Adjustment Disorder: Causes, Symptoms and Treatment

When stress overwhelms us, we may suffer from this disorder.

The adaptive disorders o adjustment disorders appeared for the first time in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). (DSM-III) and immediately thereafter appeared in the International Classification of Diseases (ICD-9).

This inclusion involved the recognition that some individuals may develop psychological symptoms or exhibit behaviors that occur in a short space of time in response to various stressful events. The consequences are also manifested by functional (social or occupational) impairment, and the most common psychological symptoms are depression or anxiety.

Definition of Adaptive Disorders

DSM-IV defines adaptive disorders as: "emotional or behavioral symptoms in response to an identifiable stressor that occur within three months of the presence of the stressor. These symptoms or behaviors are clinically significant as evidenced by distress greater than would be expected by the stressor or by significant impairment in social or occupational (or academic) activity."

The definition excludes the diagnosis of this disorder if there is another pathology that may be causing the symptoms. Adjustment disorder can be classified as acute o chronic. Within each form there are different types, such as anxious or depressive.

In the case of ICD-10, it is a requirement that the symptoms occur within one month of the onset of the stressor, while according to the DSM-IV the requirement is three months.. In addition, the latter reports that symptoms should subside within six months, although, as discussed, it also recognizes that there may be a chronic form as a result of prolonged exposure to a stressor. For example, the loss of a job may result in the loss of the home and, therefore, the separation of the marriage.

The diagnosis of this disorder has caused some controversy. One of the most important dilemmas is the distinction from the normal reaction to stress. This is unavoidable in order not to pathologize people's day-to-day lives and the normal setbacks that can arise.

Subtypes of adjustment disorders

There are different subtypes characterized by the symptoms presented by patients with this psychopathology.

• Depressive subtypeThere is a predominance of symptoms characteristic of low mood, such as crying or hopelessness.
• Anxious subtypeCharacterized by symptoms associated to anxiety: nervousness, irritability, etc.
• Mixed subtype with anxiety and depressive mood.Individuals present symptoms of the previous subtypes.
• With behavioral disorderThere is a behavioral disturbance, in which the rights of others or social norms and rules, characteristic of age, are violated.
• With mixed emotional and behavioral disturbance.There are emotional and behavioral alterations.
• Not specifiedMaladaptive reactions to stressors that are not classifiable in the other subtypes.

Differential diagnosis: it is necessary to differentiate the adaptive disorder from post-traumatic stress disorder.

Differential diagnosis is important, because in addition to ruling out other disorders such as dysthymia or generalized anxiety disorder, which have a duration of more than six months, adaptive disorder must be differentiated from post-traumatic stress disorder (PTSD).

The main difference with the latter is that the symptoms of PTSD manifest with the re-experience of the traumatic event, but, in contrast, the adaptive disorder must be preceded by a stressor or by a set of stressors..

Treatments

The choice of the appropriate treatment is a clinical decision that takes into account the patient's history. There is no consensus at present regarding the optimal treatment, but different forms of psychotherapy have been shown to be effective.. Sometimes drugs may also be administered to reduce symptomatology.

Psychopharmacology

The use of drugs should never be the first choice in the treatment, since the patient will not improve if the problem is not attacked in its totality. But sometimes, to reduce the discomfort, the patient can take small doses of anxiolytics such as Diazepam or Alprazolam. In case of insomnia, Flunitrazepam usually works very well. In cases of low mood, antidepressants such as Fluoxetine (Prozac) can reduce negative symptoms.

2. Psychotherapy

Because adjustment disorder does not last long, brief psychotherapy is usually preferred. brief rather than long-term psychotherapy is generally preferred.. Psychological therapy is useful for the following reasons:

• To analyze the stressors affecting the patient.
• To help the patient to interpret the meaning of the stressor in a more adaptive way.
• To help the patient to talk about the problems and conflicts he/she is experiencing.
• To identify ways to reduce the stressor.
• To maximize the patient's coping skills (emotional self-regulation, avoidance of inappropriate behaviors, especially substance abuse).

Some fome forms of psychotherapy that can be effective are the following:

• Cognitive behavioral therapy (CBT).
• Family and group therapies (stressor-specific support)
• Mindfulness therapy

Bibliographical references:

• Evans, Rand. (1999). Clinical psychology born and raised in controversy. APA Monitor, 30(11).
• Lemos, S. (2000). Psicopatología general. Madrid: Síntesis.
• Vallejo-Riuloba, J. (1991). Clinical cases. Psychiatry. Barcelona: Salvat.