The adaptive disorders or adjustment disorders first appeared in the third edition of the Diagnostic Manual of Mental Disorders (DSM-III) and just after that they appeared in the International Classification of Diseases (ICD-9).

This inclusion involved the recognition that some individuals may develop psychological symptoms or exhibit behaviors that occur in a short period of time in response to various stressful events. The consequences also manifest themselves in functional impairment (social or occupational), and the most common psychological symptoms are depression or anxiety.

Definition of Adaptive Disorders

The DSM-IV defines adaptive disorders as: “emotional or behavioral symptoms in response to an identifiable stressor that occurs within three months of the presence of the stressful situation. These symptoms or behaviors are clinically significant as evidenced by greater discomfort than would be expected from the stressor or by significant impairment in social or work (or academic) activity”.

The definition excludes the diagnosis of this disorder if there is another pathology that may be causing the symptoms. Adjustment disorder may be classified as either acute or chronic . Within each form there are different types, such as anxious or depressed.

In the case of the ICD-10, it is a requirement that the symptoms occur within one month of the appearance of the stressful phenomenon, while according to the DSM-IV the requirement is three months . In addition, the latter reports that the symptoms should remit after six months, although, as mentioned above, it also acknowledges that there may be a chronic form as a result of prolonged exposure to a stressor. For example, the loss of a job can lead to the loss of a home and therefore to separation from one’s marriage.

The diagnosis of this disorder has caused some controversy. One of the most important dilemmas is the distinction between normal reaction to stress. Something that becomes inevitable so as not to pathologize the day-to-day life of people and the normal setbacks that can arise.

Subtypes of adjustment disorders

There are different subtypes characterized by the symptoms presented by patients with this psychopathology.

  • Depressive subtype : There is a predominance of symptoms characteristic of a low mood, such as crying or hopelessness.
  • Anxious subtype : Characterized by symptoms associated with anxiety: nervousness, irritability, etc.
  • Mixed subtype with anxiety and depressive mood : Individuals have symptoms of the above subtypes.
  • With behavioural disorder : There is an alteration of behaviour, in which the rights of others or social norms and rules, characteristic of age, are violated.
  • With mixed alteration of emotions and behaviour : There are emotional and behavioural alterations.
  • Not specified : Misadaptive reactions to stressors that are not classifiable in the other subtypes

Differential Diagnosis: Adaptive Disorder and Post-Traumatic Stress Disorder

The differential diagnosis is important because in addition to ruling out other disorders such as dysthymia or generalized anxiety disorder, which last for more than six months, adaptive disorder must be differentiated from post-traumatic stress disorder (PTSD).

The main difference with the latter is that the symptoms of PTSD manifest themselves with the re-experience of the traumatic event, but, instead, the adaptive disorder must be preceded by a stressor or a set of stressors .

Treatments

Choosing the appropriate treatment is a clinical decision that takes into account the patient’s history. There is currently no consensus on the optimal treatment, but different forms of psychotherapy have been shown to be effective . Sometimes drugs can also be administered to reduce the symptoms.

1. Psychopharmacology

The use of drugs should never be the first choice in treatment, since the patient will not get better if the problem is not addressed in its entirety. But sometimes, to reduce the discomfort, the patient can take small doses of anti-anxiety drugs such as Diazepam or Alprazolam. In case of insomnia, Flunitrazepam usually works very well. In cases of low mood, antidepressants such as Fluoxetine (Prozac) can reduce negative symptoms.

2. Psychotherapy

Because adjustment disorder does not last long, brief rather than long-term psychotherapy is generally preferred . Psychological therapy is helpful for the following reasons:

  • To analyze stressors affecting the patient
  • To help the patient interpret the meaning of the stressor more adaptively
  • To help the patient talk about the problems and conflicts they are experiencing
  • To identify ways to reduce the stressor
  • To maximize the patient’s coping skills (emotional self-regulation, avoidance of inappropriate behaviors, especially substance abuse)

Some f orms of psychotherapy that may be effective are as follows:

  • Cognitive-behavioral therapy (CBT)
  • Family and group therapies (specific support for the stressor)
  • Mindfulness therapy

Bibliographic references:

  • Evans, Rand. (1999). Clinical psychology born and raised in controversy. APA Monitor, 30(11).
  • Lemos, S. (2000). General psychopathology.Madrid: Síntesis.
  • Vallejo-Riuloba, J. (1991). Clinical cases. Psychiatry. Barcelona: Salvat.