Adjustment disorder

    Adjustment / Psychiatric disorders.

    Adjustment disorder is a group of symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event.

    The symptoms occur because you are having a hard time coping. Your reaction is stronger than expected for the type of event that occurred.

    Causes.

    Many different events may trigger symptoms of an adjustment disorder. Whatever the trigger is, the event may become too much for you.

    Stressors for people of any age include.

    • Death of a loved one
    • Divorce or problems with a relationship
    • General life changes
    • Illness or other health issues in yourself or a loved one
    • Moving to a different home or a different city
    • Unexpected catastrophes
    • Worries about money

    Triggers of stress in teenagers and young adults may include.

    • Family problems or conflict
    • School problems
    • Sexuality issues

    Symptoms of an Adjustment Disorder.

    An adjustment disorder/stress response syndrome can have a wide variety of symptoms that are changes from someone’s usual self, which may include:

    • Feeling of hopelessness
    • Sadness
    • Frequent crying
    • Anxiety(nervousness)
    • Worry
    • Headaches or stomachaches
    • Palpitations (an unpleasant sensation of irregular or forceful beating of the heart)
    • Withdrawal or isolation from people and social activities
    • A new pattern of absence from work or school
    • New and uncharacteristic dangerous or destructive behavior, such as fighting, reckless driving, and vandalism
    • Changes in appetite, either loss of appetite, or overeating
    • Problems sleeping
    • Feeling tired or without energy
    • Increase in the use of alcohol or other drugs

    Symptoms in children and teens tend to be more behavioral in nature, such as skipping school, fighting, or acting out. Adults, on the other hand, tend to experience more emotional symptoms, such as sadness and anxiety

    Treatment & Management for Adjustment Disorder.

    Clinical treatments may substantially alleviate symptoms of adjustment disorder. In the absence of controlled trials comparing different modalities of treatment, selection of treatments remains a clinical decision, influenced by consensus and common practice. No particular treatment may be considered “optimal” or the “treatment of choice.”

    The predominant mood accompanying adjustment disorder (eg, depression or anxiety) is a major consideration for both pharmacologic and supportive treatments. For instance, clinicians should consider both psychotherapy and pharmacotherapy for patients who have adjustment disorder with depressed anxious mood.

    Treatments that are effective for other stress-related disorders also may contribute to the relief of adjustment disorder. According to Strain et al, treatment relies on the specificity of the diagnosis, the construct of stressor-related disorders, and whether the stressors are involved as causes, develop concomitantly, or are essentially unrelated.

    Psychotherapy.

    Most studies acknowledge that brief, rather than long-term, psychotherapy is most appropriate for persons with adjustment disorder because this disorder tends to be time-limited.

    Psychotherapy begins with the identification of the stressor, as consciously recognized or acknowledged by the patient. The person’s non-adaptive responses may be diminished if the stress can be eliminated, reduced, or accommodated. Strain et al suggests that the goals of psychotherapy should include the following:

    • Analyze the stressors affecting the patient and determine whether they can be eliminated or minimized
    • Clarify and interpret the meaning of the stressor for the patient
    • Reframe the meaning of the stressor
    • Illuminate the concerns and conflicts the patient experiences
    • Identify a means of reducing the stressor
    • Teach or reinforce coping skills
    • Help patients gain perspective on the stressor, establish relationships, attend support groups, and manage themselves and the stressor

    Accordingly, treatment of adjustment disorders entails psychotherapeutic counseling aimed at reducing the stressor, improving the ability to cope with stressors that cannot be reduced or removed, and developing emotional states and support systems that enhance adaptation and coping. Generic (brief “psychodynamic”) psychotherapy, crisis intervention, family and group therapies, cognitive-behavioral therapy (CBT), and interpersonal psychotherapy all may encompass these elements. The recommendation that any therapy be time-limited communicates the expectation of recovery to the patient and may contribute to a favorable outcome.

    Pharmacologic Therapy.

    Typically, the goal of pharmacologic agents for individuals with adjustment disorder is the amelioration of debilitating symptoms (insomnia, anxiety, and panic attacks) rather than treatment of the disorder itself. The agents most commonly prescribed for individuals with this disorder are benzodiazepines and antidepressants. Antidepressants may be tried in patients with minor or major depressive disorders who have not responded to psychotherapy or other supportive interventions for 3 months. The advisability of waiting that long to initiate antidepressants when a full-blown depressive syndrome develops is a matter of clinical Judgment, based on the expectation that the person will recover substantially over time, with other kinds of supportive care.

    Activity.

    For many people, aerobic exercise stabilizes the autonomic nervous system and may be associated with the release of endogenous neurotransmitters (dopamine and endogenous opioids) that induce positive mood states. Encouraging activity of any kind, but especially vigorous exercise may contribute to recovery from a disabling stress reaction.