Adjustment Disorder

An adjustment disorder is an emotional or behavioral reaction to a stressful event or change in a person’s life.

Moreover, The reaction is considered an unhealthy or excessive response to the event or change within three months of it happening.

Stressful events or changes in the life of your child or adolescent may be a family move, the parents’ divorce or separation, the loss of a pet, or the birth of a sibling.

A sudden illness or restriction to your child’s life due to chronic illness may also result in an adjustment response.

While adults can experience adjustment disorders, it is predominantly diagnosed in children also adolescents. [3]

Many different events may trigger symptoms of an adjustment disorder.

Stressors for people of any age include:

• Death of a loved one
• Either Divorce or problems with a relationship
• General life changes
• Illness or other health issues in either yourself or a loved one
• Moving to a different home or a different city
• Unexpected catastrophes
• Worries about money
• Changes in situation, such as retirement, having a baby or going away to school
• Adverse situations, such as losing a job

Risk Factors

Adjustment disorders are quite common in children and adolescents. They happen equally in males and females. While adjustment disorders happen in all cultures, the stressors and signs may vary based on cultural influences.

Adjustment disorders can also happen at any age. However, it is believed that characteristics of the disorder are different in children and adolescents than they are in adults.

Triggers of stress in teenagers and young adults may include:

• Either Family problems or conflict
• School problems
• Sexuality issues

There is no way to predict which people who are affected by the same stress are likely to develop adjustment disorder.

Your social skills before the event and how you have learned to deal with stress in the past may play roles.

Types of Adjustment Disorder

The DSM-5 lists six different types of adjustment disorders.

In addition, Although they’re all related, each type has unique signs and symptoms.

Adjustment disorders can be:

With depressed mood:

Symptoms mainly include feeling sad, tearful also hopeless and experiencing a lack of pleasure in the things you used to enjoy.

With anxiety:

• Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed.
• Children who have an adjustment disorder with anxiety may strongly fear being separated from their parents also from loved ones.

With mixed anxiety and depressed mood:

Symptoms include a combination of depression and anxiety.

With disturbance of conduct:

• Symptoms mainly involve behavioral problems, such as fighting or reckless driving.
• Youths may skip school or vandalize property.

With mixed disturbance of emotions and conduct:

Symptoms include a mix of depression and anxiety as well as behavioral problems.

Unspecified:

Symptoms don’t fit the other types of adjustment disorders, but often include physical problems, problems with family or friends, or work or school problems. [2]

Signs and symptoms depend on the type of adjustment disorder and can vary from person to person.

You experience more stress than would normally be expected in response to a stressful event, and the stress causes significant problems in your life.

In addition, Adjustment disorders affect how you feel and think about yourself and the world and may also affect your actions or behavior.

Some examples include:

• Feeling either sad, hopeless or not enjoying things you used to enjoy
• Frequent crying
• Worrying or feeling anxious, nervous, jittery or stressed out
• Trouble sleeping
• Lack of appetite
• Difficulty concentrating
• Feeling overwhelmed
• Difficulty functioning in daily activities
• Withdrawing from social supports
• Avoiding important things such as going to work or paying bills
• Suicidal thoughts or behavior

Duration of symptoms

Symptoms of an adjustment disorder start within three months of a stressful event and last no longer than 6 months after the end of the stressful event.

However, persistent or chronic adjustment disorders can continue for more than 6 months, especially if the stressor is ongoing, such as unemployment. [2]

If someone is already suffering from a medical illness, that condition may worsen during the time of the adjustment disorder.

People in the midst of adjustment disorders often do poorly in school or at work.

Very commonly they begin to have more difficulty in their close, personal relationships. [4]

DSM-IV TR criteria for the diagnosis of Adjustment Disorder are:

• Occurring within 3 months after the onset of a stressor.
• Marked by distress that is in excess of what would be expected, given the nature of the stressor, or by significant impairment in social or occupational functioning.
• Should not be diagnosed if the disturbance meets the criteria for another Axis I disorder or if it is an exacerbation of a pre-existing Axis I or II condition.
• Should not be made when the symptoms represent bereavement.
• The symptoms must resolve within 6 months of the termination of the stressor but may persist for a prolonged period (longer than 6 months) if they occur in response to a chronic stressor or to a stressor that has enduring consequences.[6]

Differential Diagnosis

• Major Depressive Disorder
• Personality Disorder
• Major Anxiety Depression
• Acute Stress Reaction
• PTSD
• Bereavement
• Normal Non-pathological Reaction to stress[8]

Treatment

Many patients with an adjustment disorder do not need any formal treatment; they recover spontaneously with the help of friends and family.

General measures:

Practical support:

It is important to try to relieve any stress that is still ongoing; for example, by providing financial support, childcare, helping to arrange a funeral, or getting an occupational therapy assessment.

Psychoeducation:

Give the patient also their family information about adjustment disorders, and reassure them that it is not a serious psychiatric condition and that they are not going mad.

Information leaflets, support groups, also websites can all be valuable.

Anxiety reduction:

Anxiety reduction can usually be achieved by encouraging patients to talk about the problems and to express their feelings to a sympathetic listener.

Moving Further, A friend or family member can provide this, and many patients will not need any more formal therapeutic input.

Psychological treatments:

Self-help materials:

A good first step is to provide the patient with appropriate self-help materials, varied according to the predominant symptoms.

CBT-based and problem solving materials (for example; books, computerized courses) are particularly useful.

Brief psychotherapy or counselling:

Talking about the problems, understanding the meaning of the stressor to the patient, also addressing cognitive distortions are the mainstay of treatment.

This can be delivered by many different health professionals, also longer formal CBT is not usually necessary.

Options include:

• Either Individual or group psychotherapy,
• Crisis intervention,
• Family therapy,
• Specific counselling.

The most effective approach is problem solving, in which the patient is helped to:

• Firstly, List the problems and think of multiple ways of overcoming them;
• Secondly, Consider the advantages and disadvantages of various solutions to the problems;
• After that, Select an action and test it out;
• At last, Evaluate the action.

If the third step succeeds, the process is repeated with another problem; if it fails, the patient tries another approach to the first problem.

Crisis intervention:

This approach is used when a patient has responded to an acute life change such as the sudden breaking up of an intimate relationship with a maladaptive coping mechanism such as deliberate self-harm.

Many mental health trusts have a crisis intervention team, who will provide daily telephone (or home visit) support to patients whilst they are at high risk in order to reduce the need for hospital admission.

Pharmacological treatments:

Short-term anxiolytics:

• It may be necessary to provide a short-term supply (a few days) of an anxiolytic in the immediate aftermath of the stressful event.
• A low-dose relatively short-acting benzodiazepine is the best choice.
• They should not be continued longer term due to the risks of tolerance and dependence.
• Occasionally insomnia is a problem, and a few nights of a hypnotic (temazepam or a z-drug) are helpful.

Antidepressants:

• There is no good evidence that antidepressants are effective in relieving the symptoms of adjustment disorders.
• However, if there are prolonged/distressing mood or anxiety symptoms, a low-dose SSRI may provide some relief.
• Other antidepressants are not recommended as the risks outweigh the benefits. [5]

Homeopathic Treatment of Adjustment Disorder

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Adjustment Disorder:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Ignatia Amara:

• Symptoms: Emotional strain; mental stress; negative effects of grief, worry, disappointment, shock; hysteria; sad, moody, sighing; insomnia; headache, often following anger or grief, which becomes worse from stooping; intolerance to tobacco.
• Worsened by: Suppressing emotions, tobacco, coffee, brandy, either smoke or strong odours.
• Better from: Lying on the painful side, warmth, also walking, hard pressure.

Phosphorus:

• Restlessness; overexcited state that causes weakness also exhaustion;
• Burning pains;
• Chilliness with thirst for cold drinks;
• Overdramatic;
• Acute senses; bothered by light also noise;
• Nervousness and fear;
• Sense that something bad will happen; fearful of being alone also crave company; easily frightened or upset, though can be reassured or distracted;
• Crave salt, spicy food, ice cream;
• Tendency to bleed easily (In other words, this should be evaluated medically); nosebleeds.
• Worsened by: cold or heat, lying on left or painful side, thunderstorms.
• On the other hand, Better from: massaging or rubbing; cold food or drink.

Aconitum Napellus:

• A panic attack that comes on suddenly with very strong fear ( even fear of death) may indicate this remedy.
• Strong palpitations may accompany a state of immense anxiety, shortness of breath, also flushing of the face.
• Sometimes a shaking experience will be the underlying cause.
• Strong feelings of anxiety may also occur when a person is just beginning to come down with a flu or cold.

Argentum nitricum:

• This remedy can be helpful when anxiety develops before a big event: an exam, an important interview, a public appearance or social engagement.
• Dizziness and diarrhoea may also be experienced.
• People who need this remedy are often enthusiastic and suggestible, with a tendency toward peculiar thoughts also impulses.
• Moreover, They often crave sweets and salt (which usually make their symptoms worse). [4]

Diet and Regimen

Here are some steps you can take to care for your emotional well-being.

Tips to improve resilience

Resilience is the ability to adapt well to stress, adversity, trauma or tragedy — basically, the ability to bounce back after experiencing a difficult event. Building resilience may vary from person to person, but consider these strategies:

• Stay connected with healthy social supports, such as positive friends and loved ones.
• Do something that gives you a sense of accomplishment, enjoyment and purpose every day.
• Live a healthy lifestyle that includes good sleep, a healthy diet and regular physical activity.
• Learn from past experiences about how you can improve your coping skills.
• Remain hopeful about the future and strive for a positive attitude.
• Recognize and develop your personal strengths.
• Face your fears and accept challenges.
• Make a plan to address problems when they occur, rather than avoid them.

Find support

It may help you to talk things over with caring family and friends, receive support from a faith community, or find a support group geared toward your situation.

Talk to your child about stressful events[7]