Adjustment disorder

Definition

Adjustment disorder is an abnormal and excessive reaction to a life stress, such as starting school, getting divorced, or experiencing grief.

Causes, incidence, and risk factors

Adults often develop adjustment disorder due to marital or financial problems.

In adolescents, common stressors include:

• Family conflict
• School problems
• Sexuality issues

Other stressors for people of any age include:

• Death of a loved one
• General life changes
• Unexpected catastrophes

There is no way to predict which people who are affected by the same stress are likely to develop adjustment disorder. Financial conditions, social support, and career and recreational opportunities can influence how well a person reacts to stress. A person's susceptibility to stress may be influenced by factors such as:

• Coping strategies
• Intelligence
• Flexibility
• Genetic factors
• Social skills

Symptoms

For a diagnosis of adjustment disorder, a person's symptoms must be severe enough to affect his or her work or social life. Some of the symptoms include:

• Agitation
• Conduct disturbances
• Depression
• Palpitations
• Physical complaints
• Trembling or twitching

Symptoms of adjustment disorder typically begin within 3 months of the stressor, and usually do not last longer than 6 months.

Signs and tests

The following criteria need to be met to establish a diagnosis:

• The symptoms clearly follow a stressor
• The symptoms are more severe than would be expected
• There do not appear to be other underlying disorders

Treatment

The primary goal of treatment is to relieve symptoms and help the person return to a similar level of functioning as before the stressful event occurred.

Most mental health professionals recommend treatments including:

• Behavior therapy
• Individual psychotherapy
• Family therapy
• Self-help groups

When medications are used, they are usually in addition to other forms of treatment.

Expectations (prognosis)

Adjustment disorders usually get better quickly without any remaining symptoms.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of adjustment disorder.

Prevention

There is no known way to prevent this disorder. Strong support from friends and family can help.

References

Katon W, Geyman JP. Anxiety disorders. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 57.

Rund DA, Vary MG. Mood disorders. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa:Mosby Elsevier;2006:chap 109.

Privitera MR, Lyness JM. Depression. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 27.