KASHAF ALI

MS CLINICAL PSYCHOLOGY
What are adjustment disorders?

• An adjustment disorder is an emotional and behavioral

reaction to stressful event or change in a person life.

• The reaction is considered unhealthy and excessive response

to the event.

• It happens within 3 months of the onset of stressor’s.

HAVE A LOOK
Stressor Behavioral symptoms
• Death of closed one • Crying easily
• Relationship issues • Being anxious
• Financial issues • Depressive symptoms
• Job difficulty • Abusing alcohol or drugs
• Retiring • Acting rebellious
• Natural disaster • Physical symptoms
• chronic illness • Suicidal thoughts & behaviors
• Marked distress is out of
proportion severity or intensity
of stressors while noticing
external context and cultural
factors.
• Significant impairment in
social, occupational or other
important areas of life.
CONT.
• The stressor related disturbance does not
meet full criteria for another mental
disorder.
• It is not merely exacerbation of a preexisting
mental disorder.
• The symptoms don’t represent normal
bereavements.
• Once the stressor or its consequences have
terminated, the symptoms don’t persist for
more than an additional 6 months.
 SPECIFIERS
With depressed mood
• Low mood
• Tearfulness
• Hopelessness
With Anxiety
• Nervousness
• Worry
• Separation anxiety
• Jitteriness
SPECIFIERS
With mixed anxiety & depressed mood
• Combination of depression & anxiety
With disturbance of conduct
• Violation of rules and law
• Violation of others rights
• Destruction of property
• Reckless driving
• Fighting
• Disobeying
SPECIFIERS
With mixed disturbance of emotions and conduct
• Combination of symptoms (depression & anxiety) with disturbance
of conduct
Unspecified
• For maladaptive reactions that are not classifiable as one of the
specific subtypes of adjustment disorder.
RISK • Environmental
People from disadvantaged life circumstances

FACTORS experience a high rate of stressors and may be at

increased risk for adjustment disorders.
PREVALENCE
It is very common disorder.
It is more common in adolescents
In psychiatric setting, its diagnosis
is reaching 50%.
DEVELOPMENT
& COURSE
• This disorder begins within 3
months of onset of stressor and
lasts no longer than 6 months
after the stressor or its
consequences have ceased.
• If stressor is acute event, the
onset is immediate & duration is
brief.
• If stressor or its consequences
persist, disorder may continue to
be present and in persistent form.
Differential diagnosis
• Major depressive disorder
If an individual has symptoms that meet criteria for a major depressive disorder in response to stressor,
diagnosis of adjustment disorder can not be given. The symptom profile differentiate it from adjustment
disorders.

• PTSD
PTSD involves traumatic event or change but adjustment disorder does not require overwhelming stressor.
PTSD has more severe manifestations such as nightmares, flashbacks and hypervigilance. And adjustment
disorder can be diagnosed immediately and persist up to 6 months after exposure to traumatic event while
PTSD cannot be diagnosed until 1 month has passed since the occurrence of traumatic stressor.
Cont.
• Acute stress disorder
Its stressor is traumatic e.g. rape, assault. Its symptoms occurs within three months to one month after a
traumatic event. Symptoms are severe and recurrent . Have flashbacks of traumatic event.

• Psychological factors affecting medical conditions

Sometimes psychological symptoms, behaviors may exacerbate medical condition. These can worsen medical
health or existing condition. But adjustment disorder is reaction to stressor.

• Normative stress reactions

When bad things happen, people become sad and agitated sometimes. But its not adjustment disorder. The
diagnosis is made only if whole criteria meet and its magnitude increases what normally is expected.
Case
• A Young female developed adjustment disorder with depressive and anxiety symptoms after a
diagnosis of pulmonary arterial hypertension. PAH is severe disabling disease with high mortality
rate. She used to cry . She was not hopeful about recovery. She was much worried and
depressive. At the start of treatment, she reported significant mental distress, indicated by score
20 on Hospital Anxiety and depression scale. She was treated with meta cognitive therapy that
seems helpful for cure by reducing the score to 9 point.
 This category applies to presentations in which symptoms characteristics of a trauma and stressor related
disorder that cause clinically significant distress or impairment in social, occupational or other important
areas of functioning but meet full criteria for any of disorders in trauma and stress related disorder.

OTHER SPECIFIED TRAUMA-&

STRESS RELATED DISORDER
EXAMPLES
• Adjustment like disorder with delayed onset of
symptoms that occur more than 3 months after the
stressor.
• Adjustment like disorder with prolonged duration of
more than 6 months without prolonged duration of
stressor.
• Ataque de nervios (attack of nerves)
• Other cultural syndromes
• Persistent complex bereavement disorder
UNSPECIFIED TRAUMA-& STRESSOR
RELATED DISORDER
This category applies to presentations in which symptom characteristic of a trauma –and stressor
related disorder that cause clinical distress or impairment in social, occupational or other
important areas of functioning predominate but meet the full criteria for any of disorder in
trauma and stress related disorders diagnostic class.
It is used in the situation in which the clinician choses not to specify the reason that the criteria
are not met for a specific trauma and stress related disorder, and include presentations in which
there is insufficient information to make a more specific diagnosis (e.g. In emergency room).