Adjustment disorder with mixed disturbance of emotions and conduct symptoms

Trauma- and stressor-related disorders are characterized by exposure to a traumatic or stressful event, followed by significant psychological distress or behavioral disturbance.  People with reactive attachment disorder and disinhibited social engagement disorder show marked alterations in social interactions resulting from social neglect or deprivation from caregivers.  People with acute stress disorder and posttraumatic stress disorder exhibit an onset of emotional symptoms following a severe traumatic experience. People with adjustment disorder show a significant disturbance of mood or behavior following an acute (though not necessarily traumatic stressor).  

What is adjustment disorder?

Adjustment disorder is characterized by the presence of emotional or behavioral symptoms in response to an identifiable stressor.  Stressors may be a single event, or multiple events. The prevalence of adjustment disorder in the population is not known, though this condition is present in 5-20% of patients receiving outpatient mental health treatment.  Adjustment disorder is associated with an increased risk of suicide or suicide attempts. Symptoms of adjustment disorder include:

• The development of emotional or behavioral symptoms following an identifiable stressor, with symptom onset beginning within 3 months of the onset of the stressor.
• Marked distress that is out of proportion to the stressor, or significant impairment in important areas of functioning.

Adjustment disorder, by definition, does not last more than 6 months following the termination of the stressor. After that point, other diagnoses must be considered.

Understanding Adjustment Disorder

There has been relatively little research to help us understand adjustment disorder. It is noted that adjustment disorder is not the same thing as a normative response to stressors. The diagnosis is appropriate when the person’s distress or behavioral disturbance exceeds that which would normally be expected, or when the disturbance causes functional impairment. Adjustment disorder can produce impairments in work, school, or social or family relationships. Adjustment disorder may be present in people with other psychiatric disorders.

How is adjustment disorder treated?

There has been little high-quality research on the treatment of adjustment disorder, and no treatment guidelines have been published on this topic.  Current practices include:

• Psychological treatment. Psychological treatment for adjustment disorder is usually relatively brief, as adjustment disorders is generally short lived, although a longer course of therapy may be needed when stressors are chronic or in the presence of personality disorder that increases vulnerability to stressors.  It may be desirable to take steps to reduce or remove the stressor, when possible. Problem-solving techniques may be used to help the patient making these decisions. When a stressor cannot be removed or reduced, cognitive-behavioral strategies such as problem-solving, cognitive restructuring, or relaxation training may be used to reduce the patient’s response to the stressor.  Psychological treatments can be delivered in an individual or group format.
• Psychiatric medications. Medication management of adjustment disorder typically consists of the management of anxious or depressive symptoms.  Benzodiazepines and antidepressant medications have been used, although evidence for the efficacy of these medications specifically for adjustment disorder is sparse.  

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