Adjustment disorder includes behavioral/emotional symptoms following a stressful life event such as a divorce, death of a family member or friend, or changes in one's school or work situation. Four key differential diagnoses to rule out before diagnosing are:
In adjustment disorder, the life event is not life threatening, a key feature that differentiates it from post-traumatic stress disorder PTSD.
In adjustment disorder, the stressor can be of any severity and results in symptoms of anxiety and depression that do not meet criteria for another psychiatric disorder. Intrusive recollections and avoidance behavior characteristic of acute stress disorder are not present.
Patients experiencing post-traumatic stress and functional impairment for the first 30 days following a traumatic event are diagnosed as having acute stress disorder, which is treated primarily with cognitive-behavioral therapy. Patients who remain symptomatic after 30 days are diagnosed with PTSD and may benefit from the addition of an antidepressant.
Symptoms of anhedonia, weight loss, or other symptoms of major depressive disorder trump dysthymic symptoms of adjustment disorder. Diagnose MDD in the presence of these.
If the patient fits normal characteristics of bereavement, adjustment disorder cannot be diagnosed. This can be a very difficult distinction to make. Rule out **symptoms directly related to the loved one **in order to diagnose adjustment disorder. For example:
As in most aspects of psychiatry, the line between physiological and pathological adjustment to a life stressor is defined by functional impairment. Adjustment disorder differs from a normal stress reaction by the presence of social/occupational dysfunction.
Symptoms in adjustment disorder can range from mood disorder symptoms (e.g. depressed mood) to anxiety symptoms, and are sub-classified as such. The symptoms begin within 3 months after the stressful life event has occurred.
Symptoms of adjustment disorder classically end within 6 months after the event is over. This is key in the differential diagnosis of adjustment disorder and other similar disorders.
While unlikely to be tested, adjustment disorder can be chronic in the face of a chronic, continuous stressor.
The best treatment for adjustment disorder is supportive psychotherapy. Medications may be used to help improve associated symptoms, such as pharmacotherapy for insomnia.