Treatment goals and objectives for adjustment disorder

Diagnosis

Diagnosis of adjustment disorders is based on identification of major life stressors, your symptoms and how they impact your ability to function. Your doctor will ask about your medical, mental health and social history. He or she may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

For diagnosis of adjustment disorders, the DSM-5 lists these criteria:

• Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life
• Experiencing more stress than would normally be expected in response to a stressful life event and/or having stress that causes significant problems in your relationships, at work or at school
• Symptoms are not the result of another mental health disorder or part of normal grieving

Types of adjustment disorders

The DSM-5 lists six different types of adjustment disorders. Although they're all related, each type has unique signs and symptoms. Adjustment disorders can be:

• With depressed mood. Symptoms mainly include feeling sad, tearful and hopeless and experiencing a lack of pleasure in the things you used to enjoy.
• With anxiety. Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have an adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones.
• With mixed anxiety and depressed mood. Symptoms include a combination of depression and anxiety.
• With disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting or reckless driving. Youths may skip school or vandalize property.
• With mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety as well as behavioral problems.
• Unspecified. Symptoms don't fit the other types of adjustment disorders, but often include physical problems, problems with family or friends, or work or school problems.

Length of symptoms

How long you have signs and symptoms of an adjustment disorder also can vary. Adjustment disorders can be:

• Acute. Signs and symptoms last six months or less. They should ease once the stressor is removed.
• Persistent (chronic). Signs and symptoms last more than six months. They continue to bother you and disrupt your life.

Treatment

Many people with adjustment disorders find treatment helpful, and they often need only brief treatment. Others, including those with persistent adjustment disorders or ongoing stressors, may benefit from longer treatment. Treatments for adjustment disorders include psychotherapy, medications or both.

Psychotherapy

Psychotherapy, also called talk therapy, is the main treatment for adjustment disorders. This can be provided as individual, group or family therapy. Therapy can:

• Provide emotional support
• Help you get back to your normal routine
• Help you learn why the stressful event affected you so much
• Help you learn stress-management and coping skills to deal with stressful events

Medications

Medications such as antidepressants and anti-anxiety drugs may be added to help with symptoms of depression and anxiety.

As with therapy, you may need medications only for a few months, but don't stop taking any medication without talking with your doctor first. If stopped suddenly, some medications, such as certain antidepressants, may cause withdrawal-like symptoms.

Lifestyle and home remedies

Here are some steps you can take to care for your emotional well-being.

Tips to improve resilience

Resilience is the ability to adapt well to stress, adversity, trauma or tragedy — basically, the ability to bounce back after experiencing a difficult event. Building resilience may vary from person to person, but consider these strategies:

• Stay connected with healthy social supports, such as positive friends and loved ones.
• Do something that gives you a sense of accomplishment, enjoyment and purpose every day.
• Live a healthy lifestyle that includes good sleep, a healthy diet and regular physical activity.
• Learn from past experiences about how you can improve your coping skills.
• Remain hopeful about the future and strive for a positive attitude.
• Recognize and develop your personal strengths.
• Face your fears and accept challenges.
• Make a plan to address problems when they occur, rather than avoid them.

Find support

It may help you to talk things over with caring family and friends, receive support from a faith community, or find a support group geared toward your situation.

Talk to your child about stressful events

If your child is having difficulty adjusting, try gently encouraging your child to talk about what he or she is going through. Many parents assume that talking about a difficult change, such as divorce, will make a child feel worse. But your child needs the opportunity to express feelings of grief and to hear your reassurance that you'll remain a constant source of love and support.

Preparing for your appointment

Whether you start by seeing your primary care doctor or a mental health professional for evaluation and treatment, here's some guidance to help you prepare for your appointment, and what to expect from your doctor.

If possible, you may want to take notes during the visit or bring along a family member or friend to help you remember information.

What you can do

To prepare for your appointment, make a list of:

• Any symptoms you've been experiencing, and for how long.
• Key personal information, including any major stresses or recent life changes, both positive and negative.
• Medical information, including other physical or mental health conditions with which you've been diagnosed. Include any medications, vitamins, herbs or other supplements you're taking, and the dosages.
• Questions to ask your doctor to make the most of your time together.

Some questions to ask your doctor may include:

• What do you think is causing my symptoms?
• Are there any other possible causes?
• Is my condition likely temporary or long term?
• Do you recommend treatment? If yes, with what approach?
• How soon do you expect my symptoms to improve?
• Should I see a mental health specialist?
• Do you recommend any temporary changes at home, work or school to help me recover?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

• What are your symptoms?
• When did you or your loved ones first notice your symptoms?
• What major changes have recently occurred in your life, both positive and negative?
• How have you tried to cope with these changes?
• How often do you feel sad or depressed?
• Do you have thoughts of suicide?
• How often do you feel anxious or worried?
• Are you having trouble sleeping?
• Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you?
• Are you avoiding social or family events?
• Have you been having any problems at school or work?
• Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you?
• Do you drink alcohol or use recreational drugs? How often?
• Have you been treated for other mental health disorders in the past? If yes, what type of therapy was most helpful?

Oct. 25, 2017

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