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Adjustment Disorders |
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Adjustment Disorders
What is an adjustment disorder?An adjustment disorder is defined as an emotional or behavioral
reaction to an identifiable stressful event or change in a person's life
that is considered maladaptive or somehow not an expected healthy response
to the event or change. The reaction must occur within three months of the
identified stressful event or change happening. The identifiable stressful
event or change in the life of a child or adolescent may be a family move,
parental divorce or separation, the loss of a pet, birth of a brother or
sister, to name a few.
What causes adjustment disorders?Adjustment disorders are a reaction to stress. There is not a
single direct cause between the stressful event and the reaction. Children
and adolescents vary in their temperament, past experiences,
vulnerability, and coping skills. Their developmental stage and the
capacity of their support system to meet their specific needs related to
the stress are factors that may contribute to their reaction to a
particular stress. Stressors also vary in duration, intensity, and effect.
No evidence is available to suggest a specific biological factor that
causes adjustment disorders.
Who is affected by adjustment disorders?Adjustment disorders are quite common in children and
adolescents. They occur equally in males and females. While adjustment
disorders occur in all cultures, the stressors and the signs may vary
based on cultural influences. Adjustment disorders occur at all ages,
however, it is believed that characteristics of the disorder are different
in children and adolescents than they are in adults. Differences are noted
in the symptoms experienced, severity and duration of symptoms, and in the
outcome. Adolescent symptoms of adjustment disorders are more behavioral
such as acting out, while adults experience more depressive symptoms.
What are the symptoms of an adjustment disorder?In all adjustment disorders, the reaction to the stressor seems
to be in excess of a normal reaction, or the reaction significantly
interferes with social, occupational, or educational functioning. There
are six subtypes of adjustment disorder that are based on the type of the
major symptoms experienced. The following are the most common symptoms of
each of the subtypes of adjustment disorder. However, each adolescent may
experience symptoms differently. Symptoms may include:
- adjustment disorder with depressed mood
Symptoms may include:
- depressed mood
- tearfulness
- feelings of hopelessness
- adjustment disorder with anxiety
Symptoms may include:
- nervousness
- worry
- jitteriness
- fear of separation from major attachment figures
- adjustment disorder with anxiety and depressed mood
A combination of symptoms from both of the above subtypes (depressed
mood and anxiety) is present.
- adjustment disorder with disturbance of conduct
Symptoms may include:
- violation of the rights of others
- violation of societal norms and rules (truancy, destruction of
property, reckless driving, fighting)
- adjustment disorder with mixed disturbance of emotions and
conduct
A combination of symptoms from all of the above subtypes are
present (depressed mood, anxiety, and conduct).
- adjustment disorder unspecified
Reactions to stressful events that do not fit in one of the
above subtypes are present. Reactions may include behaviors such as
social withdrawal or inhibitions to normally expected activities (i.e.,
school or work).
The symptoms of adjustment disorders may resemble other medical
problems or psychiatric conditions. Always consult your adolescent's
physician for a diagnosis.
How are adjustment disorders diagnosed?A child and adolescent psychiatrist or a qualified mental
health professional usually makes the diagnosis of an adjustment disorder
in children and adolescents following a comprehensive psychiatric
evaluation and interview with the child or adolescent and the parents. A
detailed personal history of development, life events, emotions,
behaviors, and the identified stressful event is obtained during the
interview.
Treatment for adjustment disorders:Specific treatment for adjustment disorders will be determined
by your adolescent's physician based on:
- your adolescent's age, overall health, and medical history
- extent of your adolescent's symptoms
- subtype of the adjustment disorder
- your adolescent's tolerance for specific medications or therapies
- expectations for the course of the stressful event
- your opinion or preference
Treatment may include:
- individual psychotherapy using cognitive-behavioral approaches
Cognitive-behavioral approaches are usedto improve age-appropriate
problem solving skills, communication skills, impulse control, anger
management skills, and stress management skills.
- family therapy
Family therapy is often focused on making needed changes within the
family system such as improving communication skills and family
interactions, as well as increasing family support among family members.
- peer group therapy
Peer group therapy is often focused on developing and using social
skills and interpersonal skills.
- medication
While medications have very limited value in the treatment of adjustment
disorders, medication may be considered on a short term basis if a
specific symptom is severe and known to be responsive to medication.
Prevention of adjustment disorders:Preventive measures to reduce the incidence of adjustment
disorders in adolescents are not known at this time. However, early
detection and intervention can reduce the severity of symptoms, enhance
the adolescent's normal growth and development, and improve the quality of
life experienced by children or adolescents with adjustment disorders.
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