Adjustment Disorder: Causes, Symptoms And Treatment
The adaptive disorders either adjustment disorders They appeared for the first time in the third edition of the Statistical Diagnostic Manual of Mental Disorders (DSM-III) and right after they appeared in the International Classification of Diseases (ICD-9).
This inclusion involved recognition that some individuals may develop psychological symptoms or exhibit behaviors that occur in 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.
The DSM-IV defines adjustment 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 by distress greater than would be expected from the stressor or by significant impairment in social or work (or academic) 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 sharp either 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 one month of the appearance of the stressful phenomenon, while according to the DSM-IV the requirement is three months. Furthermore, the latter reports that the symptoms should subside within six months, although, as mentioned, he also recognizes that there may be a chronic form as a consequence 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 between the normal reaction to stress. Something that becomes inevitable 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.
Differential diagnosis: adjustment 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 generalized anxiety disorder, which last 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, on the other hand, the adjustment disorder must be preceded by a stressor or 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 use of drugs should never be the first choice in treatment, since the patient will not improve if the problem is not attacked in its entirety. But sometimes, to reduce discomfort, the patient can take small doses of anxiolytics such as Diazepam or Alprazolam. In case of insomnia, Flunitrazepam usually works very well. In cases of low mood, antidepressants such as Fluoxetine (Prozac) can reduce negative symptoms.
Because adjustment disorder does not last long, it usually brief rather than long-term psychotherapy is preferred. Psychological therapy is useful for the following reasons:
Some Fforms of psychotherapy that may be effective are the following:
