3dAdjustment Disorders
Symptoms
Feeling sad, hopeless or not enjoying things you used to enjoy.
Crying often.
Worrying, or feeling anxious, nervous, or stressed out.
Feeling irritable or like you can't handle anything and don't know where
to start.
Having trouble sleeping.
Not eating enough.
Having difficulty concentrating.
Having difficulty with daily activities.
Withdrawing from family and friends who support you socially.
Not doing important things, such as going to work or paying bills.
Thinking about suicide or acting on those thoughts.
Diagnostic Criteria
A. The development of emotional or behavioral symptoms in response to an
identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant, as evidenced by one
or both of the following:
1. Marked distress that is out of proportion to the severity or intensity of the
stressor, considering the external context and the cultural factors that
might influence symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of
functioning.
C. The stress-related disturbance does not meet the criteria for another mental
disorder and is not merely an exacerbation of a preexisting mental disorder.
D. The symptoms do not represent normal bereavement and are not better
explained by prolonged grief disorder.
E. Once the stressor or its consequences have terminated, the symptoms do not
persist for more than an additional 6 months.
Specify whether:
F43.21 With depressed mood: Low mood, tearfulness, or feelings of
hopelessness are predominant.
F43.22 With anxiety: Nervousness, worry, jitteriness, or separation anxiety is
predominant.
F43.23 With mixed anxiety and depressed mood: A combination of
depression and anxiety is predominant.
F43.24 With disturbance of conduct: Disturbance of conduct is predominant.
F43.25 With mixed disturbance of emotions and conduct: Both emotional
symptoms (e.g., depression, anxiety) and a disturbance of conduct are
predominant.
F43.20 Unspecified: For maladaptive reactions that are not classifiable as one
of the specific subtypes of adjustment disorder.
Specify if:
Acute: This specifier can be used to indicate persistence of symptoms for less
than 6 months.
Persistent (chronic): This specifier can be used to indicate persistence of
symptoms for 6 months or longer.
Symptoms cannot persist for more than 6 months after the termination of the
stressor or its consequences.
The persistent specifier therefore applies when the duration of the disturbance is
longer than 6 months in response to a chronic stressor or to a stressor that has
enduring consequences.
Prevalence
Adjustment disorders are common, although prevalence may vary widely as a
function of the population studied and the assessment methods used. The
percentage of individuals in outpatient mental health treatment in the United
States with a principal diagnosis of an adjustment disorder ranges from
approximately 5% to 20%. Rates of adjustment disorder may be higher in
women,
as noted by research in Denmark. In Australian, Canadian, Israeli, and U.S.
hospital psychiatric consultation settings, an adjustment disorder was often the
most common diagnosis in the 1990s, frequently reaching 50%.
Association With Suicidal Thoughts or Behavior
Adjustment disorders are associated with an increased risk of suicide attempts
and suicide.
Differential Diagnosis
Major depressive disorder
Posttraumatic stress disorder and acute stress disorder
Personality disorders
Bereavement
Psychological factors affecting other medical conditions.
Psychological factors affecting other medical conditions
Normative stress reactions
Comorbidity
An individual may develop an adjustment disorder, with depressed mood, after
losing a job and at the same time have a diagnosis of obsessive-compulsive
disorder. Or, an individual may have a depressive or bipolar disorder and an
adjustment disorder as long as the criteria for both are met. Adjustment
disorders are common accompaniments of medical illness and may be the major
psychological response to a medical condition.
Causes
Experts have not identified a specific cause for why a person might struggle
with adjustment disorder, but there are certain factors that can increase your risk
for developing this condition.
Adjustment disorders can happen at any age, but they are especially common in
children. Any stressful event or series of situations can trigger this condition.
Common stressors for adults include:
Death of a loved one
Divorce or relationship problems
Financial difficulties
Getting married
Having a baby
Illness or other health issues in yourself or a loved one
Living in a high crime neighborhood
Loss of employment
Moving to a new place
Natural disaster
Retirement
Some stressors that may lead to adjustment disorder in children and teens
include:
A new brother or sister
Death of a pet
Parental divorce or separation
Entering a new school or leaving school
Leaving home for the first time
Sexuality issues (such as uncertainties related to sexual orientation)
As you can see, a stressor can be a single event (termination of a relationship) or
multiple events (relationship problems), that can be continuous (living in an
unsafe community) or recurrent (seeing your ex during the holidays).
The main goal of treatment is to relieve symptoms and help you return to a
similar level of functioning as before the stressful event occurred.
Psychotherapy
Adjustment disorder is highly treatable and often responds well to
psychotherapy. Regardless of the stressor, therapy will help you understand how
and why the stressor has affected your life. Therapy will also help you develop
better coping skills and stress management to deal with stressful events.
The form of psychotherapy will vary from patient to patient. Because of the
briefness of adjustment disorders, short-term psychotherapy, like cognitive
behavioral therapy (CBT), is generally preferred.
Some people may also benefit from family therapy, especially if the situation is
family-related or the patient is an adolescent. Couples therapy may be ideal if
the disorder is negatively impacting a romantic relationship.
Medication
Although psychotherapy is the first-line treatment for adjustment disorder,
medications are sometimes prescribed to alleviate troublesome symptoms, such
as anxiety, depression, and insomnia.
Coping
Here are a few tips to keep in mind when coping with an adjustment disorder.
Avoid unnecessary stress. Stress is sometimes unavoidable. Though you
may not have the power to avoid all stressful situations, anything you can
do to reduce your stress is helpful. For instance, if you have a big change
coming up in your life, don’t take on additional responsibilities that will
make you even more anxious.
Join a support group. Sometimes it helps to share your anxieties with
people who have been through a similar situation. There are a variety of
stressors that are addressed in support groups, from divorce to loss of a
loved one.
Lean on your support system. Having someone you trust that to listen
without judgment or shaming is invaluable during times of stress. Tell
friends and family you’re feeling overwhelmed, and let them know how
they can help you.
