Excerpt from Adjustment Disorders
Synonyms, Key Words, and Related Terms: adjustment disorder, AD, mental illness, psychiatric disorder, nonpsychotic disturbance, subthreshold disorders, subthreshold syndromes, psychosocial stressor, maladaptive reaction, stress disorders, suicide, suicidal ideation, suicidal impulses, anxiety not otherwise specified, anxiety NOS, depression NOS, depression not otherwise specified, self-harm, self-poisoning, psychopathology, stress reactions
Please click here to view the full topic text: Adjustment Disorders
Adjustment disorder (AD) is a stress-related, short-term, nonpsychotic disturbance. Persons with AD are often viewed as disproportionately overwhelmed or overly intense in their responses to given stimuli. These responses manifest as emotional or behavioral reactions to an identifiable stressful event or change in the person's life; for instance, in the pediatric population, these events could be parental separation or divorce, a new birth in the family, or loss of an attachment figure or object (eg, pets). The disorder is time-limited, usually beginning within 3 months of the stressful event, and symptoms lessen within 6 months upon removal of the stressor or when new adaptation occurs. AD is considered one of the subthreshold disorders, which are less well defined and share characteristics of other diagnostic groups. Subthreshold disorders fall between defined disorders and problem level (V Code) diagnoses.32 Subthreshold disorders allow for the "classification of early or temporary states when the clinical picture is vague and indiscreet and yet the morbid state is more than expected in a normal reaction."32 Because of insufficient behavioral criteria for patients with AD, reliability and validity of this disorder remain problematic. Diagnosis is constructed to allow for the classification of psychiatric conditions that are clinically significant but do not meet major criteria for major syndromes. In 1998, Strain et al asserted that the diagnostic construct for patients with AD is "clinically significant and deemed to be in excess of a normal reaction to the stressor in question, and not solely the result of a psychosocial problem (V Code) requiring medical attention."32 A problem with this diagnostic construct is apparent in the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR) description of AD as a "maladaptive reaction to an identifiable psychosocial stressor, or stressors, that occurs within 3 months after onset of that stressor."2 The definition of maladaptive reaction is potentially broad and systemically relative depending on the racial, ethnic, and cultural identifications of the patient and psychiatrist. No guidelines are provided to help identify a psychosocial stressor. Additionally, the delineation between AD, anxiety not otherwise specified (NOS), and depression NOS are unclear. Studies have examined the constructs of stress-related and non–stress-related diagnoses, but interpretations of the results have not been conclusive.
For related information, see Medscape's Anxiety Disorders and Depression Resource Centers.
Please click here to view the full topic text: Adjustment Disorders
|
 |
|
