Adjustment disorder: causes, symptoms and treatment

the adaptive disorders or adjustment disorders first appeared in the third edition of the Statistical Diagnostic Manual of Mental Disorders (DSM-III) and soon after in the International Classification of Diseases (ICD-9).

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

Definition of adaptive disorders

The DSM-IV defines adaptive disorders as: “emotional or behavioral symptoms in response to an identifiable stressor that occurs within three months of the presence of the stressful situation. These symptoms or behaviors are clinically significant as evidenced. expected by the stressor or by a significant deterioration in social or professional (or school) 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 or chronic. In each form there are different types, such as anxious or depressed.

In the case of ICD-10, it is mandatory that the symptoms appear within one month of the onset of the stressful phenomenon, while according to the DSM-IV, the requirement is three months.. In addition, the latter reports that symptoms should subside at six months, although, as discussed, he also recognizes that there may be a chronic form as a result of prolonged exposure to a stressor. For example, the loss of employment can lead to the loss of the domicile and therefore the separation of the marriage.

The diagnosis of this disorder has sparked some controversy. One of the most important dilemmas is the distinction from the normal reaction to stress. Something that becomes inevitable so as not to pathologize people’s daily lives and the normal setbacks that can occur.

Adjustment disorder subtype

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

  • Depressive subtype: There is a predominance of symptoms characteristic of a depressed mood, such as crying or hopelessness.
  • Anxious subtype: Characterized by symptoms associated with anxiety: nervousness, irritability, etc.
  • Mixed subtype with anxiety and depressed mood: Individuals show symptoms of the above subtypes.
  • With behavioral disorder: There is an alteration of behavior, in which the rights of others are violated or social norms and rules, characteristic of age.
  • With mixed alteration of emotions and behavior: There are emotional and behavioral alterations.
  • unspecified: Inappropriate reactions to stressors which cannot be classified into the other subtypes.

Differential diagnosis: adaptive disorder must be differentiated 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 last 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 as a new experience of a traumatic event, but adaptive disorder must be preceded by a stressor or a combination of them.

treatments

The choice of the appropriate treatment is a clinical decision in which the patient’s history is taken into account. There is currently no consensus on the optimal treatment, however different forms of psychotherapy have been shown to be effective. Sometimes they can also administer medication to reduce symptoms.

1. Psychopharmacology

Drug use should never be the first choice in treatment, as the patient will not improve if the problem is not addressed in its entirety. But sometimes, to reduce the discomfort, the patient may take small doses of anxiolytics such as diazepam or alprazolam. In cases of insomnia, flunitrazepam usually works very well. In case of bad mood, antidepressants such as fluoxetine (Prozac) can reduce negative symptoms.

2. Psychotherapy

Because adjustment disorder usually doesn’t last long short-term rather than long-term psychotherapy is preferable. Psychological therapy is useful for the following reasons:

  • Analyze the stressors that affect the patient
  • Help the patient interpret the meaning of the stressor more adaptively
  • Help the patient talk about the problems and conflicts they are experiencing
  • Identify how to reduce the stressor
  • Maximize the patient’s coping skills (emotional self-regulation, avoidance of inappropriate behavior, in particular drug addiction).

some Ftraces of psychotherapy that may be effective are:

  • Cognitive Behavioral Therapy (CBT)
  • Family and group therapies (specific support for the stressor)
  • Mindfulness therapy

Bibliographical references:

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

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