Mental Disorders

Adjustment Disorder

An adjustment disorder (AD)—sometimes called exogenous, reactive, or situational depression—occurs when an individual is unable to adjust to or with a particular stress or a major life event. Since people with this disorder normally have symptoms that depressed people do, such as general loss of interest, feelings of hopelessness and crying, this disorder is sometimes known as situational depression. Unlike major depression, the disorder is caused by an outside stressor and generally resolves once the individual is able to adapt to the situation.[] One hypothesis about AD is that it may represent a sub-threshold clinical syndrome.

The condition is different from , which lacks the presence of a stressor, or and , which usually are associated with a more intense stressor.

Common characteristics of AD include mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three. There are nine types of AD listed in the DSM-III-R. According to the , there are six types of AD, which are characterized by the following predominant symptoms: , , mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct, and unspecified. However, the criteria for these symptoms are not specified in greater detail.[] AD may be acute or chronic, depending on whether it lasts more or less than six months. According to the DSM-IV-TR, if the AD lasts less than 6 months, then it may be considered acute. If it lasts more than six months, it may be considered chronic.[] Moreover, the symptoms cannot last longer than six months after the stressor(s), or its consequences, have terminated.:679 Diagnosis of AD is quite common; there is an estimated incidence of 5%–21% among psychiatric consultation services for adults. Adult women are diagnosed twice as often as are adult men. Among children and adolescents, girls and boys are equally likely to receive this diagnosis. AD was introduced into the psychiatric classification systems almost 30 years ago, but similar syndromes were recognized for many years before that.

Signs and Symptoms

According to the , the development of the emotional or behavioral symptoms of this diagnosis have to occur within three months of the onset of the identifiable stressor(s). Some emotional signs of adjustment disorder are:

SadnessHopelessnessLack of enjoymentCrying spellsNervousnessWorryTrouble sleepingDifficulty concentratingFeeling overwhelmed and thoughts of suicideReckless drivingIgnoring important tasks such as bills or homeworkAvoiding family or friendsPerforming poorly in school/workSkipping school/work

However, the stress-related disturbance does not only exist as an exacerbation of a pre-existing disorder and cannot be diagnostic as axis 1 disorder.

Suicidal behavior is prominent among people with AD of all ages, and up to one-fifth of adolescent suicide victims may have an adjustment disorder. Bronish and Hecht (1989) found that 70% of a series of patients with AD attempted suicide immediately before their index admission and they remitted faster than a comparison group with major depression. Asnis et al. (1993) found that AD patients report persistent or suicide attempts less frequently than those diagnosed with major depression. According to a study on 82 AD patients at a clinic, Bolu et al. (2012) found that 22 (26.8%) of these patients were admitted due to suicide attempt, consistent with previous findings. In addition, it was found that 15 of these 22 patients chose suicide methods that involved high chances of being saved. Henriksson et al. (2005) states statistically that the stressors are of one-half related to parental issues and one-third in peer issues.

Risk Factors

Various factors have been found to be more associated with a diagnosis of AD than other axis I disorders, including:

younger agemore identified psychosocial and environmental problemsincreased suicidal behaviour, more likely to be rated as improved by the time of discharge from mental healthcareless frequent previous psychiatric historyshorter length of treatment