iPsychology

Index

Definition
Diagnostic Criteria - Mental Health made easy.
Treatment ( Psychotherapy )
Treatment ( Pharmacotherapy )
Specifiers and Subtypes

Definition

Adjustment disorders are defined as a inability or maladaptive reaction to an identifiable stressful life event(s) / stressor(s). ( e.g., divorce,  family crises,  ... ) Symptoms must occur within three months of the event(s) / stressor(s) and persisted for no longer than six months

During the 19th century, they view that a person who build up such symptoms after stressful events is believed to be influenced by genetic or familial weakness of the nervous system, but this theory is rejected by some of the psychosocial theorist, and instead suggest that the unconscious psychological processes contributes to the stress response of the person and that of trauma scenario may contributes to the neurotic symptoms.  In the studies in 20th century, states that a person who exposed to traumatic scenarios and patient that of develops post traumatic neuroses sometimes tend to be malingers, and it said that malingering is not a major factor in developing post traumatic neuroses, but it is a symptoms of a somatoform disorder.  Nevertheless, pre-obtainable personality characteristics founded to be a great factor of individual responses to life events.  As the study continues a person who exposed to a disaster or combat situation may manifest this disorder, yet personality characteristics is one of the factors that is consider to this disorder.

Adjustment disorder is a temporary disorder of varying severity that occurs as an acute reaction to overwhelming stress in persons of any age who have no apparent underlying mental disorders.  These disorder may activate when single or combination of stress factors (stressors) that greatly affects a single person or a group of people.  Some of these stressors are relationship problem towards others, Financial problems, Family conflicts, school issues, health problems, death of loved ones, or it could be sexuality issues.  It is also believe that a person who lives near to a village or town who’s the neighbor is a suspect of certain crime, or you’re living in a place that is unsafe, uncomfortable or uneasy, this person might probably can developed Adjustment Disorder.  Women are at most risk of having this disorder than men.  Genetics plays a big role in having this disorder.  The persons coping strategies stress (defense mechanisms), social skills towards the others and the problem and its intelligence or mentality also one of the factors that may contribute to the occurrence of these said disorder.  An individual with early childhood family history problem may also contribute to the occurrence of these disorder, and this early-childhood problem history are as follows: encountering family abuse, over protective family, an extreme trauma or post traumatic stress disorder.  A person who have an history of anxiety, depression, bipolar disorder or eating disorder may play a higher risk of having these disorder.  These such reaction of the person to stress may weaken the person’s social and occupational functioning towards others. 
According to Diagnostic and Statistical Manual of Mental Disorder 4th edition.  The diagnosis is made to a person who is pathologically experiences intense reactions to stressful life events and classified them as follows: (1)  Post Traumatic Stress Disorder, (2) Adjustment Disorder, and (3) Brief Reactive Psychosis.  They also added that when the symptoms of the person lasted within 6 months after the traumatic events, the disorder is called to be Acute and its prognosis for remission is good.  But if the person’s symptoms lasted for more than 6 months after the traumatic scenario, these reactions is called Chronic Adjustment Disorder, and it is said that this type is very difficult to treat.  If the severity criteria for Post Traumatic stress disorder doesn’t meet of life events of the person.  Therefore, Adjustment Disorder may be diagnosed.  
As define by the DSM IV TR, Adjustment Disorder is a maladaptive reaction of a person to identifiable psychosocial pressures, with its reaction response emerge within 3 months after the initiation of the stressors.  Symptoms may include  wide variety of disturbances in interpersonal and work functioning as well as maladaptive extremes of anxiety, depression, rage, shame and guilt..  is these signs and symptoms according to DSM IV TR, meets the Axis I of mental disorder (Anxiety disorder and Depressive disorder) then Adjustment disorder should not me diagnosed.The identifiable psychosocial pressures that may contribute to the disorder includes major changed in life events this includes divorced, having serious illness or disability, financial difficulties, working problems, moving from one place to another, retirement and cultural disturbance.

DSM 4th edition formulate a list to classify the patient according to their complaints.  These include (1) Depressed Mood experiences symptoms like of the minor depressions, (2) Anxious mood which symptoms of dominating anxiety, (3)Mixed anxiety and Depressed Mood  it is combination symptoms of depression and anxiety, (4) Disturbances of conduct which its symptoms greatly seen in the behaviors such as breaking the societal norms or violating the rights or laws of others, (5) Disturbances in conduct and emotions this symptoms is a combine affective and behavioral characteristics of the disorder with mixed emotional features and disorder with disturbances of conduct, and Lastly (6) Adjustment disorder Not otherwise Specified this diagnosis is used when a maladaptive reactions is not been classified under the Adjustment Disorder.
The adjustment disorder is diagnosed with the criteria set by the DSM IV TR.  According to them, the Adjustment Disorder is diagnosed when a person develops an emotional and behavioral symptoms due to stressors that occurs mainly 3 months after the onset of the stressors.  This identified symptoms may marked a distress to the situation and impairment to social, occupational and academic functioning.  Adjustment Disorder is not diagnosed when the criteria for other specific axis like of Axis I (clinical disorder which mental disorder is comparable to general medical illness) or the Axis II (Personality disorders and mental disorder such as OCD) is met.  Symptoms of mourning or bereavement is not a criteria for the disorder.  Normally, the symptoms of adjustment disorder is expected to disappear within 6 months after the stressors have been removed, thus if the symptoms last for more than 6 months and the stressors is continually affects the person s mentally, this may now termed as Chronic Adjustment Disorder.  An individual may experiences  sadness, difficulty of breathing, chest pain, anxiety, he or she may feel that he can’t cope with the problem, he or she might not to continue the present situation, in some cases, its daily hygiene routine may not be met or having conduct disorder. 
The primary goal of treating this disorder is through returning the individual to his or her normal life .  These treatment is very important so that this disorder may not become a contributory factor of having worse illness such as major depression, and anxiety disorder. There are many alternative ways to treat this disorder that includes the following: (1)  Individual or Psychotherapy, (2) Family therapy, (3)  Behavior therapy, (4) Group therapy, and (5) crisis Intervention.  These said therapy helps the person to verbalized his fears anxiety, rage, helplessness and hopelessness related to stressors (Bourgeous, et al, )  Medication or Pharmacotherapy plays also an important role in treating this disorder.  But generally mental health care professional do not use the medication to teat this disorder but in some cases, medication is given in conjunction with the therapy to lessen the common symptom of the disorder.  Commonly antidepressant or anti anxiety drugs is given as short term course until the symptoms subside. Early intervention to these disorder plays an important role in treating these disorder.  Supporting the patient in communication needs and as well as in the physical and emotional needs is one of the powerful techniques in lessening the distress experienced by the patient.  If the patient experiences insomnia, which making the patient feels fatigue and lowered coping capacity, sedating the patient with anti anxiety agents may be helpful in treating this kind of symptoms.  The patient and the persons around the patient should be aware to always remind that continued use of these drugs plus combination of different mood stabilizers such as alcohols may affect the drug effect and should be cautioned for this use.  Medication such as Anti-depressive agent should not be used by a person who experiences loss of sadness and loss of hope, because he or she might be dependent of the drug effect to his body.

Psychotherapy or counseling helps the person understand how the stressors is affecting his or her life.  This also helps the person have develop more and better coping skills.  Group Therapy helps the person by allowing this person discuss his or her feelings with other people who are also coping with the same disorder.  If the person with this kind of disorder ask or seek for an help, the therapist should help this person to cope with the reactions and also Therapeutic communication is a very helpful tools to help the patient to this disorder.

The patient who is in the acute phase to the traumatic event should be advised to avoid driving, operating a machinery or in engaging in a task that requires alertness because this might be a factor for the patient to suffer fall of attention, loss of concentration and loss of sequential planning to the task or they may have astonishing reaction that may interrupt the motor control of the patient.  Thus temporary support  is more is applicable to the patient with this kind of disorder.  Nonetheless, if the patients is not progressing since the introduction of early intervention phase, a deep and extensive intervention is now be applied for this lapses.  And this intervention appropriate to such occurrences is Dynamic Psychotherapy.

There is no know prevention to the occurrence of the disorder.  However, a strong family and social supports plays an important role in helping the person to cope with the stressful situation or events.  It is said that the best prevention for his disorder is early intervention, which in turn preventing it to cause more deeper illness such as major depression.  The very best way to help this kind of people is helping them to understand the situation and by letting them know that your always right there besides him or her, to help him and cope with the events.

1.  Behavioral or emotional symptoms must develop in response to an identifiable event(s) and occur within three months of the onset of that event(s) / stressor(s).

2.  These behaviors or symptoms must be clinically significant as evidenced by at least one of the following:

3.  The disturbance does not meet the criteria for another specific Axis I disorder or is not part of a preexisting Axis I or Axis II disorder.

4.  The behavioral or emotional symptoms do not represent Bereavement.

5.  Once the event(s) / stressor(s)  has terminated, the symptoms do not last more than an additional six months.

Acute:  Last less than six months.

Chronic:  Last for six months or longer. By definition the disturbance can not last longer then six months. Only use the chronic specifier if the disturbance is in response to a chronic event(s) / stressor(s).

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

Adlerian Therapy
Behavior Therapy
Cognitive-behavioral Therapy
Existential Therapy
Gestalt Therapy
Person-centered Therapy
Psychoanalytic
Rational-emotive Therapy
Reality Therapy
Transactional Analysis