A whole complex of psychological symptoms that manifest themselves very acutely as a response to a particular stressful situation is united by the concept of adaptation disorder.

The pathology is classified as independent and is not an exacerbation of any mental disorders. The prevalence of the disorder is very high - the ratio is 1:5, and total duration- from several months to 2 years.

At the same time, the usefulness of psychological adaptation is always closely related to the absence of disturbances in the biological and physiological sphere. Otherwise, the expected psychotherapeutic effect without eliminating the somatic root cause will be either extremely weak even with long-term therapy, or it will not exist at all.

Likewise, it is important to take into account the patient’s initial personality type, his social status and living conditions. For example, the course of an adaptation disorder in a choleric person may be exactly the opposite of that of a melancholic person. And such variability often complicates the diagnosis of the disease.

Adaptation disorder arises and develops primarily against the background of an emotionally stressful situation. Provoking factors can be both psychosocial and medical:

• breakup of a very significant relationship;
• dismissal from work;
• protracted family conflicts;
• emigration;
• low self-esteem;
• perfectionism;
• systematic dissatisfaction by society with the psychological needs of the individual: a tendency to solitude or, conversely, the need for increased attention;
• major material losses;
• regular financial difficulties;
• a complete change in the usual way of life;
• divorce;
• natural disasters or military actions;
• conscription into the army;
• individual predisposition to excessive dramatization of stressful situations;
• emerging health problems, undergoing major operations;
• serious illness of a family member.

To a large extent, the situation risks getting worse in combination with the following biological and physiological factors:

• Iron-deficiency anemia;
• immunodeficiency state;
• changes in loads for the worse;
• forced changes in diet and microelement composition of water;
• changes in atmospheric pressure;
• sudden climatic changes.

The disease rarely occurs immediately. Typically, the intensity of destructive emotions increases during the first 1-3 months after the causative factor, and in some cases provokes negative social and even medical consequences.

Important. Despite the fact that the death of a loved one causes most of the same temporary difficulties in professional and social life, such behavioral pathologies are not considered as an adaptation disorder. Everything that happens is considered within the acceptable norm for reacting to the loss of a loved one.

Symptoms

The patient has a clear connection with the stressful situation he suffered. Moreover, stress means both acute and chronic. In a situation with acute stress, clinical symptoms develop within 10-14 days.


The patient's mood is constantly depressed to a mild or moderate degree. There is a trend of improvement in the evening and a significant decrease in the morning. In almost every case there is an alarming state. There is a certain amount of anxiety that is directly related to the psychotraumatic factor. The experiences are difficult, exhausting, appear immediately after waking up and persistently persist throughout the day.

Sometimes you manage to distract yourself, and by the evening it can become much better, but only before going to bed. When you try to sleep, your anxiety gets worse again. Such painful and painful experiences become a serious obstacle in the learning process and professional activity.

One of the symptoms of adjustment disorder is sleep disorders. The process of falling asleep is very long, the dreams are disturbing or nightmarish. Awakenings are most often premature, very early, with the inability to fall back to sleep.

Appetite is slightly reduced, but the patient often forgets about food due to complete immersion in experiences. If offered food, most often he eats the entire portion.

General state . Concentration suffers, fatigue increases, and the body feels constant lethargy. Often all this is accompanied by excessive tearfulness and varying degrees of irritability, up to open conflict and aggression.

Noted urgent need for privacy. The patient minimizes the number of contacts and closes off completely.

Behavioral disorders and decreased moral standards are manifested in actions that are unusual for the patient. Often this is driving a car or motorcycle at top speed. In this case, there is a real threat to health and life from accidents. It could also be vandalism, hooliganism or serious offenses up to criminal liability.

Rarely without physiological problems. Patients complain of difficulty breathing, pressing chest pain, tachycardia, severe headaches and insomnia.

There are changes in self-esteem. It is rapidly declining.

Often the patient looks older than his age. Skin turgor is significantly reduced, early wrinkles and gray hair are observed.

In some cases, abuse of alcohol, nicotine or drugs begins. Joining sects is common.

The melancholy is clearly expressed. It is very painful. It is against this background that the patient often experiences suicidal thoughts. Fortunately, they are not persistent, the patient retains critical thinking, and timely psychotherapeutic assistance eliminates this threat.

Diagnostics

Adaptation disorder must be differentiated from other pathological conditions that are not related to mental disorder. These are severe depressive disorders in the form of somatization, substance abuse disorders, and behavioral pathologies.


The main diagnostic criteria for adjustment disorder are as follows:

1. The pathological condition is a consequence of the response to stress, which manifests itself during the first 3 months after a particular incident.
2. Relationships with others, the learning process or professional work activity carried out by the patient with great difficulty.
3. Clinical signs inherently go beyond the normal range of conventional reactions. The patient overdramatizes the event, exaggerates its hopelessness, and such a reaction is greatly delayed.

Treatment

The basis of treatment, in addition to psychosocial factors, is mandatory should also cover the biological. Depending on the predominance of specific manifestations, treatment is differentiated, step-by-step and comprehensive.

The basic component in this case is psychotherapy. It is necessary to change the patient's attitude towards what happened and convince him to accept the situation as part of the necessary life experience. Reassess the patient’s role in the current situation and form an active position in him in relation to overcoming the current circumstances.

Group psychotherapy is often particularly effective, the techniques of which allow you to openly express your anger, anxiety, fears and the subjective feeling of complete hopelessness of the situation.

The attitude of specialists towards drug treatment in the case of adjustment disorder remains ambiguous. But the best results are still achieved faster by patients with a competent combination of medications and cognitive behavioral therapy.

In the case of a short-term disorder with mild or moderate anxiety and asthenic symptoms, taking anxiolytics is often quite sufficient. Wherein the dynamics of the patient's condition requires careful monitoring. If hypochondriacal and depressive reactions worsen, an antidepressant should be added. In terms of effectiveness, Paroxetine, Sertraline, Citalopram, Fluoxetine and Fluvoxamine are among the first.

Phenazepam, Clonazepam, Alprazolam and Tofisopam help relieve acute anxiety. Slightly less often drugs with barbiturates are used: Valocordin, Valoserdin, Corvalol.

Attention. Uncontrolled and prolonged use of barbiturates, even after 1 month of use, leads to the formation of persistent psychological and physical dependence.

Adjustment disorder in the army

The diagnosis of adaptation disorder for military service is a serious problem that gives every reason for a commission. A strict regime, heavy physical activity, distance from home and the inability to communicate with loved ones create enormous psychological stress.

Not everyone can cope with this. Open access to weapons creates a very real threat to the lives of others from a sick soldier.

The risk group consists of conscripts who have poor relationships with their parents, who do not know how to stand up for themselves, systematically feel their own inferiority and react sharply to failures.

The test results of soldiers with the identified disorder show 3 main root causes for the rapid development of the pathology:

1. Separation from loved ones. 88% of respondents admit that they begin to suffer from this issue from the first day of service.
2. Inability to cope with the difficulties of preparation. In particular, categorically abandon your taste habits, follow a difficult daily routine and endure excessive physical exertion.
3. Hazing. Ridicule and humiliation from the command and comrades.

The following manifestations can be considered obvious signs of adaptation disorder in a conscript in the army:

• lack of interest in any activity, reluctance to achieve any results;
• general loss of strength and lack of faith in one’s own capabilities;
• lack of appetite, insomnia, blood pressure fluctuations, unusual sweating, frequent headache;
• open anger, conflict, irritability mixed with excessive vulnerability;
• memory impairment, basic errors in simple tasks, state of prostration;
• aggressive opposition to discipline, attempts at communication from colleagues, isolation.

To be classified, the disorder requires an official opinion from a psychiatrist. This can be either a civilian specialist, or an examination by specialists from a military medical commission.


Due to the potential for symptoms of the disorder to manifest in the future, despite the treatment received, the soldier is registered with a psychiatrist. This is a precaution against possible violence towards strangers, causing intentional harm to both oneself and others, which is typical for such a diagnosis.

Adaptation disorder is a specific diagnosis, the symptoms of which manifest themselves primarily in the form of a persistent negative reaction to a sudden and, as a rule, stressful change in the usual situation, an unfavorable event, etc.

Most often, such a diagnosis as adaptation disorder occurs against the background of stress or the complex influence of stress factors and internal problems. A person whose psyche is affected by such a diagnosis as adaptation disorder exhibits extremely unfavorable symptoms that significantly worsen the quality of life in general and its professional and social state in particular.

Understanding Adjustment Disorder

The symptoms that accompany this diagnosis manifest themselves as a maladaptive response to stressful circumstances. Let's look at the example of the army.

A man lived in his usual surroundings, and suddenly - a summons. Upon arrival in the army, the life of a citizen undergoes many changes with its own characteristics and limitations. Life typical of the army, of course, becomes familiar over time. But at the beginning (usually during the first 3-4 months of being in the army), the consciousness resists what happened, which causes stress.

Such a diagnosis as adaptation disorder recedes when the stress factor ceases. If the provoking factors and accompanying symptoms remain, the body, as a rule, gets used to it and moves to a new level of stress resistance. No special treatment is used in such conditions.

If the patient has to experience events that go beyond normal reality, causing significant damage to his professional or social activities, a diagnosis such as adaptation disorder is highly likely to develop. If the stress is long-term, the diagnosis may persist throughout life. There are no age, gender or any other restrictions.

Key symptoms and signs of the pathological condition

Manifestations of such deviation can take on a wide variety of forms. As a rule, the main symptoms are anxious and depressive, often mixed. In most cases, maladjustment is accompanied by symptoms such as a feeling of weakness and inability to cope with the events that have occurred. Often the manifestations are reinforced by a feeling of some kind of external threat, excessive irritability, suspiciousness, and a feeling of internal tension.

In many patients, the picture is complemented by a deterioration in mood, even to a melancholy state. The usual circle of interests is greatly narrowed. Physical and mental exhaustion occurs, it becomes difficult to concentrate and remember something new, difficulties appear in various issues, requiring quick and balanced decision-making, analysis and responsibility for the consequences.
Thus, the symptoms include the following:

• depressed mood;
• persistent anxiety;
• depression and inner feelings;
• disturbances of normal behavior;
• anxiety;
• internal discomfort.

Causes of maladjustment

The problem arises against the background of a citizen’s overly emotional, close and personal reaction to stressful circumstances and very serious life changes.
The most common causes of stressful situations include:

• difficulties in relationships;
• financial difficulties;
• conflicts in the family;
• problems at the place of study/work;
• sudden changes in the traditional way of life;
• detection of serious health problems;
• serious illness and/or death of a loved one;
• intimate failures.

In the presence of certain circumstances (for example, in the case of forced living in a disadvantaged and unsafe area), maladjustment can take a long course.

Possible risk factors

Under certain circumstances, the propensity for the occurrence of the disorder in question may increase significantly. Thus, the list of key risk factors includes the following provisions:

• genetic predisposition;
• features of individual adaptability;
• characteristic social skills;
• lack of opportunities to eliminate disturbing circumstances;
• gender identity.

There are suggestions that women, due to their psycho-emotional characteristics, are more at risk of developing the problem in question.

People with serious illnesses, as well as people living in unfavorable, difficult conditions are traditionally at increased risk. According to average statistical data, about half of the representatives of the listed groups show a tendency to maladjustment

Certain factors experienced by the patient in early childhood can lead to the occurrence of the disorder under study. Examples include the following:

• frequent moving;
• peculiarities social status families (for example, too poor or too rich);
• various kinds of extreme influences, for example, living in a military combat zone;
• injuries that can lead to the development of problems with adaptation to life.

People who are predisposed to developing problems such as maladjustment are at risk for other common psycho-emotional disorders, for example, depression, anxiety, bipolar disorder and so on.

Features of manifestation and diagnosis of deviations

Most often, the disorder in question completely ceases to cause discomfort and anxiety to the patient on average six months after the end of the adverse events. If the disorder becomes chronic, its manifestations may persist for 6 months or more - this usually happens if the source of stress does not disappear.

The presence of a problem is indicated, first of all, when a person experiences difficulties in social and other areas of life. Among the characteristic manifestations are:

• painful and uncomfortable sensations in the chest area;
• restless and anxious state;
• lack of strength to solve current problems, plan the future, achieve important goals;
• difficulties in everyday life;
• parallel development of behavioral disturbances and psycho-emotional background.

During the diagnostic process, the treating specialist studies the nature of the impact of stressors and draws conclusions regarding the intensity of their severity.

Additionally, examinations are prescribed to confirm or refute the presence of problems such as post-traumatic stress, anxiety, depression, etc. To clarify the diagnosis, the patient may be referred to a psychiatrist for consultation.

Treatment methods

When selecting the appropriate treatment, the specialist assesses the individual characteristics of the patient’s condition and draws up a program that can effectively neutralize the manifestations that prevent a person from leading a full life. Additionally, treatment is aimed at eliminating the likelihood of developing a depressive state.

Remember: treatment can only be prepared by a specialist and it must be comprehensive

1. Psychotherapy. It is considered as the main therapeutic method that allows you to effectively cope with the problem of maladjustment. It is used, first of all, to search for provoking moments and the subsequent development of mechanisms of resistance to newly emerging stress. As a rule, it is short-term and can be carried out in different forms: family, individual, behavioral, group.
2. Drug treatment. Usually used in combination with psychotherapy methods to alleviate general characteristic symptoms. The patient may be recommended medications that have a sedative and antidepressant effect. Medicines are used to relieve associated symptoms.

There are no preventive measures as such. You just need to minimize exposure to stressful situations and promptly seek medical help - then positive results won't keep you waiting long. Be healthy!

Important! Be sure to check out this material! If after reading you still have any questions, we strongly recommend that you consult with a specialist by phone:

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Treatment of adaptation disorders. Symptoms of adjustment disorder

Adjustment disorder is an intermediate state between a person’s normal reaction to misfortune and a mental illness. The complexity of the pathology lies in its intermediateness, since the person himself and those around him often cannot determine it. The prognosis depends on the timeliness of diagnosis and timely provision of assistance.

Causes

Most often observed adjustment disorder in children and adolescents, which is explained by the instability of their psyche. But, with prolonged experience of stressful situations, it is diagnosed in people of working age and elderly patients. The pathological condition appears when:

• Stress;
• Neuroses;
• Psychosis.

With these diseases, patients complain of insomnia and deterioration of the person’s general condition, which leads to adaptation disorder. Personality adjustment disorder has varying degrees of severity, depending on the severity of the stress.

The onset of the disease can be observed during a serious single stress, for example, the loss of a prestigious job, the death of a loved one, etc. Pathology develops with periodic stress that occurs against the background of poverty or chronic diseases.

People with a genetic predisposition are at risk of developing pathology. If a person has problems with intimacy or conflicts in the family, this leads to maladjustment. It appears when there are material difficulties or difficulties in relationships with others. If the traditional way of life changes dramatically, this leads to a pathological process.

Signs of pathology

Symptoms of adjustment disorder are not always clearly expressed and may differ in each individual case, which complicates the diagnosis process. The main symptoms are of an anxious and depressive nature. Maladjustment is accompanied by a feeling of inability to cope with the troubles that appear in life. With pathology, the patient becomes suspicious and irritable. Most people note the appearance of a feeling of internal tension. Psychiatry adjustment disorder has information that it is accompanied by:

• Anxiety;
• Persistent anxiety;
• Internal discomfort;
• Violations in normal behavior.

In patients with pathology, the mood worsens. In especially severe cases, a sad state appears. A person becomes uninterested in his usual activities. A person becomes physically and mentally exhausted, so he cannot make informed decisions. He does not analyze the situation and is not responsible for the decisions made.

Disadaptation has a vague clinical picture, so when the first suspicious symptoms appear, it is recommended to seek help from a specialist who will correctly diagnose and prescribe effective treatment.

Types of pathology

In accordance with the causes and characteristics of its course, maladjustment is divided into several types:

• Disorder social adaptation. With pathology, the patient cannot communicate with his usual circle of friends and acquaintances. He gradually moves away from them and retires. If the pathology is severe, the patient cannot be in society at all. He may not leave the apartment for months.
• Depressive adjustment disorder. The disease develops against the background of depression. A person is constantly depressed. They have no desire to communicate and gradually lose their usual interests.
• Mental adjustment disorder. A pathological process occurs in the form of an acute reaction to stress, which develops in the form of psychological shock. It is accompanied by various mental disorders.
• Prolonged adjustment disorder. The pathological process is characterized by a long course. The situation is aggravated when a stressful situation of varying severity appears.
• Anxious adjustment disorder. With this type of pathology, patients experience alarming symptoms under any circumstances.
• Mixed adjustment disorder. This form of pathology combines several of the above.

There are several types of pathology that are recommended to be determined in order to assign the correct diagnosis of adjustment disorder.

Diagnostic measures

Only a qualified specialist can determine maladjustment. It determines the development of somatic symptoms in children and adolescents and alarming signs in older people, which indicate the progression of pathology. The diagnosis is made in accordance with the diagnostic criteria of DSM-III-R:

• Reactions to overt psychosocial stresses that occur within three months.
• The nature of maladjustment. At this stage of diagnosis, the presence of impairments in school or work and symptoms that should not be present during stress are determined.
• The duration of the maladjustment reaction is more than 6 months.

In case of maladaptation, differential diagnosis is recommended. Pathology must be distinguished from conditions such as disorders that appear due to the use of psychoactive drugs, post-traumatic disorders that occur due to stress, and aromatization.

Treatment of the disease

requires the use of psychotherapy. It is recommended to conduct group therapy for patients who experience the same stress, for example, retirees or people with the same chronic illness. Individual psychotherapy is aimed at ensuring that a person begins to understand that the onset of the disease is observed under stress. This is the main cause of the pathology. If treatment methods are selected correctly, the patient gains strength and endurance with which to combat stress.

To avoid secondary gain, proper implementation of psychiatric decision is recommended. Treatment of the disease will be successful if the doctor has an attentive and caring attitude towards the patient. When symptoms of secondary gain appear, the treatment process becomes more complicated.

If diagnosed anxiety depressive disorders, then this requires drug therapy. Patients are recommended to take anti-anxiety medications and tricyclic agents, which help relieve depression.

With maladjustment, the patient may become overly aggressive, which leads to conflicts at work or school, committing crimes, etc. Doctors should not justify these actions of patients and try to justify them to law enforcement agencies. With this line of behavior of the doctor, the person’s emotional state does not improve. In addition, he does not criticize himself, and such socially unacceptable behavior becomes the norm for him.

Disadaptation is a dangerous pathological process that has a blurred clinical picture. That is why pathology is often diagnosed untimely. The choice of treatment method should be made by a doctor, which will ensure its effectiveness.

The private clinic “Salvation” has been providing effective treatment for various psychiatric diseases and disorders for 19 years. Psychiatry is a complex field of medicine that requires maximum knowledge and skills from doctors. Therefore, all employees of our clinic are highly professional, qualified and experienced specialists.

When to ask for help?

Have you noticed that your relative (grandmother, grandfather, mother or father) does not remember basic things, forgets dates, names of objects, or does not even recognize people? This clearly indicates some kind of mental disorder or mental illness. Self-medication in this case is not effective and even dangerous. Tablets and medications taken independently, without a doctor’s prescription, will, at best, temporarily alleviate the patient’s condition and relieve symptoms. At worst, they will cause irreparable harm to human health and lead to irreversible consequences. Traditional treatment at home is also not able to bring the desired results, not a single folk remedy will not help with mental illness. By resorting to them, you will only waste precious time, which is so important when a person has a mental disorder.

If your relative has poor memory, complete loss of memory, or other signs clearly indicating a mental disorder or serious illness– don’t hesitate, contact the private psychiatric clinic “Salvation”.

Why choose us?

The Salvation clinic successfully treats fears, phobias, stress, memory disorders, and psychopathy. We provide assistance with oncology, care for patients after a stroke, inpatient treatment for elderly and geriatric patients, and cancer treatment. We do not refuse the patient, even if he has the last stage of the disease.

Many government agencies are unwilling to take on patients over 50-60 years of age. We help everyone who applies and willingly provide treatment after 50-60-70 years. For this we have everything you need:

• pension;
• nursing home;
• bed-ridden hospice;
• professional caregivers;
• sanatorium.

Old age is not a reason to let the disease take its course! Complex therapy and rehabilitation gives every chance of restoring basic physical and mental functions in the vast majority of patients and significantly increases life expectancy.

Our specialists use modern methods of diagnosis and treatment, the most effective and safe. medications, hypnosis. If necessary, a home visit is carried out, where doctors:

• an initial examination is carried out;
• the causes of mental disorder are determined;
• a preliminary diagnosis is made;
• an acute attack or hangover syndrome is relieved;
• in severe cases, it is possible to force the patient into a hospital - rehabilitation center closed type.

Treatment in our clinic is inexpensive. The first consultation is free. Prices for all services are completely open, they include the cost of all procedures in advance.

Relatives of patients often ask questions: “Tell me what a mental disorder is?”, “Advice how to help a person with a serious illness?”, “How long do they live with it and how to extend the allotted time?” You will receive a detailed consultation at the private clinic “Salvation”!

We provide real help and successfully treat any mental illness!

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After you have faced some kind of problem (job loss, serious illness, divorce, financial problems, etc.). You may feel depressed. The same goes for big life changes (marriage, having a child, moving, etc.). You may feel nervous, irritable, sad or anxious.

If you feel this way after any of these stressful events, don't worry, it's completely normal. However, if your symptoms significantly affect your daily life, you may be suffering from adjustment disorder.

Violations listed in this category:

1. Post-traumatic stress disorder.
2. Acute stress disorder.
3. Reactive attachment disorder.
4. Refusal of social activity.
5. Regulation disorder.

Psychological distress after a traumatic or stressful event varies from person to person. For some people, symptoms are based on fear and anxiety.

However, many people who have experienced traumatic or stressful situations have symptoms such as moodiness, anger, hostility, or dissociative symptoms.

Because of the variety of symptoms that occur after a traumatic or stressful event, psychologists group the above disorders under the category of “trauma and stress-related disorders.” Some people overcome adverse experiences sooner than others.

If it takes you more than 3 months to adjust to changes and is difficult to recover from, you may have adjustment disorder.

What exactly is an adjustment disorder?

An essential characteristic of this disorder is emotional or behavioral symptoms caused by an identifiable stressor.

This stressor could be a single event, such as a breakup. But multiple stressors can also affect a patient, like problems at work or problems in a marriage.

These stressors or problems may appear repeatedly. Two examples are temporary business crises or unsatisfactory sex.

Alternatively they can appear constantly, in case of a chronic illness or living in an area with a high crime rate.

Stress factors can affect an individual, an entire family, or large group or community. This is the case when a natural disaster occurs.

Additionally, these stressors may result from the death of a loved one. But only when the intensity, quality or duration of grief exceeds what you would normally expect. As a result, adjustment disorders are associated with an increased risk of suicide.

How does a psychologist diagnose adjustment disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders Psychologists should consider the following diagnostic criteria:

A. Development of emotional or behavioral symptoms in response to stress. This occurs within three months of the onset of the stressor.

B. The behavior or symptoms are clinically significant. It manifests with one or both of the following characteristics:

1. Intense stress is disproportionate to the severity or intensity of the stressor. Keep in mind that the external context and cultural factors influence the severity and manifestation of symptoms.
2. Significant decrease in functionality in important areas (work, social life, etc.)

C. Changes associated with the stressor do not meet criteria for another mental disorder.

D. The symptoms are not the same as with normal bereavement.

E. Once the stressor or its effects are over, symptoms do not last more than six months.

Types of adjustment disorders

Diagnostic and Statistical Manual of Mental Disorders distinguishes adjustment disorder by:

1. Depressed mood: the patient feels depressed, desperate and often cries.
2. Anxiety: the patient feels nervous, anxious, or experiences separation anxiety.
3. Mixed depressed mood and anxiety: a combination of depression and anxiety are dominant factors.
4. Behavioral disorder.
5. Mixed behavioral and emotional disorder: the patient experiences emotional symptoms and behavioral changes.
6. Not indicated: maladjustment reactions that do not fit into any of the other subtypes of adjustment disorders.

These disorders are also divided into acute adjustment disorder (if it lasts less than 6 months) or permanent (six months or more).

How does adjustment disorder develop?

After problems or stress in your life you begin to experience symptoms within three months of the incident. After eliminating the problem, symptoms do not last more than 6 months.

If the problem is an acute event (such as being fired from a job), the onset of symptoms is usually immediate. You can experience them for a few days and they won't last that long (no more than a few months).

However, if the problem or consequences last longer, the adjustment disorder may persist and become chronic.

Is adjustment disorder common?

Adaptation disorders are very common. The percentage of mental health outpatients diagnosed with adjustment disorder ranges from 5 to 20%.

On the other hand, in-hospital mental health clinics tend to see more cases of adjustment disorders. In fact, the number of people in hospitals may be as high as 50%.

What are the risk factors for adjustment disorder?

People going through difficult situations often face a large number of stressors. These people have more high risk occurrence of this disorder.

At the same time, clinicians must consider the patient's cultural context when making a diagnosis. They must find out whether the response to the stressor is inappropriate or not.

In addition, they should consider whether the mental disorder associated with the stressor is greater than you expect.

What can be done?

1. Think about whether you have been in a similar situation before and how you resolved it.
2. Talk about how you feel with your family and friends.
3. Organize your ideas. You may worry about everything at once. So, think a little, because there are definitely some things that worry you more than others. In a notebook, write down your current concerns and organize them according to how concerned you are about them, from least concerned to most concerned. You will see that some things are not very important.
4. Choose only one problem. Start with the simplest problem to solve.
5. Think about how to solve your problem and put it into action. Change.
6. Play sports, take relaxing baths, relax yourself.

If your problems persist or you cannot control your symptoms, consult a professional. You can contact your doctor or a psychologist directly. Ultimately, psychologists will help you, whether you have a disorder or not.

According to DSM-III-R, adjustment disorder is a maladaptive response to clearly detectable psychosocial stress or stresses, manifesting 3 months after the onset of stress. This pathological reaction may be perceived by the subject as a personal misfortune; it is not an exacerbation of a mental illness that meets other criteria. The disorder usually resolves soon after the stress ceases, or, if the stress remains, a new level of adaptation is achieved. The reaction is maladaptive due to disturbances in social or professional functioning or due to manifestations that go beyond the normal, usual, expected reactions to such stress. Therefore, this diagnosis should not be made if the patient meets the criteria for a more specific disorder.

Prevalence

Adaptation disorders are very common. During one examination, adaptation disorders were identified in 5% of patients who had been in the clinic for more than 3 years. This diagnosis is most often made in adolescents, but can occur at any age.

Causes

Adjustment disorders increase in the presence of one or more stresses. The severity of stress or stress does not always determine the severity of adjustment disorder. Personal organization and cultural or societal norms and values ​​contribute to maladaptive responses to stress. Its severity is a complex function of degree, quantity, duration, reversibility, environment and personal relationships. As an example, the loss of a parent is experienced very differently at the age of 10 and 40 years.

Stresses can be single, such as divorce or job loss, or multiple, such as death dear person, occurring at the same time when a person loses his job or is seriously ill somatically. Stress can be periodic, such as seasonal work pressures, or persistent, such as chronic illness or living in poverty. Discordant family relationships can cause adjustment disorders that affect the entire family as a whole. If adaptation disorders occur in the victim of a crime or as a result of a serious illness, the disorder is limited to one person. Sometimes adjustment disorders appear in a group or social layer, stress affects several individuals, as in a natural disaster or racial, social or religious persecution. Specific developmental stages, such as starting school, moving away from home, marriage, the birth of a child, failure to achieve professional goals, leaving home of the last child, and retirement, are often associated with adjustment disorders.

Some psychoanalysts believe that the same stress causes a range of different reactions in normal people. Throughout his life, Freud was interested in the question of why the stresses of everyday life cause illness in some people and not in others, why illness takes one form or another, and why certain phenomena predispose and others do not predispose to the development of psychopathology. He attached a significant role to constitutional factors and believed that the interaction of these factors with everyday experiences causes fixation.

Psychoanalytic research emphasizes the important role played by the mother and caregivers in developing the patient's ability to respond to stress. Of particular importance is Winnicott's concept of a good enough mother who listens to the child's needs and provides support so that he grows up to be able to deal with frustration when he encounters it in life.

In the presence of a simultaneous personality disorder or organic lesion, adaptation disorder may also develop. Such exposure may also result from the loss of a parent during childhood.

Diagnosis

Although, by definition, adjustment disorder occurs after stress, symptoms do not necessarily begin immediately, nor do they immediately go away when the stress stops. With constant stress, the disorder can last a lifetime. It can also occur at any age. Its manifestations are very diverse, with the most common symptoms in adults being depressive, anxious and mixed symptoms.

Somatic symptoms are most common in children and the elderly, but may occur in others. Sometimes patients become violent and reckless, drinking, committing crimes, or withdrawing from society. Below are the DSM-III-R diagnostic criteria for adjustment disorders.
A. Response to overt psychosocial stress (or multiple stresses) that occurs within 3 months of the onset of stress(es).
B. The maladaptive nature of the reaction is indicated by one of the following:

1. disruption in professional (including school) activities or in normal social life or relationships with others,
2. symptoms that are outside the normal range and expected reactions to stress.

C. The disorder is not simply an example of an overreaction to stress or an exacerbation of one of the previously described mental disorders.
D. The maladjustment reaction lasts no more than 6 months.

Subtypes of maladaptation reaction

WITH DEPRESSIVE MOOD
In adjustment disorder with depressive mood, the main symptoms are depressed mood, fear and hopelessness. This subtype must be distinguished from major depressive disorder or uncomplicated bereavement.

WITH AN ANXIETY MOOD
The symptoms seen in adjustment disorder with anxious mood, such as palpitations, tremors and agitation, should be distinguished from anxiety disorders.

WITH MIXED EMOTIONAL TRAITS
The main manifestations of adjustment disorder with mixed emotional features are a combination of anxiety and depression or other emotions. This subtype must be differentiated from depressive and anxiety disorders.

WITH BEHAVIORAL DISORDERS
In adaptation disorders with behavioral disorders, the main manifestation is behavior in which the patient infringes on the rights of others or violates accepted social norms, including age norms. Examples of such behavior include truancy, vandalism, reckless driving, and wrestling. This category should be distinguished from conduct disorders.

WITH DISRUPTIONS IN WORK OR STUDY
These are adaptation disorders that interfere with work or study, if the person did not previously have such disorders in this regard. Anxiety and depression are often observed, so this condition must be differentiated from depressive and phobic disorders.

The following are clinical characteristics of adjustment disorder with disruption of work or study.

Main features: severe stress that interferes with any kind of work or study, manifested by anxiety during exams or when taking any tests, inability to write business papers, make reports or engage in artistic activities; difficulty concentrating during work, avoidance of work or school, with loss of social control; these disturbances are absent during periods of time when the subject does not think about difficulties in work and study; availability of adequate intellectual and professional abilities; normal performance of work or school in the past; the use of special efforts aimed at work and study, even if they are then secondarily suppressed by the symptoms described above.

Additional features: anxiety and depression; sleep disorders; compulsive behavior; disorganization of the daily routine; appetite disorders; drug, alcohol or tobacco abuse; loneliness.

Thus, a nineteen-year-old college student, repeating his second year, contacted mental health services due to difficulties associated with studying. He may well have learned the first paragraph, writing it well and understanding it, but is unable to progress further and is therefore in danger of failing 2 or 3 subjects. He also finds it difficult to attend classes as he sleeps a lot.

He states that the difficulties began about 2 years ago and continued throughout his first year of study, but he somehow managed to cope with his coursework and exams.

The patient visited a private high school and did well until his senior year, when he began to struggle after his mother was diagnosed with a recurrence of cancer and died. He had no conflicts about being in college, and he was eager to overcome these difficulties and continue his education to become a lawyer.

Discussion. A learning disability is clinically very significant, as it greatly interferes with the patient’s career aspirations. Therefore, it is classified as an adjustment disorder with a learning disability.

Most cases of impairment (inhibition) of the ability to work and study are a manifestation of a personality disorder, usually compulsive personality disorder. But in this case, the disorder appears to have appeared suddenly in response to psychological stress, and there is no evidence to support a diagnosis of personality disorder.
Diagnosis according to DSM-III-R Axis I: Adjustment disorder with inhibition of learning.

WITH AUTISM
The diagnosis of adjustment disorder with autism is made in cases of social autism without depression or anxiety.

WITH PHYSICAL COMPLAINTS
Adjustment disorder with physical complaints manifests itself with symptoms such as headache, fatigue, or other physical complaints.

ADAPTATION DISORDER NOT CLASSIFIED ANYWHERE ELSE (NO OTHER NAME, BOTTOM)
Adjustment disorder, not classified elsewhere, is a residual category for atypical maladaptive reactions to stress. Examples include inappropriate responses to physical illness, such as complete denial of the diagnosis and refusal of treatment.

Differential diagnosis

Adjustment disorders should be differentiated from conditions that are not related to mental disorders. According to DSM-III-R, these non-psychiatric events do not cause impairment in social or occupational functioning or any symptoms or manifestations that fall outside normal criteria for stress. Due to the lack of absolute criteria to facilitate the differential diagnosis between an adjustment disorder and a condition not associated with a mental illness, it is advisable to examine the patient in a hospital setting.

Although uncomplicated bereavement also involves temporary disruption of social and occupational functioning, the impairment observed remains within the normal response to the loss of a loved one and thus is not considered an adjustment disorder.

Other disorders from which adjustment disorder must be distinguished include major depressive disorder of somatization, substance abuse disorder, conduct disorders, and post-traumatic stress disorder.

In all cases, these diagnoses should be named as primary if they meet the appropriate criteria, even in the presence of a stress or series of stresses that may have served as a precipitating factor. However, some patients have conditions that meet the criteria for both disorders, personality disorder and adjustment disorder.

In post-traumatic stress disorder, symptoms that develop after a psychologically traumatic event or events are beyond the scope of normal human experience. This means that similar symptoms can be expected after these stresses in most people. Stress can be experienced individually (rape or assault) or among people (for example, on the battlefield). A range of natural disasters such as floods, plane crashes, atomic bombing and death camps are also regarded as severe stress. Stress always contains a psychological component, and often an accompanying somatic component, which has a direct damaging effect on nervous system. The disorder is thought to be more severe and long-lasting when the stress is caused by the person's actions (eg, rape) rather than by external causes (eg, flooding).

Forecast

The prognosis for adaptation disorders is generally favorable with appropriate treatment. Most patients return to their previous lifestyle within 3 months. Teenagers take longer to recover than adults. For some, especially adolescents, the diagnosis of adjustment disorder is then changed to a diagnosis of mood disorders or substance abuse disorders.

Treatment

Psychotherapy is the treatment of choice for adjustment disorders. Group therapy can be especially useful for patients who have experienced the same stress - for example, a group of retired people or a group of patients on an artificial kidney. As a result of individual psychotherapy, the patient begins to understand the role that stress played in his illness and overcomes old traumas. Sometimes, after successful therapy, patients who have suffered an adaptation disorder become stronger than before the disease, although during this period they did not have any pathology.

Psychiatric treatment of adjustment disorder must be administered judiciously to avoid secondary gain. A painful condition may be rewarding for a person who has not previously encountered this problem by relieving him of responsibility. Thus, the clinician's attention, empathy, and understanding, which are necessary for success, can become reinforcers in the process of developing secondary gain. All these factors must be taken into account when conducting psychotherapy. Once secondary gain symptoms have already developed, treatment becomes more difficult.

Sometimes, in the treatment of anxiety, which often occurs in streets suffering from adjustment disorder, anti-anxiety agents have a good effect; less often - tricyclic antidepressants, which are effective for depression. Indeed, when a doctor plans a course of antidepressant therapy, he must reconsider the diagnosis and think through the features of the depressive disorder. Only a few or no diseases at all can be cured only with medications. Patients whose adjustment disorders include behavioral disorders sometimes commit crimes and have conflicts with their superiors at work or at school. It is not recommended that doctors try to save such patients from responsibility for their actions. Too often, such kindness only reinforces socially unacceptable ways of reducing tension and prevents the development of criticism and subsequent improvement in emotional well-being.

Because stress can be clearly traced in adjustment disorders, it is often assumed that psychotherapy is not indicated and that the disorder will resolve on its own. But this point of view does not take into account that many people who have experienced the same stress do not show painful symptoms, and that this is a pathological reaction. Psychotherapy can help the subject better adapt to enduring stress if it is permanent or time-limited, and can serve as a preventive measure if the stress recurs.