ADJUSTMENT D/O

Patient tend to blame a particular event, when a less

short term maladaptive rxns to a “personal calamity” obvious event may have had more meaning
 aka PSYCHOSOCIAL STRESSOR Current events may awaken past traumas or
 everyday events > catastrophic disappointments
must appear w/in 3 mo
Some children have less mature defensive constellations
resolve w/in 6 mo
than other children
 after the stressor ceases
 longer if chronic stressor or w/ long lasting Resilience  determined by nature of children’s early
consequences relationships w/ their parents
2-8% of general population
Response to traumatic life events is partially under genetic
♀ 2x control
boys = girls (children & aolescent) physical s/s most common in children and the elderly
freq in adolescents
 school problems Diagnosis and Clinical Features
 parental rejection & divorce ADJUSTMENT d/o …
 subst abuse w/ DEPRESSED MOOD  in adolescents (↑ risk for MDD)
in adults
 Depressed mood,
 marital problems, divorce
 Tearfullness
 new environment
 Hopelessness
 financial
w/ ANXIETY
the severity of the stressor does NOT always predict  palpitations, jitteriness, agitation
the severity of the d/o w/ MIXED ANXIETY and DEPRESSED MOOD
stressor severity is a complex fxn of w/ DISTURBANCE of CONDUCT
 degree  rights of others are violated
 quantity  age appropriate societal norms and rules are
 duration disregarded
 reversibility  truancy, vandalism, reckless driving, fighting
 environment w/MIXED DISTURBANCE of EMOTIONS and CONDUCT
 personal context UNSPECIFIED
 loss of parent is diff for a 10 y/o & 40 y/o  Maladaptive rxns to stress
stressors may be…  Inappropriate responses to the dx of physical illness
 single / multiple  Massive denial
 recurrent / continuous  Severe noncompliance w/ tx
 intrafamilial  Social withdrawal
 crime victim  W/O depressed or anxious mood
 physical illness
ICD 10
 @ community  nat’l disaster/ persecution
adjustment d/o is in same category as rxns to severe stress
 developmental stages  leaving home, getting  acute stress rxn
married, retiring  post-traumatic stress d/o
onset: within one month of event
Psychodynamic factors duration: no more than 6 months
3 FACTORS maladjustment features:
 NATURE of stressor  regressive behaviors
 MEANING (conscious & unconscious) of stressor  bed wetting
 (preexisting) VULNERABILITY of patient  baby-ish speech
 personality d/o  thumb sucking
 organic impairment DDX: px w/ adjustment d/o are impaired in social or
 loss of parent during infancy occupational functioning and show s/s beyong the normal
 reared in dysfunctional family and expectable reaction to the stressor
 support from key relationships
Acute & posttraumatic stress d/o
the same stress can produce a range of responses  More severe & longer lasting when stressor is of human
origin (rape) than when it is not (floods)
A person’s capacity to respond to stress is greatly  Most patients return to their previous level of fxning
influenced by … w/in 3 mos
 Mother  Adolescents usually req longer time
 Good enough mother Psychotherapy
 D. Winnicott
 Treatment of choice
 A person who adapts to the infants needs  Group therapy
and provides enuf support to tolerate the
 Individual therapy
frustrations in life 
 Family therapy
 Rearing environment
 Crisis Intervention
 Pharmacotherapy  not as a primary modality
 Diazepam
 Psychostimulant
 Anti psychotics
 SSRI

DSM IV Diagnostic Criteria for Adjustment d/o

the dvlpt of emotional/behavioral symptoms in
response to an identifiable stressor occuring w/in 3
months of the onset of stressor
these symptoms or behaviors are clinically significant
as evidenced by either of the ff:
 marked distress that is in excess of what would be
expected from exposure to the stressor
 significant impairment in social or occupational
(academic) fxning
the stress related disturbance does NOT meet the
criteria for another specific Axis I d/o and is not merely
an exacerbation of a preexisting Axis I or II d/o
the symptoms do NOT represent bereavement
once the stressor (or it’s consequences) has
terminated, the symptoms do not persist for more than
an additional 6 months

Acute : <6months
Chronic >/=6 months
Classify to subtype

L’08