Marcos is 27 years old and a week ago his grandfather died. The relationship between the two was always very close. When Marcos was young and his parents had to travel for work, they always left him with his grandparents. The relationship with his grandmother was also fantastic, but Marcos's predilection was his grandfather. The day he passed away, Marcos seemed unmoved, but after a week he began to manifest altered behaviors. He stopped going to work and going out with his friends, was sulky and angry. Possibly, Marcos was suffering from one of the adjustment disorders.
Adaptation disorders are included in the "Trauma-related disorders and stress factors". They are called "disorders" and not "disorder" because different symptoms may predominate, for example and as will be seen later, anxiety, depressed mood, behavioral disturbance, etc. can be highlighted. Throughout the article, the diagnostic criteria, types, main characteristics, course and development and treatment will be addressed.
- 1 Diagnostic criteria for Adaptation Disorders
- 2 Characteristics of Adaptation Disorders
- 3 Development and course
- 4 Treatment
Diagnostic criteria of Adaptation Disorders
The diagnostic criteria for adaptation disorder will be defined through the latest update of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5 (2014).
TO. Development of emotional or behavioral symptoms in response to a stress factor or factors identifiable that occur in the three months following the start of the stress factor (s).
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following characteristics:
- Severe disproportionate discomfort to the severity or intensity of the stress factor, taking into account the external context and cultural factors that could influence the severity and presentation of symptoms.
- Significant deterioration in social, labor or other important areas of operation.
C. The stress-related disorder does not meet the criteria for another mental disorder and it is not simply an exacerbation of a preexisting mental disorder.
D. The symptoms they do not represent normal grief.
E. Once the stress factor or its consequences are over, the symptoms are not maintained for more than another six months.
It must be specified if it is presented with:
- Depressed mood: Low mood, a desire to cry or a feeling of hopelessness prevails.
- Anxiety: nervousness, worry, agitation or separation anxiety predominates.
- Mixed anxiety and depressed mood: a combination of depression and anxiety predominates.
- Alteration of behavior: Altered behavior predominates.
- Mixed alteration of emotions and behavior: Emotional symptoms predominate (example: depression and anxiety) and a behavior disorder.
- Unspecified: for poor adaptation reactions that cannot be classified as one of the specific subtypes of adaptation disorder.
It should also be specified if the alteration lasts less than six months (acute) or lasts six months or more (persistent).
Characteristics of Adaptation Disorders
As described by Suárez, Iglesias and Cañive (2011): "In all adaptation disorders, the reaction to the stressor seems to be an intensification of the normal reaction or a reaction that significantly interferes with the normal course of social, educational or occupational activities". The central feature of this disorder is the presence of behavioral or emotional symptoms in response to an identifiable stress factor. The most frequent behavioral forms consist of: aggressiveness, hostility, substance abuse, challenge, promiscuity and antisocial acts.
This stress factor can be generated from a single event (for example, the dismissal of a job) or it can be caused by multiple factors stress triggers (for example: work, couple and family problems at the same time). The stressors are diverse and can affect both a single person, a couple, a larger group or an entire community (for example, a natural disaster).
Adaptation disorders can be diagnosed, for example, after the death of a loved one. In the diagnosis it is essential that the intensity, quality or persistence of grieving reactions exceed what would normally be expected, taking into account cultural, religious or age-appropriate norms. Adaptation disorders have been linked to an increased risk of suicide attempts and consummated suicides.
Development and course
Usually, Alterations in the adjustment disorder begin within three months after the onset of a stress factor or factors and it does not last more than six months after the end of the stressful agent or its consequences. If the stressor is an acute event (for example, being fired), the onset of the alteration is usually immediate (in a few days after the dismissal) and the duration is relatively short (a few months). If the stressor or its consequences lengthen over time, the adjustment disorder may continue and become persistent.
Treatment in adaptation disorders is usually effective. The duration depends on each person and the circumstances, however, generally they are not very long treatments. When dealing with persistent adaptation disorders, treatment may extend over time. The most effective treatments are psychotherapy, pharmacology or both.
Psychological therapy, without a doubt, is one of the best alternatives in the treatment of adaptation disorders. Depending on the type of disorder and event, the therapy may be individual, as a family or in a larger group. Through therapy, it is intended: provide emotional support, teach stress management skills, helps to return to the usual habits and help to know the reason why the event affected so disproportionately.
Medications will always have to be prescribed if they are needed by a medical professional. The most commonly used are antidepressants and anti-anxiety medications. The duration of famarcological therapy will depend on the professional's criteria and the patient's progress. However, it is very important not to abandon medications even if we notice a great improvement, since a large number of antidepressants can lead to withdrawal symptoms.
American Psychiatric Association (2014). DSM-5 Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American Medical Editorial.
Suárez, D., Iglesias, J. and Cañive, C. (2011). Adaptation disorder in Child Psychopathology. Journal of the Faculty of Health Sciences, 8(2), 213-225.