How To Diagnose Adjustment Disorder

The stress that leads to Adjustment Disorder can be either a one-shot deal or a chronic problem that casts a shadow over many years. Single events are things like being fired from a job, starting or ending school, relocating to another city, or a romantic disappointment. Whenever the stressor is so clearly delineated, there is a six-month time limit on the symptoms because it gets harder after that to be sure that the more persistent problems were indeed caused by the stressor. For example, if a person continues to remain significantly depressed two years after ending a relationship, it becomes less likely that the breakup was by itself responsible for the depression and more likely that the person may have an independent mental disorder, like Major Depressive Disorder or Dysthymic Disorder.

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Sometimes the stressful events do not have such a clear-cut endpoint. Examples of ongoing stressors include being physically abused on a regular basis by a violent spouse, or working in an unbearable job, or dealing with being HIV positive. Some stressful events may seem to be time-limited but have serious ongoing repercussions that are long-term, like the continuing financial hardship after a divorce or the loss of a job. A chronic form of Adjustment Disorder is present when there is a long-term maladaptive reaction to a chronic stress and the person does not develop the full-blown severity of symptoms that would meet the definitional requirements of another mental disorder.

The most common problems that people develop in response to a stressful event are depression, anxiety, physical symptoms, a change in behavior, or some combination of these. After being fired from work, a woman falls into a funk, feeling depressed, drained of energy, and unable to get motivated to look for another job. Prior to an impending marriage, a man becomes so anxious, restless, and jumpy that he cannot concentrate at work or sleep through the night. Children may develop conduct problems that are completely out of character for them. After his parents’ separation, a previously well-behaved seven-year-old starts beating up his younger sister and trashing her toys.

Adjustment Disorder occurring in the context of medical illness is a common and sometimes even a potentially deadly combination. There is a large body of evidence that a positive outlook about an illness can make a big difference in achieving a good outcome. The symptoms of Adjustment Disorder can place a serious roadblock on the path to recovery. For example, a middle-aged businessman becomes depressed and listless after having a heart attack, gives up hope for the future, and repeatedly forgets to take his medication or follow his exercise program. Successful management of his Adjustment Disorder may be the most crucial step in improving his chances of recovery from the heart attack. You may need to consult a doctor online or visit a family doctor to get medication and consultation for a thorough examination.

Differential Diagnosis

Many psychiatric disorders are more likely to occur in someone who is under the gun of stressful life circumstances. The diagnosis of Adjustment Disorder is reserved for those situations in which the stress is causing significant problems but these have not crystallized into one of the more specific conditions.

Suppose a fifty-five-year-old man becomes anxious and depressed after being fired from a managerial job, loses interest in his family, friends, and hobbies, has trouble sleeping, loses weight, and is tired all the time. If his symptoms persist for at least two weeks, and are sufficiently severe, this would conform to the description of Major Depressive Disorder. If the symptoms last only for a few days or are relatively mild, this would be Adjustment Disorder with depressed mood. Adjustment Disorder is diagnosed only when a more specific diagnosis is not appropriate.

Adjustment Disorder and Posttraumatic Stress Disorder (PTSD) are alike in that these are the only two conditions in DSM-IV that require the presence of an external stressor. They differ, however, in the characteristic nature of the stressor and in the symptoms that result from it In PTSD the stress is a life-threatening event (a natural disaster, or a serious accident, or being the victim of a violent crime), whereas in Adjustment Disorder the stressors are more everyday and not life-threatening. The characteristic symptoms in PTSD (nightmares, flashbacks, and avoidance of reminders) distinguish it from the milder and more general symptom presentation in Adjustment Disorder.

Also keep in mind that even when an emotional symptom develops immediately after a stressful event, there are possible explanations other than its being a psychological reaction to it. Consider a seventy-five-year-old woman who becomes depressed after suffering a stroke that paralyzes the right side of her body. Although her depression could be a psychological reaction to her incapacity, it is equally possible that the stroke has caused it by damaging a part of her brain responsible for regulating mood. A college student, upset over the breakup of a romantic relationship, starts drinking heavily and then becomes alternately agitated, irritable, and weepy. Assuming a cause-and-effect relationship between the breakup and the mood changes ignores the alternative explanation that his unstable mood is a direct result of his heavy drinking.

Author Bio

Dr Chris Sailen s a consultant physician at Doctor Spring. He loves to write articles on Various medical condition and how it can be treated.

3 years ago

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