Adjustment Disorder
A PowerPoint Presentation by Jessica Way, RN
Objectives: What’s it all about?
• To learn more about Adjustment
Disorder
• To learn the who, what, where, why and
how of Adjustment Disorder
• To learn how to treat Adjustment
Disorder
What is Adjustment Disorder?
•
Adjustment Disorder is a condition of emotional distress triggered by
significant subjective events in an individual’s life.
•
According to the World Health Organization 10 Classification of
Diseases (ICD-10), Adjustment Disorder (AD) is defined as “a state of
subjective distress and emotional disturbance, usually interfering with
social functioning and performance, arising in the period of adaptation
to a significant life change or stressful event.”
•
According to Taber’s Cyclopedic Medical Dictionary, AD is “a
maladaptive reaction to an identifiable psychological or social stress
that occurs within three months of the stressful situation.”
•
According to the Diagnostic and Statistical Manual of Mental
Disorders (DSM IV-TR), “the development of emotional or behavioral
symptoms in response to an identifiable stressor occurring within
three months of the onset of the stressor.”
It is important to note...
•
....that Adjustment Disorder is different from depression in that the
symptoms must resolve within six months of the onset of the stressor.
•
According to DSM IV-TR, “the symptoms must resolve within six
months of the termination of the stressor (or its consequences)” and
the diagnosis of Adjustment Disorder “should not be made when the
symptoms represent bereavement.”
•
And, according to WHO ICD-10, “the acute stress reactions occur
within one month of a psychosocial stressor that is not of an unusual
or catastrophic type.”
Pathophysiology of Adjustment Disorder
•
Pathophysiology may be
defined as the functional
changes associated with, or
resulting from, a particular
injury or disease.
•
With Adjustment Disorder, the
“disease” or “injury” would be a
subjective stressor in an
individual’s life.
•
The stressor is any event in an
individual’s life that is
perceived as stressful by that
individual....and it can be
eustress, too! (Good stress is
still stress!)
Who’s at Risk for Adjustment Disorder?
•
Anyone and everyone! Each one of us has had plenty of stressful
events in our lives (remember, good stress is still stress) and each
one of us reacts differently to each stressor. For instance, the loss of
a pet is devastating for some people, whereas other people may not
be affected at all.
•
Different life/developmental stages may play a part in being at-risk for
AD. As we age, we learn different coping skills in response to various
life events, and can reflect on and use them to “get through” major
events that cause stress.
•
We may not have learned those coping mechanisms at certain stages
in life (i.e., adolescence, older adults) and we may not have
encountered certain stressors yet (i.e., changes associated with
aging).
Manifestations of Adjustment Disorder
•
According to the DSM IV-TR, some
emotional signs of AD are crying spells,
sadness, hopelessness, lack of
enjoyment, nervousness, anxiety, worry,
difficulty sleeping or concentrating,
feeling overwhelmed and in extreme
cases, thoughts of or attempts of
suicide.
•
Behavioral signs may include avoidance
of important tasks (i.e., not paying bills,
not completing homework), fighting,
reckless or risk-taking activities (i.e.,
reckless driving), calling in sick to work
excessively, isolation of oneself from
family and friends.
Some illustrations of typical
manifestations of
Adjustment Disorder
What Diagnostic Tests Are Involved?
•
Adjustment Disorder is a psychological or mental health
issue and according to the Mayo Clinic’s website, AD is
diagnosed based on signs and symptoms and a
thorough psychological evaluation. To be diagnosed
with adjustment disorder, someone must meet criteria
spelled out in the Diagnostic and Statistical Manual of
Mental Disorders (DSM IV-TR).
•
These signs and symptoms are listed in the previous
slide.
How do we treat Adjustment Disorder?
=Most
cases of Adjustment Disorder are
effectively treated with psychotherapy.
Pharmacotherapy for Adjustment Disorder
•
Pharmacotherapy is sometimes
used in adjunct to
psychotherapy treat Adjustment
Disorder.
•
Antidepressants such as
imipramine (Tofranil), sertraline
(Zoloft) or bupropion
(Wellbutrin) and anxiolytics like
buspirone (BuSpar) or
paroxetine hydrochloride (Paxil)
can be very helpful.
•
Benzodiazepines like
alprazolam (Xanax) or
chlordiazepoxide (Librium) can
be used for severe cases.
You may be thinking, “I’m a nurse, not a psychotherapist.
How can I help in ways other than just passing
meds to my patient?”
•
Offer support, reassurance,
and understanding.
•
Let your patient know their
reactions are normal.
•
Giving patients choices helps
empower them
•
Encourage them to express
their feelings.
•
LISTEN.
Don’t believe me?
• We all know they can’t put anything that isn’t
true on the Internet (haha) so here’s a
YouTube video about Adjustment Disorder:
•
http://www.youtube.com/watch?v=f-8gnXuX-VQ
•
According to the DSM IV-TR, Dr. Spiegel is incorrect at
0:32 when he states “loss of a loved one.” (Please refer
to slide #3.)
References
=American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders fourth edition text
revision. Washington D.C.: American Psychiatric
Association.
=Carta, M. G. (2009). Adjustment disorder: Epidemiology,
diagnosis and treatment . Clinical Practice and
Epidemiology in Mental Health, 5(15), doi: 10.1186/17450179-5-15
=(2009). D. Venes (Ed.), Taber's Cyclopedic Medical
Dictionary (21st ed.). Philadelphia: F.A. Davis Company.
=Mayo Clinic Staff. (2011, March 17). Adjustment
disorders: Tests and diagnosis. Retrieved from
http://www.mayoclinic.com/health/adjustmentdisorders/DS00584/DSECTION=tests-and-diagnosis
=World Health Organisation, (1994). The ICD-10
classification of mental and behavioural disorders.
Retrieved from website:
http://www.who.int/classifications/icd/en/bluebook.pdf