Adjustment disorder

In psychology, adjustment disorder (AD) is a classification of mental disorder
that is a psychological response from an identifiable stressor or group of
stressors that causes significant emotional or behavioral symptoms that does
not meet criteria for more specific disorders.[1] 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.

There are nine different types of adjustment disorder listed in the DSM-III-R.
In DSM-IV, adjustment disorder was reduced to six types, classified by their
clinical features. Adjustment Disorders may also be acute or chronic, depending
on whether it lasts more or less than six months. Diagnosis of adjustment
disorder is quite common; there have been reports of it being a common and
serious condition among adolescents and it has estimated incidences of 5-21%
in psychiatric consultation services for adults. In clinical samples of adults,
women are given the diagnosis twice as often as men.

Adjustment disorder link to suicide
Suicide behavior is prominent among AD patients 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. Asnis et al. (1993) found that AD
patients report persistent ideation or suicide attempts much less frequently
than those diagnosed with major depression.

Treatment
The primary treatment for adjustment disorder is talking. This reduces the
pressure of the stressor and enhances coping. It allows the patient to put his
or her rage into words rather than into destructive actions. Counseling,
psychotherapy, crisis intervention, family therapy, and 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 patients with severe life stresses and a significant anxious
component, benzodiazepines are used, although triccyclic antidepressants or
buspirone has 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.

Stressors
A stressor is generally an event of a serious, unusual nature that an individual
or group of individuals experience. It should be mentioned that the stressors
that cause Adjustment Disorders are not extreme events which are in the
criteria for Post-Traumatic Stress Disorder. They may be grossly traumatic
but may also be apparently minor, like loss of a boyfriend/girlfriend, 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,
yet this is modified greatly by the support the patient receives from those
around him or her. Stressors believed to involve a loss usually have particular
significance like an interpersonal failure, physical or sexual abuse, cognitive
impairment, a lengthy duration of frequent recurrence, or cognitive
uncertainty. 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. Patients that face a stressor with
enthusiasm and view it as a challenge are much less likely to develop a
disorder.

Risk factors
Factors that are intrinsic toward the development of Adjustment Disorder
include age, gender, ego development, past experiences and coping skills. Age
can be a factor because young children have fewer coping resources, however
they are less likely to understand a stressor as stressful and are thus less likely
to develop a disorder. Men have been shown to be more vulnerable to stressors
across all ages and types of stressors, for unknown reasons. A poorly developed
ego is also a factor that could make one more vulnerable to this disorder,
whether it is caused by cerebral impairment or upbringing. Those damaged by
repeated trauma also are at greater risk, even if that trauma is in the distant
past.

Coping
One important factor that dictates the extent of the emotional or behavioral
symptoms displayed in Adjustment Disorder is their method of coping with the
stressors. Coping is defined as the strategies and mechanisms that people use
to modify their environment or reduce internal distress. Coping is generally
organized into four categories.
The first category includes all efforts to practically handle stressors. This category
contains two subcategories of problem-focused coping, which is the practical
and physical dealing with stressors by actively problem solving, and restraint,
which is waiting for an appropriate opportunity to act.

The second category includes cognitive or internal strategies. This involves
avoiding, minimizing, distancing, or seeking value in negative events.
The third category includes efforts to diminish stress by utilizing available
situational or environmental factors. The most commonly investigated
mechanism in this category is social support.

The fourth category includes personal approaches or individuals' cognitive
orientations. This category includes constructs such as an individual’s
hardiness, sense of coherence, and locus of control.

Many studies have been done, documenting the effectiveness of various
activities in coping with stressful situations. The effective activities included
internet and computer based entertainment, watching television and
listening to music.

From Wikipedia, the free encyclopedia

Symptoms
The signs and symptoms of adjustment disorders vary from person to person.
The symptoms you have may be very different from those of someone else
with adjustment disorder. But for everyone, symptoms of an adjustment
disorder begin within three months of a stressful event in your life.

Emotional symptoms of adjustment disordersSigns and symptoms of adjustment
disorder may affect how you feel and think about yourself or life, including:
§ Sadness
§ Hopelessness
§ Lack of enjoyment
§ Crying spells
§ Nervousness
§ Thoughts of suicide
§ Anxiety
§ Worry
§ Desperation
§ Trouble sleeping
§ Difficulty concentrating
§ Feeling overwhelmed

Behavioural symptoms of adjustment disordersSymptoms of adjustment
disorder may affect your actions or behaviour, such as:
§ Fighting
§ Reckless driving
§ Ignoring bills
§ Avoiding family or friends
§ Poor school or work performance
§ Skipping school
§ Vandalism

Length of symptomsHow long you have symptoms of an adjustment disorder
also can vary:
§ Six months or less (acute). In these cases, symptoms may go away on their
own, especially if you actively follow self-care measures.

§ Longer than six months (chronic). In these cases, symptoms continue to
bother you and disrupt your life. Professional treatment can help symptoms
improve and prevent the condition from continuing to get worse.

Types of adjustment disordersYour health care provider may ask detailed
questions about how you feel and how you spend your time. This will help
him or her pinpoint which specific type of adjustment disorder you have.
There are six main types of adjustment disorders. Although they're all related,
each type of adjustment disorder has certain signs and symptoms.

The six types are:

§ Adjustment disorder with depressed mood. Symptoms mainly include
feeling sad, tearful and hopeless, and a lack of pleasure in the things you
used to enjoy.
§ Adjustment disorder with anxiety. Symptoms mainly include nervousness,
worry, difficulty concentrating or remembering things, and feeling overwhelmed.
Children who have adjustment disorder with anxiety may strongly fear being
separated from their parents and loved ones.
§ Adjustment disorder with mixed anxiety and depressed mood. Symptoms
include a mix of depression and anxiety.
§ Adjustment disorder with disturbance of conduct. Symptoms mainly
involve behavioral problems, such as fighting, reckless driving or ignoring
your bills. Youngsters may skip school or vandalize property.
§ Adjustment disorder with mixed disturbance of emotions and conduct.
Symptoms include a mix of depression and anxiety as well as behavioral problems.
§ Adjustment disorder unspecified. Symptoms don't fit the other types of
adjustment disorders but often include physical problems, problems with
family or friends, or work or school problems.

Lifestyle and home remedies
When you face a stressful event or major life change, you can take some steps
to care for your emotional well-being. Do what works for you. Some examples
include:
§ Talking things over with caring family and friends
§ Trying to keep eating a healthy diet
§ Sticking to a regular sleep routine
§ Getting regular physical activity
§ Engaging in a hobby you enjoy
§ Finding a support group geared toward your situation
§ Finding support from a faith community