Adjustment disorder
An adjustment disorder is a reaction to one-off or continuing stressful events.
Molding
- Adjustment disorder with predominant disturbance of social behavior: Examples are: irritability, group clown, outsider, aggressive behavior, lack of self control, introversion.
- Adjustment disorder with predominant disturbance of emotions: Examples are: indifference, helplessness, aggression, depressed mood, apathy.
- Mixed adjustment disorder ( both conduct disorder and the feelings)
The DSM - IV lists various types of adjustment disorders to as adjustment disorders with anxiety or depressive mood. These diagnoses are made when the symptoms occur within three months after the onset of stress. The symptoms can be up to six months after the load has declined continue.
Synonyms for adjustment disorder are hospitalism in children, bereavement, culture shock, homesickness, nostalgia, neurotic depression or reactive depression.
Symptoms
The symptoms can be very varied and depend individually on the person and the perceived as a burden from event.
The following symptoms are possible:
- Feeling of distress
- Emotional impairment
- Altered social behavior
- Problems with proximity / distance
- Possibly social withdrawal
- Feelings of emptiness
- Thoughts circles
- Increased concern
- Joylessness
- Mourning
- Anxiety
- Depressed mood
The manifestations vary and include depressed mood, anxiety or worry (or a mixture of these), but not be so striking that the specific diagnoses can be given. In addition, a feeling persists, with the everyday realities not cope, not being able to plan ahead or resume. Conduct disorders may be an additional problem, particularly among young people.
Causes
The adjustment disorders are reactions to stress. Such stresses may be ending a relationship, marriage problems, difficulties at work or bullying. But even so-called critical life events such as changing schools, marriage, birth, death of a family member, unemployment, emigration, retirement can be a burden and lead to an adjustment disorder in the lack of ability to cope. It also applies to events such as flight accidents, robbery or operations. In children and adolescents can neglect ( see: hospitalism, Deprivationssyndrom, deprivation ) may be the cause.
Individual predisposition or vulnerability plays an important role in the possible occurrence and in the form of adjustment disorder; it is still assumed that the disease would not have occurred without the burden.
Frequency
Adjustment disorders are relatively common, estimates put the 5 to 20% of patients in outpatient psychotherapy, psychiatric treatment. There is probably a high number of unreported cases. However, there are doubts as to whether adjustment disorders occur as frequently as suggested by this finding. This diagnosis seems instead to be one of the most popular among clinicians because it can be applied to a number of symptoms.
Differential Diagnosis
There are several disorders that are similar to adjustment disorder at first glance, such as the attachment disorder, borderline, Autism, Asperger syndrome and schizoid personality disorder.
A distinction from other disorders is often only possible if the person concerned is not in a home, a hospital or an institution, that is not in an environment that promotes the hospitalism. If the person brought in a "normal" environment, the behavior improves often after several months.
In contrast to attachment disorder the person is not prone to violent or aggressive behavior and not to a " frozen" facial expression or to increased vigilance against the environment.
The autism differs from the adjustment disorder primarily by the fact that the autistic behavior persists even with good care and enough stimulation. Also, found in patients with an adjustment disorder is not the specific behavior of autistic people. People with adjustment disorder have, in contrast to people with autism also no language deficits.
A differentiation from Asperger's syndrome is to perform a neurological examination, which provides in people with Asperger syndrome often abnormal findings.
Differentiation from schizoid personality disorder can sometimes be difficult.
Consequences and complications
The subjective well-being of those concerned is impaired; there are feelings of anxiety, depression and / or anxiety. There may be difficulties to cope with everyday life and its requirements. Especially in adolescents social behavior may be impaired, so that it comes to loneliness and isolation. The consequences may be disability, difficulties in the relationship, or suicidal thoughts.
Treatment
Adjustment disorders are treated with psychotherapy, in individual cases, antidepressants are given supportive.