Adjustment disorders fall somewhere between having a psychiatric disorder and normalcy. It is like someone with a slightly weaker psychological disposition, when faced with normal life stresses, develops psychological problems.
A normal person may still experience mild short-lasting stress symptoms in the face of normal life stress but the severity of the symptoms is not sufficient to warrant a clinical diagnosis or a diagnosis of adjustment disorder. Adjustment disorders are therefore subclinical manifestation of an individual’s reactions to normal life stress.
The nature of stress could be in the form of migration, marriage, divorce, change of job, unemployment, marital discord, leaving school/college/university, work-relates stress, bereavements, retirement etc.
The diagnosis of adjustment disorder is used when the following conditions are met:
- Symptoms occur within one month of the occurrence of stressful event or life change.
- The duration of symptoms does not usually exceed six months, the exception of prolonged depressive reaction which can last up to 2 years.
- The symptoms can be understood in the light of life stresses and our circumscribed around the stresses with periods of normalcy in between.
- The severity of the symptoms is such that it does not warrant a clinical diagnosis of anxiety disorder or depressive episode.
- The subjective distress and emotional disturbance generally interferes with one’s social functioning and performance.
- Individual predisposition or vulnerability plays a greater role in the risk of occurrence and the shaping of the manifestations of adjustment disorder. The condition would not have occurred without the stressor.
The adjustment disorder can manifest in one of the following ways:
- Anxiety, depression, irritability, anger
- A feeling of inability to cope, plan ahead or continue in the presence of situation and some degree of disability in the performance of daily routine.
- outbursts of violence
- Children it can manifest as return of bed-wetting, thumb sucking, babyish speech, etc.
- Bereavement reactions can be included under this category if the duration is more than six months.
Although the severity of symptoms is subthreshold for the diagnosis of anxiety disorder or depressive disorder, adjustment reactions do require a treatment in the form of counselling, psychotherapy and medication. The choice of medication will depend upon the presentation and generally antidepressants are the first line of treatment even for anxiety symptoms.
- The ICD – 10 Classification of Mental and Behavioural Disorders, Clinical Descriptions and Diagnostic Guidelines, WHO, Geneva, 1992