Adjustment disorders are characterized by an emotional response to a stressful event. It is one of the diagnostic entities in which an external stressful event is linked to the development of symptoms. Typically, the stressors involve financial issues, a medical illness, relationship, relocation, death of near and dear one and other major life events. The symptoms that develop may involve anxious or depressive affect or may present with a disturbance in conduct. The development of emotional or behavioural symptoms in response to identifiable stressor(s) should occur within 1-3 months of the onset of stressful events.
According to ICD 10/DSM 5, there are following types of adjustment disorder:
Adjustment disorder with depressed mood
Adjustment disorder with anxiety
Adjustment disorder with mixed anxiety and depressed mood
Adjustment disorder with disturbance of conduct
Adjustment disorder with mixed disturbance of emotions and conduct.
Common signs and symptoms
Acting anxious
Withdrawn attitude
Feeling low and hopeless
Loss of appetite
Hypersomnia/ insomnia
Acting impulsive/confused
Irritability
Crying
Suicidal Thoughts
Etiology
An adjustment disorder is precipitated by one or more stressors. Personality organization and cultural or group norms and values contribute to the disproportionate responses to stressors. Stressors may be single like divorce or job loss; or multiple like death of near or dear one which coincides with the person’s own physical illness or job loss. Stressors can be recurrent, such as seasonal business difficulties or it could be chronic like poverty, chronic illness. Sometimes, adjustment disorders occur in a group or community setting, and the stressors affect several persons, as in a natural disaster or in racial, social, or religious persecution. Specific developmental stages, such as beginning school, leaving home, getting married, becoming a parent, failing to achieve occupational goals, having the last child leave home, and retiring, are often associated with adjustment disorders.
Management
Treatment regime for adjustment disorder includes psychotherapy, medications or both. Individual psychotherapy offers the opportunity to explore the meaning of the stressor to the patient so that earlier traumas can be worked through. Psychotherapy can help persons adapt to stressors that are not reversible or time limited and can serve as a preventive intervention if the stressor does remit.
Crisis intervention and case management are short term treatment regime aimed at helping persons with adjustment disorders resolve their situations quickly by supportive techniques, suggestions, reassurance, environmental modification, and even hospitalization, if necessary.
Medicines are also used to help patients with adjustment disorder depending on the type of adjustment disorder. A patient may response to an anti-anxiety agent or to an anti-depressant. Anti-psychotic drugs can also be used if there is sign of impeding psychosis.
Nirvan Hospital – Centre of excellence in Behavioral and Addiction Medicine has very efficient team of Psychiatrists and Clinical Psychologists to manage adjustment disorders.
