically excluded as there is a separate diagnosis available.
  • Physical exam: This is not generally necessary unless the symptoms suggest a physical cause. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide essential signs to diagnose the illness.
  • Tests: Psychological testing may be helpful in clarifying the diagnosis.

Preventive measures

No specific preventive measures known.

Predicted outcome

As with any psychiatric condition, the outcome is highly variable. By definition, a complete recovery should occur within six months of the ending of the stressful event or its consequences. Among the criteria that define this condition in the DSM-IV is a "significant impairment in social or occupational functioning." So, although the stressor itself might be relatively trivial, there can be a major impact on work performance. If the stressor persists or the consequences, this can become a chronic impairment.

The two most important factors are good previous psychological adjustment and the presence of a strong support system such as friends and family.

Possible complications

  • Difficulty maintaining relationships or jobs.
  • Lingering problems in adolescents.
  • Self-treatment using alcohol or drugs to overcome undesired symptoms and feelings.
  • Chronic anxiety and depression.

Adjustment Disorder treatment

General measures

  • Self-care, psychotherapy and, in some cases, medications, depending on severity of disorder and impact on lifestyle.
  • For family/friends. Helping the person adapt to and cope with the event and helping foster a change to prevent a recurrence.
  • For yourself. Learning to cope with stress, keeping a journal about your stressors and feelings, talking to a friend, joining a support group, and taking good care of your physical health (diet, exercise, sleep).
  • Psychotherapy. Several therapy methods are effective and are often needed for a brief period. Family therapy (including marital counseling) may be recommended for some.

Medications

Since adjustment disorders are usually of short duration, medications are normally not necessary. A medication may be prescribed short term for insomnia or for other specific symptoms, depending on their severity.

Information Brand Generic Label Rating
Zoloft price Zoloft Sertraline On-Label
Paxil 40mg Paxil Paroxetine On-Label
Buy Effexor Effexor Venlafaxine On-Label

Prozac (Fluoxetine), Klonopin (Clonazepam), Xanax (Alprazolam)

Alternatives

It is worth noting again that this is a diagnosis of exclusion. In making the diagnosis, it is assumed that other conditions have been considered such as major depression, bipolar affective disorder, mood disorders due directly to medical disorders or substance abuse, dysthymic disorder, or bereavement. Other psychiatric conditions that necessarily follow a stressful event include acute stress disorder and posttraumatic stress disorder. These follow an extraordinarily stressful event and result in a specific set of symptoms. The adjustment disorders are not specific regarding the symptoms (in this case generally depressed) and the event that triggers the reaction can be rather minor.

Activity

No restrictions. A routine physical exercise program is recommended. Physical exertion helps reduce anxiety and stress.

Diet

Eat a nutritionally balanced diet to maintain optimum health.

Appropriate specialists

Psychiatrist or psychologist.

Notify your physician if

  • You or a family member has symptoms of an adjustment disorder.
  • Symptoms continue to worsen after treatment is started.
  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Last updated 21 December 2011


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