Adjustment Disorders

Adjustment disorders may be among the most common mental health diagnoses you will see in primary care.  

Adjustment disorders are defined as emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor and either/both:

  • Distress out of proportion with expected reactions to stressor
  • Symptoms must be clinically significant and impairing

And

  • Distress and impairment are related to the stressor and not an escalation of existing mental health disorders.
  • The reaction isn’t part of normal bereavement
  • Once the stressor is removed or the person has begun to adjust and cope, the symptoms must subside within 6 months.

Types:

  • Adjustment disorder with depression
  • Adjustment disorder with anxiety
  • Adjustment disorder with mixed depression and anxiety
  • Adjustment disorder with disturbance of conduct

Essentially, a child or adolescent experiences a difficult or stressful event, like parental separation or divorce, an unwanted move to a new community or school, or the diagnosis of a serious illness, and they don't do well.  They develop symptoms of anxiety, depression, or exhibit behavioral disturbance, or some combination of all these.  

By definition, kids either get through an adjustment disorder and it resolves, or it worsens into something else such as a depressive episode or more chronic conduct problems.  

Treatment

There is little research into the treatment of adjustment disorders in children and adolescents, but a pragmatic approach includes providing support, helping the child develop coping skills and strategies, and enlisting family support in mitigating the effects of the stressor to the extent possible. 

For example, in cases of parental divorce or separation, parental cooperation and consistency in treatment of the children can reduce the emotional impact.  Helping a child find new activities and peer groups in a new setting may improve the transition. 

Providing clear, developmentally appropriate information about a new medical diagnosis and treatment plan and offering ongoing support to the patient and family can reduce the stress of the diagnosis and reduce likelihood of disordered adjustment. 

In some cases, referral to psychotherapy may be appropriate.