An adjustment disorder occurs when an individual is unable to adjust to or cope with a particular

stressor, like a major life event. Since people with this disorder normally have symptoms that depressed
people do, such as general loss of interest, feelings of hopelessness and crying, this disorder is also
sometimes known as situational depression. Unlike major depression however, the disorder is caused by
an outside stressor and generally resolves once the individual is able to adapt to the situation.[1] One
hypothesis for adjustment disorder is that it may represent a sub-threshold clinical syndrome.[2]

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.

Its common characteristics include mild depressive symptoms, anxiety symptoms, and traumatic stress
symptoms or a combination of the three. There are nine different types of adjustment disorders listed in
the DSM-III-R. In DSM-IV, adjustment disorder was reduced to six types, classified by their clinical
features, which characterize the predominant symptoms. Adjustment disorder may also be acute or
chronic, depending on whether it lasts more or less than six months. According to the DSM-IV-TR, if the
adjustment disorder lasts less than 6 months, then it may be considered acute. If it lasts more than 6
months, it may be considered chronic.[3] However, the symptoms cannot last longer than six months after
the stressor(s), or its consequences, have terminated.[4] Diagnosis of adjustment disorder is quite
common; there is an estimated incidence of 5–21% among psychiatric consultation services for adults.
Adult women are diagnosed twice as often as are adult men, but among children and adolescents, girls
and boys are equally likely to receive this diagnosis.[5] Adjustment disorder was introduced into the
psychiatric classification systems almost 30 years ago, but the concept was recognized for many years
before that.[6] When considering biopsychosocial disorders, an athlete’s overtrained state can be due to
an adjustment disorder.[7]

Contents

[hide]

1 Signs and symptoms

2 Risk factors

3 Diagnosis

4 Treatment

5 ICD 10 Classification

6 Criticism

7 References

8 External links

[edit]Signs and symptoms

According to the DSM IV-TR, the development of the emotional or behavioral symptoms of this diagnosis
have to occur within three months of the onset of the identifiable stressor(s).[8] Some emotional signs of
AD are sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, worry,
desperation, trouble sleeping, difficulty concentrating, feeling overwhelmed and thoughts of suicide. Some
behavioral signs of AD are fighting, reckless driving, ignoring important tasks such as bills or homework,
avoiding family or friends, performing poorly in school, skipping school, or vandalizing property.
[9]
However, the stress-related disturbance does not only exacerbation of a pre-existing axis 1 or axis 2
disorder and cannot be diagnostic as axis 1 disorder.[10]

Suicidal behavior is prominent among people with AD 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 AD attempted suicide immediately before their index admission and they remitted faster than
a comparison group with major depression.[11] Asnis et al. (1993) found that AD patients report persistent
ideation or suicide attempts less frequently than those diagnosed with major depression.[12] According to a
study on 82 AD patients at a clinic, Bolu et al. (2012) found that 22 (26.8%) of these patients were
admitted due to suicidal attempt, consistent with previous findings. In addition, it was found that 15 of
these 22 patients chose suicidal methods that involved high chances of being saved.[13] Henriksson et al.
(2005) states statistically that the stressors are of one half related to parental issues and one third in peer
issues.[14]

[edit]Risk factors
Various factors have been found to be more associated with a diagnosis of AD than other Axis I
disorders, including:[15]

 younger age
 more identified psychosocial and environmental problems
 increased suicidal behaviour, more likely to be rated as improved by the time of discharge from
mental healthcare
 less frequent previous psychiatric history
 shorter length of treatment
Those exposed to repeated trauma are at greater risk, even if that trauma is in the distant past. Age can
be a factor due to young children having fewer coping resources; however, children are also less likely to
assess 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. The stressors that cause adjustment disorders may be grossly traumatic or relatively minor,
like loss of a girlfriend/boyfriend, a poor report card, or moving to a new neighborhood. It is thought that
the more chronic or recurrent the stressor, the more likely it is to produce a disorder. The objective nature
of the stressor, however, is of secondary importance. Stressors' most crucial link to their pathogenic
potential is their perception by the patient as stressful. The presence of a causal stressor is essential
before a diagnosis of adjustment disorder can be made p. 279.</ref>

There are certain stressors that are more common in different age groups:[16]

Adulthood:

 Marital conflict
 Financial conflict
Adolescence and childhood:
 Family conflict/parental separation
 School problems/changing schools
 Sexuality issues
 Death/illness in the family
In a study conducted from 1990 till 1994 on 89 psychiatric outpatient adolescent, 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.[17]

[edit]Diagnosis

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 AD. In addition, the diagnosis of AD is less clear when patients are exposed to stressors long-
term, because this type of exposure is not only associated with AD but also MDD and GAD.[18]

Some signs and criteria used to establish a diagnosis are important, however. 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.[19]

Adjustment disorders have the ability to be self-limiting. Within 5 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 in nature.[10]

[edit]Treatment

Often, the recommended treatment for adjustment disorder is psychotherapy. The goal of psychotherapy
is symptom relief and behavior change. Anxiety may be presented as "a signal from the body" that
something in the patient's life needs to change. Treatment allows the patient to put his or her distress or
rage into words rather than into destructive actions. Individual therapy can help a person gain the support
they need, identify these abnormal responses and maximize the use of the individual's strengths.
Counseling, psychotherapy, crisis intervention, family therapy, behavioral therapy and self-help group
treatment are often used to encourage the verbalization of fears, anxiety, rage, helplessness, and
hopelessness. Sometimes small doses of antidepressants and anxiolytics are also used in addition to
other forms of treatment. In patients with severe life stresses and a significant anxious
component, benzodiazepines are used, although non-addictive alternatives have been recommended for
patients with current or past heavy alcohol use, because of the greater risk of dependence. Tianeptine,
alprazolam, and mianserin were found to be equally effective in patients with AD with anxiety.
Additionally, antidepressants, antipsychotics (rarely) and stimulants (for individuals who became
extremely withdrawn) have been used in treatment plans.

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.[20] However, for some individuals treatment may be
beneficial. AD sufferers with depressive and/or anxiety symptoms may benefit from treatments usually
used for depressive and/or anxiety disorders. One study found that AD sufferers received similar
interventions to those with other psychiatric diagnoses, including psychological therapy and medication.
[21]
Another study found that AD responded better than major depression to antidepressants.[22] Given the
absence of a meaningful evidence base for the treatment of AD per se, watchful waiting should be
considered initially, but if symptoms are not improving or causing the sufferer marked distress then
treatment should be directed at the predominating symptoms.

In addition to professional help, parents and caregivers can help their children with their difficulty adjusting
by:[23]

 offering encouragement to talk about his/her 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
[edit]ICD 10 Classification
International Statistical Classification of Diseases and Related Health Problems, mostly knows as "ICD" is
a classification that assigns codes to classify diseases and, symptoms, complains, social behaviors,
injuries and diseases and such medical related finding.

ICD 10 classifies Adjustment disorders under F40-F48 and under Neurotic, stress-related and
somatoform disorders.[24]

[edit]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.[25]

Adjustment disorder has been classified as being so "vague and all-encompassing...as to be useless,"[26]
[27]
but it has been retained in the DSM-IV 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.
Adjustment disorder

Last reviewed: March 7, 2012.

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, and the reaction
is stronger or greater than what would be expected for the type of event that occurred.

Causes, incidence, and risk factors

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

There is no way to predict which people who are affected by the same stress are likely
to develop adjustment disorder. Your social skills before the event, and how you have
learned to deal with stress in the past may play roles.

Symptoms
Symptoms of adjustment disorder are often severe enough to affect work or social life.
Some of the symptoms include:

 Acting defiant or showing impulsive behavior

  Acting nervous or tense
 Crying, feeling sad or hopeless, and possibly withdrawing from other people
 Skipped heartbeats and other physical complaints
 Trembling or twitching

To have adjustment disorder, you must meet the following criteria:

 The symptoms clearly come after a stressor, most often within 3 months
 The symptoms are more severe than would be expected
 There do not appear to be other disorders involved
 The symptoms are not part of normal grieving for the death of a loved one

On occasion, symptoms can be severe and the person may have thoughts of suicide or
make a suicide attempt.

Treatment
The main goal of treatment is to relieve symptoms and help you return to a similar
level of functioning as before the stressful event occurred.

Most mental health professionals recommend some type of talk therapy. This type of
therapy can help you identify or change your responses to the stressors in your life.

Cognitive behavioral therapy (CBT) can help you deal with your feelings.

 First your therapist helps you recognize the negative feelings and thoughts that
occur.
 Then your therapist teaches you how to change these into helpful thoughts and
healthy actions.

Other types of therapy may include:

 Long-term therapy, where you will explore your thoughts and feelings over
many months or more
 Family therapy, where you will meet with a therapist along with your family
 Self-help groups, where the support of others may help you get better

Medicines may be used, but only along with some type of talk therapy. These
medicines may help if you are:

 Nervous or anxious most of the time

 Not sleeping very well
  Very sad or depressed

Expectations (prognosis)
With the right help and support, you should get better quickly. The problem usually
does not last longer than 6 months, unless the stressor continues to be present.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of
adjustment disorder.