Treatment goals and objectives for adjustment disorder with anxiety

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An adjustment disorder refers to a psychological disturbance that develops in response to  stress.  Adjustment disorders are caused by specific sources of stress, such as severe personal crisis (e.g., divorce, death of loved one, recent abuse, layoffs, break-ups, recent job changes) or major unexpected negative events (e.g., a storm or fire destroys a person's home, auto accident, or even witnessing a terrible accident).

Most of the time adjustment problems, while uncomfortable, are ultimately dealt with and do not need professional help to resolve them.  However, sometimes your adjustment problems can cause you such discomfort that contacting a therapist or mental health provider proves invaluable.

Understanding an Adjustment Disorder

Adjustment disorders can occur at any age. People are particularly vulnerable during normal transitional periods such as adolescence, mid-life, and late life. Adjustment disorder is very common in the U.S. and affects approximately the same number of males and females

Most of the time, after a stressful event, coping techniques such as talking about your problems with loved ones, taking time off, or getting extra rest, may help you feel better within a few months. But if you've recently experienced a stressful event and your usual self-care steps aren't working, you may have an adjustment disorder.  A person with adjustment disorder often experiences feelings of depression and/or anxiety. As a result, the person may act out behaviorally against the "rules and regulations" of family, work, or society or, instead of acting out, may tend to withdraw socially and isolate themselves.  Still others may not experience behavioral disturbances, but will begin to suffer from physical problems and illnesses.  No two people develop the identical symptoms in response to an adjustment disorder.

If you begin to feel distressed or out of control within three months of a stressful event, you may have an adjustment disorder. The specific signs and symptoms of an adjustment disorder may vary greatly from one affected person to the next, but they typically fit into one of the following Adjustment Disorder Subtypes:

Adjustment disorder with depressed mood: If your symptoms primarily include feeling depressed, tearful and hopeless, and you don't take pleasure in the things you used to enjoy, you may have this type of adjustment disorder

Adjustment disorder with anxiety: The primary symptoms of this type of adjustment disorder include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones.

Adjustment disorder with mixed anxiety and depressed mood: People with this condition have symptoms that fit both of these types of adjustment disorder.

Adjustment disorder with disturbance of conduct: Behavioral problems, including violence and impulsive behavior, are characteristic of this type of adjustment disorder. Children and adolescents who are affected by this condition may skip school, vandalize property and get into fights.

Adjustment disorder with mixed disturbance of emotions and conduct: People with this type of adjustment disorder experience symptoms of depression and anxiety as well as behavioral problems.

Adjustment disorder unspecified: You may be diagnosed with this type of adjustment disorder if you experience emotional or behavioral problems soon after a difficult event, but your symptoms don't fit the other subtypes.

Researchers have suggested a distinct subtype called adjustment disorder with embittered mood. This proposed type of adjustment disorder is characterized by strong feelings of injustice and thoughts of revenge after a negative life experience. Obsessive thoughts about the negative event, a sense of helplessness and self-blame also are typical of this as-yet unofficial type of adjustment disorder.

Acute adjustment disorders: These last less than six months. Most adjustment disorders resolve in this time frame.

Chronic adjustment disorders: These persist beyond six months. If your symptoms last this long, your doctor may change your diagnosis to a more serious mental health disorder such as major depression or generalized anxiety disorder.

Signs and Symptoms of an Adjustment Disorder

Hopelessness
Frequent crying
Depressed mood
Impaired occupational/social functioning
Insomnia
Agitation
Trembling or twitching
Somatic complaints (general aches and pains, stomachache, headache, chest pain)
Palpitations
Conduct disturbances
Physical complaints
Withdrawal
Anxiety, worry, stress, and tension

Causes of an Adjustment Disorder

The cause is a life stressor. The stressor may be a single event (a flood or fire, marriage, divorce, starting school, new job) or may occur often (child witnessing parents constantly fighting, chemotherapy, financial difficulties).  Adults frequently develop adjustment disorders to stressors related to marital discord, finances, work, or some traumatic event. In adolescents, common stressors include school problems, family or parents' marital problems, or sexuality issues. Other types of stressors include, life changes, unexpected catastrophes, medical conditions such as cancer and subsequent treatments.  There is no way to predict which people are likely to develop adjustment disorder, given the same stressor.

Treatment of an Adjustment Disorder

In working with clients with adjustment problems, I have found that the primary goals of treatment are to relieve symptoms and assist with achieving a level of adaptation that is comparable to the affected person's level of functioning before the stressful event. 

Most mental health professionals recommend a form of psychosocial treatment for this disorder. Treatments include individual psychotherapy, family therapy, behavior therapy, self-help groups, reality therapy and pharmacotherapy.

Traditional psychotherapy and cognitive behavioral therapy, can be very helpful to lessen or alleviate ongoing symptoms of adjustment disorder before they become disabling.  Realistic short-term goals should be made at the start of therapy, as the course treatment of an adjustment disorder is usually short-term in nature. Goals of therapy will often center around social supports available to the individual in his or her life in the form of family, friends, and community. The individual's coping and problem solving skills will be explored and developed.

Relaxation techniques might be explored to help the individual deal with feelings of stress.

Group therapy can be useful to individuals who are enduring similar stress. 

Mental health professionals generally do not use medication to treat an adjustment disorder.  When medications are used, they are usually in addition to other forms of treatment.  However, in some situations the use of prescription medications can be very useful to ease the depression or the anxiety associated with an adjustment disorder.

Additional Information

For more information about an adjustment disorder and other mental health problems, please click on the linked websites listed below.

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