Adjustment disorder

Definition:

A reaction to an identifiable stressor or multiple stressors that occurs within 3 months of the onset of the stressor(s). This reaction results in some impairment of functioning or in symptoms that are in excess of a normal or expected reaction to the stressor(s).

Causes, incidence, and risk factors:

An adjustment disorder has its onset within 3 months of the identifiable stressor. Symptoms generally do not last longer than 6 months. There are several types of adjustment disorders that are all reactions to stressors, but the behavior or mood manifestations differ. The symptoms of adjustment disorder may be manifested by a depressed or anxious mood, conduct disturbances, physical complaints, or mixed emotional features (such as depression and anxiety). People diagnosed with adjustment disorders do not have an underlying history of another psychiatric illness, or do not have a prior history of repeated overreaction to stress.

Adjustment disorders are caused by a disruption of the normal process of adaptation to stressful life experiences. Psychological symptoms result from disruption of normal functioning caused by the stress. Symptoms may take many forms. Some people react as if the stressful event never occurred and are isolated or removed from it. In others, the event becomes so intrusive that they are unable to eat or sleep. It is the persistence of unwanted emotions or images and the inability to control them that distinguish the adjustment disorder from normal adaptation.

Contributing factors to the disorder are the stressors, the situational context in which the stressors occur, and intrapersonal factors relating to the affected person. Adults usually develop adjustment disorders related to stressors such as marital discord, finances, work, or school. In adolescents, common stressors include school problems, parental rejection, sexual problems, or parents' marital problems. Other stressors may include death of a loved one, life changes such as retirement or menopause, or unexpected catastrophes. Situational factors that influence how well a person reacts to stress may include economic conditions, availability of social supports, and occupational and recreational opportunities. Intrapersonal susceptibility to stress may include such factors as social skills, intelligence, flexibility, and coping strategies. In children, parental divorce can be a significant stressor.

The exact incidence of adjustment disorder is not known, but it is thought to be quite common.