Signs and symptoms
Some emotional signs of adjustment disorder are: sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, desperation, feeling overwhelmed and thoughts of suicide, performing poorly in school/work etc. Common characteristics of Adjustment disorder include mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three. According to theSubtypes and their symptoms
Adjustment disorder has six different subtypes, and they are all based on what the main symptoms are. Those subtypes are as follows: * With depressed mood: depression, hopelessness, lack of interest or joy from previously enjoyed hobbies, tearfulness * With anxiety: anxiousness, being overwhelmed, trouble concentrating, worry, separation anxiety (common in children) * With anxiety and depressed mood: combination of symptoms from both subtypes above * With disturbance of conduct: acting destructive, reckless behavior, rebellious * With mixed disturbance of emotions and conduct: combination of symptoms from both subtypes above * Unspecified: symptoms that do not fall into above subtypes; often include physical symptoms and withdrawal from everyday activitiesRisk factors
Those exposed to repeated trauma are at greater risk, even if that trauma is in the past. Age can be a factor due to young children having fewer coping resources and because they are less likely to realize the consequences of a potential stressor. A stressor is generally an event of a serious, unusual nature that an individual or group of individuals experience. Adjustment disorders can come from a wide range of stressors that can be traumatic or relatively minor, like the loss of a girlfriend/boyfriend, a poor report card, or moving to a new neighborhood. It is thought that the more often the stressor occurs, the more likely it is to produce Adjustment disorder. The objective nature of the stressor is of secondary importance. A stressor gains its pathogenic potential when the patient perceives it as stressful. The identification of a causal stressor is necessary if a diagnosis of adjustment disorder is to be made. There are certain stressors that are more common in different age groups: Adulthood: * Marital conflict * Financial conflict * Health issues with oneself, partner, or dependent children * Personal tragedy such as death or personal loss * Loss of job or unstable employment conditions e.g., corporate takeover or redundancy Adolescence and childhood: * Family conflict or parental separation * School problems or changing schools * Sexuality issues * Death, illness, or trauma in the family In a study conducted from 1990 to 1994 on 89 psychiatric outpatient adolescents, 25% had attempted suicide in which 37.5% had misused alcohol, 87.5% displayed aggressive behaviour, 12.5% had learning difficulties, and 87.5% had anxiety symptoms.Diagnosis
DSM-5 classification
The basis of the diagnosis is the presence of a precipitating stressor and a clinical evaluation of the possibility of symptom resolution on removal of the stressor due to the limitations in the criteria for diagnosing Adjustment disorder. In addition, the diagnosis of Adjustment disorder is less clear when patients are exposed to stressors long-term, because this type of exposure is associated with Adjustment disorder andICD-11 classification
Treatment
Individuals with an adjustment disorder and depressive or anxiety symptoms may benefit from treatments usually used for depressive or anxiety disorders. The use of different therapies can be beneficial for any age group. There is also a list of medications that can be used to help people with adjustment disorder whose symptoms are too severe for therapy alone. If a person is considering taking medication, they should talk to their doctor. Specific treatment is based on factors of each individual separately. These factors include but are not limited to age, severity of symptoms, type of adjustment disorder, and personal preference. Different ways to help with the disorder include: * Individual Psychotherapy * Family Therapy * Peer Group Therapy * Medication (used only when the symptoms are severe or with a doctors approval) In addition to professional help, parents and caregivers can help their children with their difficulty adjusting by: * offering encouragement to talk about their emotions * offering support and understanding * reassuring the child that their reactions are normal * involving the child's teachers to check on their progress in school * letting the child make simple decisions at home, such as what to eat for dinner or what show to watch on TV * having the child engage in a hobby or activity they enjoyCriticism
Like many of the items in the DSM, adjustment disorder receives criticism from a minority of the professional community as well as those in semi-related professions outside the healthcare field. First, there has been criticism of its classification. It has been criticized for its lack of specificity of symptoms, behavioral parameters, and close links with environmental factors. Relatively little research has been done on this condition. An editorial in the ''British Journal of Psychiatry'' described adjustment disorder as being so "vague and all-encompassing… as to be useless," but it has been retained in the DSM-5 because of the belief that it serves a useful clinical purpose for clinicians seeking a temporary, mild, non- stigmatizing label, particularly for patients who need a diagnosis for insurance coverage of therapy. In the US military there has been concern about its diagnosis in active duty military personnel.In relation to the COVID-19 pandemic
A study was conducted in Poland, during the first phase of the pandemic. The study used self-report surveys to measure the prevalence and severity of symptoms of adjustment disorder compared to PTSD, depression, and anxiety. The data was collected in the first quarantine period between March 25 to April 27, 2020. Results from the study * The current COVID-19 pandemic was a highly stressful event for 75% of the participants and the most powerful predictor of adjustment disorder. * 49% reported an increase in adjustment disorder symptoms, which were more common among females and those without a full-time job. 14% of the sample met the criteria for a diagnosis of adjustment disorder. * A significant proportion of the sample was also positive for generalized anxiety (44%) and depression (26%): the presumptive diagnosis rate of PTSD was 2.4%References
Further reading
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{{Mental and behavioural disorders, selected = neurotic Adjustment disorders Stress-related disorders