Stressful events are bound to exist and appear within an individual’s lifetime, however the reaction to the event may be deemed inappropriate due to the negativity that results from it in one’s daily living. This negative reaction is also known as adjustment disorder. Adjustment disorder is a common condition, with 5-20 percent of individuals being treated for this as their sole diagnosis in an outpatient care setting. If not addressed appropriately, adjustment disorder can lead to worsening of other psychiatric disorders, substance abuse, and even suicide. It is important for the clinician to recognize the symptoms and diagnosing criteria of adjustment disorder in order to properly treat the patient with swiftness.
What is Adjustment Disorder?
Adjustment disorder falls into the wide categorical spectrum of anxiety and depressive disorders. The DSM 5 criteria describes adjustment disorder as a development of emotional or behavioral symptoms in response to an identifiable stressor within three months of onset. The type of stressor may vary in significance for children and adolescents versus adults. These stressors can include but are not limited to death, medical diagnoses, marital discord, unexpected life events, finances, sexuality discoveries, family problems, and the list goes on. The difference between adjustment disorder and other mental disorders lies in the impact it takes on one’s daily activities, with a true associated stressor for the cause.
Many people may experience a difficult time in response to a stressful life event. Unfortunately, many people are not taught great coping skills, hence the dramatic rise of anxiety and depressive disorders. How does a clinician recognize the signs of a person presenting with adjustment disorder, and differentiate them from anxiety or depression? Patients experiencing adjustment disorder may exhibit one or a combination of the following symptoms following an identifiable life event three months prior:
- Depressed mood behavior such as dysthymia, tearfulness, hopelessness
- Anxiety mood behavior such as excessive worrying, nervousness, uneasiness
- Disturbance of conduct. For example, if a child is exhibiting this symptom, they may begin to misbehave in school or become aggressive
- Unspecified due to maladaptive reactions
In addition, these symptoms must affect the patient’s daily activities, such as social or occupational functioning. The negative impact on the patient’s daily activities must be disproportionate to the event. This factor makes the diagnosing material rather subjective for the clinician, because cultural and external circumstances may impact.
There is speculation that a patient’s cultural and economic status may create the influence of reaction in adjustment disorder. One’s cultural and economic background may impact their upbringing and therefore coping skills. Undoubtedly, genetics, IQ, and social skills play a huge role in the precipitation of adjustment disorder.
How is adjustment disorder diagnosed?
One way for a clinician to successfully diagnose adjustment disorder is to be cognizant and well versed of it’s diagnosing criteria. Firstly, the clinician must differentiate adjustment disorder from symptoms of normal bereavement. The bereavement exclusion is the only special consideration of diagnostic criteria with adjustment disorder, and is rather limiting as some people react to death in different ways and may grieve even a year after the loss.
How long does adjustment disorder last?
Secondly, the symptoms must arise within one month after the offending stressor. In addition, once the offending stressor has terminated, the patient must not display symptoms for more than six months after onset, otherwise this patient may classify under a different disorder.
It is important to recognize the differential diagnoses for adjustment disorder, which include major depressive disorder, normal nonpathologic reaction to stress, personality disorder, mixed anxiety depression, acute stress reaction, post traumatic stress, and bereavement. Early discovery of adjustment disorder will result in a better prognosis, and most patients’ symptoms will resolve with proper psychotherapy.
To learn more about Adjustment Disorder, you can participate in the Adjustment Disorder CE Courses and obtain CE credits!