Special Topic Report



ADJUSTMENT DISORDER

I. Definition

• type of mental disorder resulting from maladaptive, or unhealthy, responses to stressful or psychologically distressing life events. .

• often called situational depression

II. Epidemiology

• Women are diagnosed with adjustment disorder twice as often as men (2:1).

• Single women are generally overly represented as being most at risk.

III. Etiology

• An adjustment disorder is precipitated by one or more stressors. Stressors are adjustive demands made on the individual.

• Stressors may be:

o Single, such as a divorce or the loss of a job

o Multiple, such as the death of a person important to a patient which coincides with the patient’s physical illness and loss of a job.

o Recurrent, such as seasonal business difficulties OR

o Continuous, such as chronic illness or poverty.

IV. Pathophysiology

• The most seriously disruptive reaction to stress is decompensation. When the stressor situation is extremely demanding or prolonged any adaptive capacities of the individual may be overwhelmed.

V. Signs and Symptoms

six subtypes of adjustment disorder,

• depressed mood: The chief manifestations are feelings of sadness and depression, with a sense of hopelessness

• anxiety: He or she may feel unable to control his or her thoughts of doom.

• mixed anxiety and depressed mood: The patient has a combination of symptoms from the previous two subtypes. Do not meet the criteria for an already established anxiety or depressive disorder.

• disturbance of conduct: The patient disregards the rights of others or previously followed rules of conduct with little concern, guilt or remorse.

• mixed disturbance of emotions and conduct

• Unspecified: This subtype covers patients who are adjusting poorly to stress but who do not fit into the other categories.

NOTE: Adjustment disorders may lead to suicide or suicidal thinking

Posttraumatic Stress Disorder:

Symptoms develop after a psychologically traumatazing event or events outside the range of normal human experience.

VI. Course and Prognosis

• Symptoms of an adjustment disorder must appear within three months of a stressor. The symptoms usually resolve within 6 months, although they may last longer if produced by a chronic stressor.

• For most people, an adjustment disorder is temporary and will either resolve by itself or respond to treatment. For some, however, the stressor will remain chronic and the symptoms may worsen.

• With appropriate treatment, the overall prognosis of an adjustment disorder is generally favorable

VII. Medical Management

The judicious use of medications can help patients with adjustment disorders, but they should be prescribed for brief periods.

VIII. OT application

A. FOR -

• Cognitive – Behavioral FOR

▪ The cognitive behavioral approach assumes that a person's cognitive function and beliefs influence their behavior, and that by helping a person, they will be empowered to change their behavior.

• Role Acquisition Frame of Reference

▪ The goal of therapy becomes assisting the individual to relearn a more functional role or in the case of chronic terminal illness, to adapt the role so that function is maintained.

▪

B. Evaluation and assessment

• Psychotherapy remains the treatment of choice for adjustment disorder.

- can help people adapt to stressors.

o Group therapy can be particularly useful for patients who have undergone similar stresses.

o Individual psychotherapy offers the opportunity to explore the meaning of the stressor to the patient.

C. OT Management

Goodman Battery

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