Adjustment Disorder

Adjustment disorder is a psychological response to an identifiable stressor. The condition by emotional or behavioral symptoms that develop within 3 months of exposure, and do not last more than 6 months. Adjustment disorder is a diagnosis of exclusion, which means that they are not diagnosed if the patient meets the criteria for any other psychiatric disorder or if their symptoms are better explained by substance use or withdrawal. The 1st line of treatment is psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy.

Last update:

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Table of Contents

Share this concept:

Share on facebook
Share on twitter
Share on linkedin
Share on reddit
Share on email
Share on whatsapp

Overview

Definition

Adjustment disorder is a psychological and physical response (feeling sad, stressed, or hopeless, and certain physical symptoms) to an identifiable stressor (death of a loved one, divorce, life changes, illness, family problems, school problems, or sexual issues).

Epidemiology

  • Lifetime prevalence: approximately 2%–8% of the general population
  • Women are twice as likely to be diagnosed as men.
  • One of the most common psychiatric diagnosis for patients hospitalized for any other medical/surgical reason

Etiology

  • Precipitated by 1 or multiple stressors
  • Severity of stressor does not predict prognosis.
  • Personality of the patient as well as societal norms contribute to the pathologic reactions to the stressors.

Diagnosis

Adjustment disorder is difficult to diagnose as it shares symptoms with other mental disorders.

History and physical exam elicit the following criteria:

  • Development of psychological symptoms in response to identifiable stressor
  • Occurring within 3 months of the onset of stressor
  • Symptoms or behaviors are clinically significant, causing marked distress and decline in function.
  • Once stressor is removed, symptoms do not last more than 6 months.

Adjustment disorder cannot be diagnosed if symptoms:

  • Meet criteria of any other psychiatric disorder 
  • Are explained by substance use disorder or withdrawal 
  • Last over 6 months after the stressor
  • Cause no decline in patient functioning or marked distress
  • Represent normal bereavement

Management

Psychotherapy

  • 1st-line therapy
  • Different modalities, such as CBT, can help the patient to cope with the stressors.
  • Group therapy may be useful, especially among patients undergoing similar stressors.

Crisis intervention

Crisis intervention may be help provide timely reassurance and support to prevent sentinel outcome.

Pharmacotherapy

  • Generally not indicated but may help treat comorbid symptoms 
  • Severe anxiety may be treated with long-acting benzodiazepines Benzodiazepines Benzodiazepines work on the gamma-aminobutyric acid type A (GABAA) receptor to produce inhibitory effects on the CNS. Benzodiazepines do not mimic GABA, the main inhibitory neurotransmitter in humans, but instead potentiate GABA activity. Benzodiazepines (e.g., diazepam).  
  • Antipsychotics if showing symptoms of psychosis 
  • Antidepressants (selective serotonin reuptake inhibitors Serotonin Reuptake Inhibitors Antidepressants encompass several drug classes and are used to treat individuals with depression, anxiety, and psychiatric conditions, as well as those with chronic pain and symptoms of menopause. Antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and many other drugs in a class of their own. Serotonin Reuptake Inhibitors and Similar Antidepressant Medications (SSRIs)) may be useful adjuncts.

Differential Diagnosis

  • Acute stress disorder Acute stress disorder Acute stress disorder describes stress reactions displayed after an individual has experienced a traumatic event. Symptoms last more than 3 days but less than 1 month and include re-experiencing the event as flashbacks or nightmares, avoidance of reminders of the event, irritability, hyperarousal, and poor memory and concentration. Acute Stress Disorder: stress reactions that present after an individual has experienced a life-threatening event. Symptoms last > 3 days and < 1 month and involve re-experiencing the event as flashbacks or nightmares, avoiding reminders, irritability, hyperarousal, and poor memory and concentration. The traumatic event must have occurred within 1 month and last < a month.
  • Bereavement/grief: emotions or thoughts and actions in response to the death of someone close to the patient. The duration and form of expression vary based on the patient’s culture and customs.  Depression of mood as well as a feeling of loss can be expected. Unlike in adjustment disorder, bereavement causes no significant impairment in function. Bereavement is not pathological. 
  • Generalized anxiety disorder Generalized anxiety disorder Generalized anxiety disorder (GAD) is a common mental condition defined by excessive, uncontrollable worrying causing distress and occurring frequently for at least 6 months. Generalized anxiety disorder is more common in women. Clinical presentation includes fatigue, low concentration, restlessness, irritability, and sleep disturbance. Generalized Anxiety Disorder (GAD): a psychiatric disorder marked by chronic multiple worries, usually about things that are not important. Associated with fatigue, low concentration, restlessness, irritability, and sleep Sleep Sleep is a reversible phase of diminished responsiveness, motor activity, and metabolism. This process is a complex and dynamic phenomenon, occurring in 4-5 cycles a night, and generally divided into non-rapid eye movement (NREM) sleep and REM sleep stages. Physiology of Sleep disturbance. These symptoms last for > 6 months. The diagnosis of GAD does not require a trigger event causing its symptomatology, unlike adjustment disorder. 

References

  1. Sadock BJ, Sadock VA, Ruiz P. (2014). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Chapter 11, Trauma and stressor-related disorders, pages 446-450. Philadelphia, PA: Lippincott Williams and Wilkins.
  2. Zelviene P, Kazlauskas E. (2018). Adjustment disorder: current perspectives. Neuropsychiatr Dis Treat. 14:375-381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790100/ 
  3. O’Donnell ML, Agathos JA, Metcalf O, Gibson K, Lau W. (2019). Adjustment Disorder: Current Developments and Future Directions. Int J Environ Res Public Health. 16(14):2537. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678970/

USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

User Reviews

0.0

()

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details