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Some emotional signs of adjustment disorder are: sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, desperation, feeling overwhelmed and thoughts of suicide, performing poorly in school/work etc.{{Citation needed|date=February 2022}}
Some emotional signs of adjustment disorder are: sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, desperation, feeling overwhelmed and thoughts of suicide, performing poorly in school/work etc.{{Citation needed|date=February 2022}}


Common characteristics of AjD include mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three. According to the [[DSM-5]], there are six types of AjD, which are characterized by the following predominant symptoms: [[Depression (mood)|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.<ref name="Patricia, C. 2009">Casey, P. (2009). Adjustment Disorder: Epidemiology, Diagnosis and Treatment. ''CNS drugs'', ''23''(11), 927-938.</ref> AjD may be acute or chronic, depending on whether it lasts more or less than six months. According to the DSM-5, if the AjD lasts less than six months, then it may be considered acute. If it lasts more than six months, it may be considered chronic.<ref name="Patricia, C. 2009" /> Moreover, the symptoms cannot last longer than six months after the stressor(s), or its consequences, have terminated.<ref name="DSM-IV">{{cite book|author=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders|edition=5th|pages=271–281}}</ref>{{rp|679}} However, the stress-related disturbance does not only exist as an exacerbation of a pre-existing mental disorder.<ref name="bis">{{Cite journal |last1=Bisson |first1=J. I. |last2=Sakhuja |first2=D. |doi=10.1053/j.mppsy.2006.04.004 |title=Adjustment disorders |journal=Psychiatry |volume=5 |issue=7 | pages=240–242 |date=July 2006 }}</ref>
Common characteristics of AjD include mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three. According to the [[DSM-5]], there are six types of AjD, which are characterized by the following predominant symptoms: [[Depression (mood)|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.<ref name="Patricia, C. 2009">Casey, P. (2009). Adjustment Disorder: Epidemiology, Diagnosis and Treatment. ''CNS drugs'', ''23''(11), 927-938.</ref> AjD may be acute or chronic, depending on whether it lasts more or less than six months. According to the DSM-5, if the AjD lasts less than six months, then it may be considered acute. If it lasts more than six months, it may be considered chronic.<ref name="Patricia, C. 2009" /> <ref>{{Cite journal|last=Carta|first=Mauro Giovanni|last2=Balestrieri|first2=Matteo|last3=Murru|first3=Andrea|last4=Hardoy|first4=Maria Carolina|date=2009-06-26|title=Adjustment Disorder: epidemiology, diagnosis and treatment|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710332/|journal=Clinical Practice and Epidemiology in Mental Health : CP & EMH|volume=5|pages=15|doi=10.1186/1745-0179-5-15|issn=1745-0179|pmc=2710332|pmid=19558652}}</ref>Moreover, the symptoms cannot last longer than six months after the stressor(s), or its consequences, have terminated.<ref name="DSM-IV">{{cite book|author=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders|edition=5th|pages=271–281}}</ref>{{rp|679}} However, the stress-related disturbance does not only exist as an exacerbation of a pre-existing mental disorder.<ref name="bis">{{Cite journal |last1=Bisson |first1=J. I. |last2=Sakhuja |first2=D. |doi=10.1053/j.mppsy.2006.04.004 |title=Adjustment disorders |journal=Psychiatry |volume=5 |issue=7 | pages=240–242 |date=July 2006 }}</ref>


Unlike major depression, the 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.
Unlike major depression, the 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.

Revision as of 21:51, 11 February 2022

Adjustment disorder
SpecialtyPsychiatry, clinical psychology Edit this on Wikidata
ComplicationsSuicide;[1] Progression to more serious psychiatric disorders, e.g., PTSD or Major Depressive Disorder.
Usual onsetTheoretically, within one to three months after a stressful event.
DurationTheoretically, up to six months unless the stressor or its consequences continue.
TypesMild, moderate, severe.
Risk factorsHistory of mental disorder; low social support.
Differential diagnosisRule out PTSD, Depressive Disorders, & Anxiety Disorders.
TreatmentPsychotherapy; bibliotherapy; structured paraprofessional help.
PrognosisRelatively good compared to many other mental disorders, but severity varies.

Adjustment disorder (AjD) is a mental and behavioral disorder,[2] which is a maladaptive response to a psychosocial stressor that occurs when an individual has significant difficulty adjusting to or coping with a stressful psychosocial event. 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]

Diagnosis of AjD is quite common and consultation services estimate that 5-21% [7]of adults meet the diagnostic criteria. Adult women are diagnosed twice as often as are adult men. Among children and adolescents, girls and boys are equally likely to be diagnosed.[8]

AjD was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 1980. Prior to that, it was called "transient situational disturbance."[9]

Signs and symptoms

Some emotional signs of adjustment disorder are: sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, desperation, feeling overwhelmed and thoughts of suicide, performing poorly in school/work etc.[citation needed]

Common characteristics of AjD include mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three. According to the DSM-5, there are six types of AjD, 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] AjD may be acute or chronic, depending on whether it lasts more or less than six months. According to the DSM-5, if the AjD lasts less than six months, then it may be considered acute. If it lasts more than six months, it may be considered chronic.[8] [10]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 depression, the 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 AjD 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 AjD 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 AjD patients report persistent ideation or suicide attempts less frequently than those diagnosed with major depression.[4] According to a study on 82 AjD 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.[11]

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

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.

A stressor is generally an event of a serious, unusual nature that an individual or group of individuals experience. 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 AjD. 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.[9]

There are certain stressors that are more common in different age groups:[12]

Adulthood:

  • Marital conflict
  • Financial conflict
  • Health issues with oneself, partner, or dependent children
  • Personal tragedy such as death or personal loss
  • Loss of job or unstable employment conditions e.g., corporate takeover or redundancy

Adolescence and childhood:

  • Family conflict or parental separation
  • School problems or changing schools
  • Sexuality issues
  • Death, illness, or trauma in the family

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.[11]

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 AjD. In addition, the diagnosis of AjD is less clear when patients are exposed to stressors long-term, because this type of exposure is associated with AjD and major depressive disorder (MDD) and generalized anxiety disorder (GAD).[13]

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.[9]

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

ICD-11 classification

International Statistical Classification of Diseases and Related Health Problems (ICD), assigns codes to classify diseases, symptoms, complaints, social behaviors, injuries, and such medical-related findings.

ICD-11 classifies Adjustment disorder (6B43) under "Disorders specifically associated with stress".[14]

Treatment

There has been little systematic research regarding the best way to manage individuals with an adjustment disorder. Because natural recovery is the norm, it has been argued that there is no need to intervene unless levels of risk or distress are high.[15] However, for some individuals treatment may be beneficial. AjD sufferers with depressive or anxiety symptoms may benefit from treatments usually used for depressive or anxiety disorders. One study found that AjD sufferers received similar interventions to those with other psychiatric diagnoses, including psychological therapy and medication.[16]

In addition to professional help, parents and caregivers can help their children with their difficulty adjusting by:[17]

  • offering encouragement to talk about their emotions;
  • offering support and understanding;
  • reassuring the child that their reactions are normal;
  • involving the child's teachers to check on their progress in school;
  • letting the child make simple decisions at home, such as what to eat for dinner or what show to watch on TV;
  • having the child engage in a hobby or activity they enjoy.

Criticism

Like many of the items in the DSM, adjustment disorder receives criticism from a minority of the professional community as well as those in semi-related professions outside the health-care field. First, there has been criticism of its classification. It has been criticized for its lack of specificity of symptoms, behavioral parameters, and close links with environmental factors. Relatively little research has been done on this condition.[15]

An editorial in the British Journal of Psychiatry described adjustment disorder as being so "vague and all-encompassing… as to be useless,"[18][19] 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.[20]

In the US military there has been concern about its diagnosis in active duty military personnel.[21]

Adjustment Disorder and 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.[22]

Results from the study [22]

  • The current COVID-19 pandemic was a highly stressful event for 75% of the participants and the most powerful predictor of adjustment disorder.
  • 49% reported an increase in adjustment disorder symptoms, which were more common among females and those without a full-time job. 14% of the sample met the criteria for a diagnosis of adjustment disorder.
  • A significant proportion of the sample was also positive for generalized anxiety (44%) and depression (26%): the presumptive diagnosis rate of PTSD was 2.4%

References

  1. ^ "Adjustment disorders - Symptoms and causes". Mayo Clinic. Retrieved 30 May 2019.
  2. ^ a b American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). pp. 271–281.
  3. ^ a b Bolu, A., Doruk, A., Ak, M., Özdemir, B., & Özgen, F. (2012). Suicidal behavior in adjustment disorder patients. Dusunen Adam, 25(1), 58–62.
  4. ^ a b Asnis, G.M.; Friedman, T.A.; Sanderson, W.C.; Kaplan, M.L.; van Praag, H.M.; Harkavy-Friedman, J.M. (January 1993). "Suicidal behavior in adult psychiatric outpatients, I: Description and prevalence". American Journal of Psychiatry. 150 (1): 108–112. doi:10.1176/ajp.150.1.108. PMID 8417551.
  5. ^ a b Bronish, T., & Hecht, H. (1989). Validity of adjustment disorder, comparison with major depression. Journal of Affective Disorders, 17, 229–236.
  6. ^ a b c d Bisson, J. I.; Sakhuja, D. (July 2006). "Adjustment disorders". Psychiatry. 5 (7): 240–242. doi:10.1053/j.mppsy.2006.04.004.
  7. ^ Portzky, Gwendolyn; Audenaert, Kurt; van Heeringen, Kees (2005-08-01). "Adjustment disorder and the course of the suicidal process in adolescents". Journal of Affective Disorders. 87 (2): 265–270. doi:10.1016/j.jad.2005.04.009. ISSN 0165-0327.
  8. ^ a b c Casey, P. (2009). Adjustment Disorder: Epidemiology, Diagnosis and Treatment. CNS drugs, 23(11), 927-938.
  9. ^ a b c Adjustment Disorders at eMedicine
  10. ^ Carta, Mauro Giovanni; Balestrieri, Matteo; Murru, Andrea; Hardoy, Maria Carolina (2009-06-26). "Adjustment Disorder: epidemiology, diagnosis and treatment". Clinical Practice and Epidemiology in Mental Health : CP & EMH. 5: 15. doi:10.1186/1745-0179-5-15. ISSN 1745-0179. PMC 2710332. PMID 19558652.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. ^ a b Pelkonen, Mirjami; Marttunen, Mauri; Henriksson, Markus; Lönnqvist, Jouko (May 2005). "Suicidality in adjustment disorder: Clinical characteristics of adolescent outpatients". European Child & Adolescent Psychiatry. 14 (3): 174–180. doi:10.1007/s00787-005-0457-8. PMID 15959663. S2CID 33646901.
  12. ^ Powell, Alicia D. (2015). "Grief, Bereavement, and Adjustment Disorders". In Stern, Theodore A.; Fava, Maurizio; Wilens, Timothy E.; et al. (eds.). Massachusetts General Hospital Comprehensive Clinical Psychiatry (2nd ed.). Elsevier. pp. 428–32. ISBN 978-0-323-32899-9.
  13. ^ Casey, Patricia; Doherty, Anne (2012). "Adjustment disorder: Diagnostic and treatment issues". Psychiatric Times. 29: 43–6.
  14. ^ "6B43 Adjustment disorder". ICD-11 - Mortality and Morbidity Statistics. Retrieved 2019-08-28.
  15. ^ a b Casey, Patricia (January 2001). "Adult adjustment disorder: a review of its current diagnostic status". Journal of Psychiatric Practice. 7 (1): 32–40. doi:10.1097/00131746-200101000-00004. PMID 15990499. S2CID 24932443.
  16. ^ Strain, J.J.; Smith, G.C.; Hammer, J.S.; McKenzie, D.P.; Blumenfield, M.; Muskin, P.; Newstadt, G.; Wallack, J.; Wilner, A.; Schleifer, S.S. (May 1998). "Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting". General Hospital Psychiatry. 20 (3): 139–49. doi:10.1016/S0163-8343(98)00020-6. PMID 9650031.
  17. ^ "Adjustment disorders: Lifestyle and home remedies". Mayo Clinic. Retrieved 2 December 2016.
  18. ^ Casey P, Dowrick C, Wilkinson G (December 2001). "Adjustment disorders: fault line in the psychiatric glossary". British Journal of Psychiatry. 179 (6): 479–81. doi:10.1192/bjp.179.6.479. PMID 11731347.
  19. ^ Fard K, Hudgens RW, Welner A (March 1978). "Undiagnosed psychiatric illness in adolescents: A prospective study and seven-year follow-up". Archives of General Psychiatry. 35 (3): 279–82. doi:10.1001/archpsyc.1978.01770270029002. PMID 727886.
  20. ^ Baumeister, H., & Kufner, K. (2009). It is time to adjust the adjustment disorder category. Current Opinion in Psychiatry, 22(4), 409-412.
  21. ^ "Discharges for adjustment disorder soar". 29 March 2013. Retrieved 31 July 2018.
  22. ^ a b Dragan, Małgorzata; Grajewski, Piotr; Shevlin, Mark (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). doi:10.1080/20008198.2020.1860356. ISSN 2000-8198.

Further reading

External links

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