Essentials

  • Adjustment disorders are reactive and usually short-lasting states associated with life situations. They manifest as anxiety, depression or behavioural symptoms and appear after a major change in life or a psychologically straining experience.
  • The diagnosis of adjustment disorder is made by excluding other disorders. The presence of a stressor does not automatically mean that the patient has adjustment disorder. Stressors may also trigger several other psychological disorders, particularly states of depression 1.
  • Although adjustment disorders are mostly mild and transient they should not be underestimated. An adjustment disorder may develop into a more severe disorder, and particularly in the young it may be associated with self-destructive behaviour.

Diagnosis

Diagnostic criteria

  • Emotional or behavioural symptoms develop within one month (ICD-10) from the appearance of a stressor.
  • Symptoms or behavioural characteristics are clinically significant
    • The stressor causes more suffering than expected or
    • Impairs considerably the patient's social and occupational functioning
    • The disorder does not fulfil the criteria of some other psychological disorder that could be pertinent to the patient's life situation nor is it the aggravation of an earlier disorder.
  • The symptoms are not grief caused by a loss.
  • When the stressor has ceased to affect the patient, the symptoms resolve within 6 months.

Diagnoses based on the major symptom

  • Reactive depression
    • The principal symptoms are depressed state, crying and hopelessness.
  • Reactive anxiety
    • The principal symptoms are nervousness, worry and tension.
  • Reactive behavioural disorders
    • The principal manifestations are behaviour that violates the rights of other people and breaks central age-associated social norms and rules (e.g. vandalism, reckless driving, fighting).
  • Reactive emotional and behavioural disorder
    • The principal manifestations are both emotional symptoms and those associated with behaviour disorder.

Treatment

  • The treatment of adjustment disorder is carried out according to the principles of crisis psychotherapy.
  • The patient needs to be heard and understood. The person providing care should both accept the psychological malaise associated with the patient's life situation and at the same time calmly help the patient to see that the situation can be overcome or that it can be alleviated.
  • Typically, one or two meetings alleviate the condition, and the patient begins to see how he/she could function in this new life situation.
  • The need for sick leave varies from a few days to a few weeks.
  • The role of pharmacotherapy is secondary.
  • Persons suffering from substance abuse and personality disorders often have psychosocial strain associated with their own behaviour, which may worsen their mental health status. Adjustment disorder related to the stress factors can be used as a parallel diagnosis.

Evidence Summaries


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TY - ELEC T1 - Adjustment disorders ID - 456386 BT - Evidence-Based Medicine Guidelines UR - https://evidence.unboundmedicine.com/evidence/view/EBMG/456386/all/Adjustment_disorders PB - Duodecim Medical Publications Limited DB - Evidence Central DP - Unbound Medicine ER -