33 - Adjustment Disorders Flashcards
What are adjustment disorders?
Emotional or behavioral symptoms in response to a stressor, occurring within 3 months of the onset of the stressor
You can’t diagnose an adjustment disorder unless there is something the patient is having to adjust to
Describe the requirement for symptoms for diagnosing adjustment disorders
Symptoms are clinically significant ***
- Marked distress that is disproportionate to stressor
- Significant impairment in functioning
When you have a stressor, you are SUPPOSED to be stressed, but in order to diagnose this, it needs to be MORE than expected
Example: Can’t get out of bed, can’t get out of bed, can’t stop sobbing for a month after a divorce
What are the other requirements for diagnosing adjustment disorders?
Does not meet criteria for another mental disorder, and is not an exacerbation of a pre-existing disorder
- If someone has MDD on top of this presentation, it is just MDD, you don’t diagnose adjustment disorder on top of it
- It is just an exacerbation of MDD
Not normal bereavement
- We don’t want to turn grieving due to a death into a disorder
What is the time frame for adjustment disorders?
Symptoms do not last more than 6 months after end of stressor or its consequences
Once the consequences and it has been more than 6 months, the symptoms should stop, or it is something other than adjustment disorder
Is normal bereavement an adjustment disorder?
NO - Adjustment disorder is NOT normal bereavement
We don’t want to turn grieving due to a death into a disorder
What are the specifiers of adjustment disorder we see in the DSM-5
We can have an adjustment disorder with…
- With depressed mood
- With anxiety
- With mixed anxiety and depressed mood (internalizing the disorder - I’m worthless)
- With disturbance of conduct (externalizing the disorder)
- With mixed disturbance of emotions and conduct (internalize and externalize)
- Unspecified (none of the above)
Describe a diagnosis of adjustment disorder
Something bad has happened to someone, and they do NOT qualify for something else
Can’t be PTSD, MDD, etc.
When you see this diagnosis, you should realize that it isn’t a catastrophe, but they are just having a hard time adjusting and can’t function properly
How common is an adjustment disorder?
Diagnosis is common: 5-20% of patients in outpatient mental health treatment
What is adjustment disorder associated with?
Traditionally a less-severe diagnosis, although associated with elevated risk of attempted and completed suicide
What do you need to rule out when you are diagnosing adjustment disorder?
Need to rule out Major Depressive Disorder and Acute Stress Disorder/PTSD
What are common causes of adjustment disorder?
- Job loss
- Sudden financial loss
- End of relationship
- Death of loved one
- Natural disaster
- Overwhelming stress
- Multiple or recurrent stressors
What are the risk factors associated with adjustment disorder?
- Adjustment disorders may be more likely in individuals with underlying emotional vulnerability
- The higher the level of stress, the more likely a disorder is to develop, even in individuals with little vulnerability
- Stressors that reactivate feelings or memories of a previous, similar stressful event may be particularly problematic (had house fire as child, now have another one)
What are the treatment options for adjustment disorder?
- Supportive counseling is often the most helpful approach
- Medications may be prescribed to address symptoms that are interfering with functioning (example: unable to sleep, job is at risk, exhaustion, can give sleep aid)
- Prognosis is generally good (but remember acutely elevated risk of suicide***)
Describe coping with life transition
- Transitions and changes involve an element of grief
- Trying to convince a patient that a transition or loss is not really that bad, or trying to help them see the bright side, is often unhelpful
- Instead, encourage the patient to acknowledge both the good and the bad aspects of a transition or loss
- Help the patient identify what skills will be necessary in the new role/current situation
Describe coping with stress
- Identify your sources of stress (School? Family? Finances?)
- Identify your reactions to stress (Trouble concentrating? Irritability? Anxiety? Physical symptoms?)
- How are you currently responding to stress? Any unhealthy habits like drinking, poor eating, social isolation?
- One step at a time, try to add in healthy stress management practices (don’t add 5 things in one week, add 1 thing at a time)
Really important to be judgmental, or they will not share with you
