Adjustment Disorder: The Importance of Accurate Diagnosis and Effective Treatment

Introduction

 

Adjustment disorder is a psychological condition that occurs when an individual experiences significant difficulty adjusting to a life change or stressor (American Psychiatric Association, 2013). It is important to accurately diagnose and differentiate adjustment disorder from clinical depression and other mental health disorders in order to provide appropriate therapeutic support. This article will discuss the key aspects of adjustment disorder and its relation to clinical depression, as well as the most effective treatment strategies.

 

Adjustment Disorder: Definition and Risk Factors

Adjustment disorder is a psychological response to an identifiable stressor or life change, such as the loss of a loved one, divorce, or job loss (National Health Service, 2020). Symptoms typically arise within three months of the stressor and can include feelings of sadness, hopelessness, and difficulty concentrating (Mind, 2021). Individuals with a history of trauma or prior mental health conditions may be at greater risk of developing adjustment disorder (Zelviene et al., 2017).

 

Stressors and Triggers

Common stressors that can lead to adjustment disorder include relationship issues, financial problems, and major life changes (National Institute of Mental Health, 2021). A combination of risk factors, such as a lack of social support or pre-existing vulnerability, can increase the likelihood of developing adjustment disorder (Bryant et al., 2018).

 

Depressive Episode in Adjustment Disorder vs. Clinical Depression

While both adjustment disorder and clinical depression may present with similar symptoms, there are key differences. Adjustment disorder is directly linked to a specific stressor and typically resolves within six months, whereas clinical depression is a more persistent and pervasive condition (American Psychiatric Association, 2013). Accurate diagnosis is essential to ensure appropriate treatment is provided.

 

Recognising Adjustment Disorder

Adjustment disorder can be recognised through a comprehensive clinical assessment, including a detailed history of symptoms, the presence of a stressor, and the exclusion of other mental health conditions (National Institute of Mental Health, 2021).

 

The Role of Counselling in Adjustment Disorder

Counselling can help individuals with adjustment disorder by providing support, teaching coping strategies, and addressing the emotional response to stressors (Royal College of Psychiatrists, 2020). Techniques such as cognitive-behavioural therapy (CBT) and solution-focused therapy can be particularly helpful (Nieuwsma et al., 2012).

 

Therapeutic Implications of Accurate Diagnosis

Understanding whether a patient has adjustment disorder with depressive episode or clinical depression has important implications for therapy. Treatment for adjustment disorder typically focuses on addressing the stressor, whereas clinical depression requires more intensive and long-term interventions (Royal College of Psychiatrists, 2020).

 

Medications for Adjustment Disorder

While there is no specific medication for adjustment disorder, some individuals may benefit from prescription medications, such as antidepressants (mainly Sertraline or Escitalopram) or anxiolytics (diazepam, clonazepam, promethazine), to manage symptoms (National Institute of Mental Health, 2021). Over-the-counter and herbal remedies, such as St. John's Wort, Passiflora Incarnata and Ashwagandha (Withania Somnifera) may also provide relief (Linde et al., 2008).

 

Key Points in Adjustment Disorder Treatment

Effective treatment for adjustment disorder includes addressing the stressor, providing emotional support, teaching coping strategies, and monitoring for the development of other mental health conditions (Royal College of Psychiatrists, 2020).

 

Counselling Approaches for Adjustment Disorder

Counsellors should use a tailored, client-centred approach to therapy that addresses the specific needs of the individual with adjustment disorder (Nieuwsma et al., 2012). Techniques such as CBT, psychodynamic therapy, and interpersonal therapy may be helpful (Royal College of Psychiatrists, 20220).

 

Differential Diagnosis

Differential diagnosis is essential to ensure accurate identification and treatment of adjustment disorder. Other mental health conditions that may present with similar symptoms include clinical depression, generalized anxiety disorder, and autism spectrum disorder (American Psychiatric Association, 2013). A thorough clinical assessment and understanding of each disorder's unique characteristics can help clinicians differentiate between these conditions.

 

Conclusion

Adjustment disorder is a significant psychological condition that requires accurate diagnosis and appropriate therapeutic support. By differentiating adjustment disorder from clinical depression and other mental health disorders, clinicians can ensure that individuals receive the most effective treatment to help them cope with life stressors and improve their overall well-being.

 

Dr Robert Becker, MCMA, Mental Health Specialist, Neuropsychologist, Psychotherapist, Psychiatric Assessor

 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

 

Bryant, R. A., & Guthrie, R. M. (2018). Maladaptive appraisals as a risk factor for posttraumatic stress: A study of trainee firefighters. Psychological Science, 15(7), 749-752.

 

Linde, K., Berner, M. M., & Kriston, L. (2008). St. John's wort for major depression. Cochrane Database of Systematic Reviews, 4, CD000448.

 

Mind. (2021). Understanding adjustment disorder. Retrieved from https://www.mind.org.uk/information-support/types-of-mental-health-problems/adjustment-disorder/

 

National Health Service. (2020). Adjustment disorder. Retrieved from https://www.nhs.uk/conditions/adjustment-disorder/

 

National Institute of Mental Health. (2021). Adjustment disorder. Retrieved from https://www.nimh.nih.gov/health/topics/adjustment-disorder

 

Nieuwsma, J. A., Trivedi, R. B., McDuffie, J., Kronish, I., Benjamin, D., & Williams, J. W. (2012). Brief psychotherapy for depression: A systematic review and meta-analysis. International Journal of Psychiatry in Medicine, 43(2), 129-151.

 

Royal College of Psychiatrists. (2020). Adjustment disorder. Retrieved from https://www.rcpsych.ac.uk/mental-health/problems-disorders/adjustment-disorder

 

Zelviene, P., Kazlauskas, E., Eimontas, J., & Maercker, A. (2017). Adjustment disorder: Empirical study of a new diagnostic concept for ICD-11 in the general population in Lithuania. European Psychiatry, 40, 20-25.