| In an adjustment disorder, a psychological response occurs to an identifiable stressor or life event that results in significant emotional or behavioral symptoms. These symptoms usually result in decreased performance at work or school and temporary changes in social relationships.
The life stressor may be a single event such as termination of a relationship, or a recurrent situation such as a seasonal business crises, a continuous source of stress such as living in a crime-ridden neighborhood, a prolonged difficulty such as a chronic, debilitating medical condition, or multiple circumstances such as business difficulties plus marital problems.
In adjustment disorder with depressed mood, the main symptoms include depressed mood, tearfulness, or feelings of hopelessness.Risk: As many as 50% of individuals who are subject to a specific stressor such as cardiac surgery will experience an adjustment disorder. Incidence and Prevalence: Adjustment disorders occur in up to 12% of general hospitalized individuals referred for a mental health consultation and in 10% to 30% of those in mental health outpatient settings. |
Source: Medical Disability Advisor
| History: Diagnosis is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). The symptoms should occur within 3 months of the recognizable stressful event and should not last longer than 6 months after resolution of the stressful event or its consequences unless symptoms are in response to a chronic stressor.
The symptoms or behaviors are identified as either a marked distress in excess of what would be expected, or a significant impairment in social or occupational functioning. The context of the individual's cultural setting should also be considered in determining whether the reaction to stress is in excess of what is expected. The stress-related disturbance cannot be diagnosed as another specific psychiatric disorder or be merely an exacerbation of a pre-existing psychiatric disorder. The symptoms cannot be related to bereavement. However, adjustment disorder may be diagnosed in the presence of another psychiatric disorder if the latter does not account for the pattern of symptoms occurring in response to the stressor. Physical exam: The exam is generally not helpful in diagnosing adjustment disorders. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide essential signs to help diagnose the illness. For example, the individual may show poor attention to grooming or give statements inconsistent with emotional state (affect) such as saying "I feel fine" while clenching the jaw and frowning. Depressed mood may be associated with low volume and output of speech, blank or sad expression, and decreased or slowed spontaneous movement (psychomotor retardation). The mental status examination may reveal a decrease in attention and concentration. Tests: Psychological testing can be helpful as an adjunct to diagnosing adjustment disorders. This may include the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2), or other tests. |
Source: Medical Disability Advisor
| Psychotherapy is the treatment of choice for adjustment disorders along with resolving the stressful situation or removing the individual from the situation. Group therapy can be effective especially when individuals in the group have experienced similar stressors. Individual psychotherapy helps explore the meaning of the stressor to the individual so that earlier traumas can be explored. Brief psychotherapy when utilized in a crisis intervention can help resolve the situation quickly using supportive techniques, suggestion, reassurance, environmental modification, and, if necessary, hospitalization. Cognitive behavioral therapy helps correct disordered thinking and maladaptive behavior. Pharmacotherapy utilizes anti-anxiety agents and antidepressants to reduce symptoms of anxiety and depression. These should be used judiciously and for brief periods. |
Source: Medical Disability Advisor
| The overall prognosis of adjustment disorder is favorable with appropriate treatment. Adjustment disorders generally occur within a short period of time following the stressor and, by definition, should last no longer than 6 months after the stressor or its consequences have ended. Individuals generally return to normal functioning within a few months. |
Source: Medical Disability Advisor
| Adjustment disorders may be associated with excessive substance abuse or use, somatic complaints and suicide attempts or, occasionally, suicide. If an individual with a pre-existing mental or medical illness is also diagnosed with an adjustment disorder, the course of that illness may be complicated or prolonged by decreased compliance with recommended treatment or increased hospital length of stay. |
Source: Medical Disability Advisor
| Work restrictions or accommodations are necessary only infrequently and only for the most serious cases. In these instances, time-limited restrictions and work accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote timely and safe transition back to full work productivity. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was diagnosis confirmed?
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Were similar disorders considered and ruled out such as major depression, bipolar affective disorder, mood disorders due directly to medical disorders or substance abuse, dysthymic disorders, acute stress disorder, post-traumatic stress disorder, or bereavement?
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Was there a history of depression or other psychological problem contributing to the current condition?
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What was the previous level of functioning?
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Was there significant reduction in functioning and if so, in what ways?
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If there is concurrent drug or alcohol abuse, to what extent were these conditions causing additional problems?
Regarding treatment:
- Was the stressful situation resolved?
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Was individual removed from it?
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If suicidal tendencies are present, is environmental modification being considered?
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If utilized, were antidepressants or tranquilizers effective?
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Would a longer trial be warranted?
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Are social supports adequate?
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Is additional supportive group or individual therapy needed?
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Has psychotherapy been added to the pharmacotherapy regimen for more effective results?
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Is the frequency of psychotherapy visits adequate?
Regarding prognosis:
- How are current stresses being dealt with?
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How were major stresses dealt with in the past?
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If healthy and adaptive methods were used in the past, are they being used currently?
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If drug and/or alcohol abuse present, to what extent are these conditions causing additional problems?
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Are social supports available? Family? Friends? Church or other community affiliations? Are these being utilized?
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Did symptoms resolve within 6 months?
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Are events outside of work contributing to or worsening the problems experienced at work?
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Are there incentives not to improve such as ongoing litigation, social security, or disability insurance?
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Did individual enjoy working previously?
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Source: Medical Disability Advisor
| Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000. |
Source: Medical Disability Advisor