Adjustment Disorder: causes, symptoms and treatment

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

This inclusion was the recognition that some individuals may develop psychological symptoms or exhibit behaviors that occur in a short space of time in response to different events stressful. 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 a identifiable stressor that occurs within three months of the occurrence of the triggering situation stress. These symptoms or behaviors are clinically significant as evidenced by discomfort greater than what would be expected due to the stressor or a significant deterioration in social or work activity (or academic) ”.

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. 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 a 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 the symptoms should remit after six months, although, as mentioned, 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 can lead to the loss of the house 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 of the normal reaction to stress. Something that is unavoidable so as not to pathologize people's daily lives and the normal setbacks that may arise.

Subtypes of adjustment disorders

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

• Depressive subtype: There is a predominance of characteristic symptoms of a low 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 present symptoms of the previous subtypes.
• With behavioral disorder: There is an alteration of behavior, in which the rights of others or social norms and rules, characteristics of age, are violated.
• With mixed disturbance of emotions and behavior: There are emotional and behavioral alterations.
• Not specified: Maladaptive reactions to stressors that are not classifiable in the other subtypes.

Differential diagnosis: adaptive disorder must be differentiated from post-traumatic stress disorder

The differential diagnosis is important, because in addition to ruling out other disorders such as dysthymia or the disorder anxiety disorders, which last for more than six months, adjustment 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, instead, the adjustment disorder must be preceded by a stressor or by a set of them.

Treatments

Choosing the appropriate treatment is a clinical decision that takes into account the patient's history. There is currently no consensus regarding the optimal treatment, but different forms of psychotherapy have shown their effectiveness. Sometimes drugs can also be administered to reduce symptoms.

1. Psychopharmacology

The drug use it should never be the first choice in treatment, since the patient will not improve if the problem is not addressed in its entirety. But sometimes, to reduce discomfort, the patient can take small doses of anxiolytics such as Diazepam or Alprazolam. For 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, it usually short-term rather than long-term psychotherapy is preferred. Psychological therapy is helpful for the following reasons:

• To analyze the stressors that affect the patient
• To help the patient more adaptively interpret the meaning of the stressor
• To help the patient talk about the problems and conflicts that she experiences
• 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 Fforms of psychotherapy that can be effective are the following:

• The cognitive behavioral therapy (CBT)
• Family and group therapies (specific support for the stressor)
• Mindfulness Therapy

Bibliographic 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: Salvat.