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The Nurses International Community

Course: Mental Health Nursing

Topic: Mood Disorder: Adjustment Disorder

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Module Goals

Learners will be able to

Define adjustment disorder
Identify the symptoms that are reported by clients with adjustment disorder
Identify the clinical manifestations of adjustment disorder
Discuss the evidence based management of adjustment disorder
Identify the appropriate nursing interventions for client with adjustment disorder

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An adjustment disorder is an unhealthy behavioral response to a stressful event or circumstance

Stressful events of a child or adolescent
A family move
Parental divorce or separation
The loss of a pet
Birth of a sibling

Adjustment Disorder

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(Virginia Commision on Youth, 2017)

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Symptoms do not last more than six months, and the majority of individuals quickly return to normal functioning
May be difficult to distinguish from major depressive disorder
Males and females are equally affected
Occurs at all ages
Symptoms in adolescents are primarily behavioral
Symptoms in adults are primarily depressive

Adjustment Disorder

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(Virginia Commision on Youth, 2017)

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Emotional and behavioral disturbances
Feeling of sadness
Anxious
Overwhelmed
Social withdrawal
Difficulties with activities of daily living such as washing, cleaning, and cooking

Characteristics of Adjustment Disorder

(Mental Health Foundation, 2021)

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Critical Thinking Question

A diagnosis other than Adjustment Disorder, is more appropriate if a client has symptoms for less than 6 months.

True
False

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Common trigger:

Grief and bereavement (death of a family member or sibling)

No evidence of biological factors
Vulnerability of the individual (in children, depends on the characteristics of both the child and the child’s environment)
High stressor rate

Individuals in “disadvantaged life circumstances” as stated in the DSM-5 are at increased risk

Causes of Adjustment Disorder

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May be acute (lasting up to 6 months) or chronic (lasting beyond 6 months)

Reduced desire to eat
Increased feelings of hopelessness or sadness
Reduced capacity to enjoy or have an interest in hobbies
Increased episodes of crying
Increased feelings of anxiety, nervousness, worry
Spending less time around friends or family
Reduced capacity to focus
Problems sleeping

Symptoms of Adjustment Disorder

(Mental Health Foundation, 2021)

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Problems performing everyday functions
Feeling overwhelmed
Difficulty carrying out daily activities
Delinquent in paying bills
Missing work
Suicidal ideation

Symptoms of Adjustment Disorder

(Mental Health Foundation, 2021)

Image by, Wikimedia Commons

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Critical Thinking Question

Which of the following are the risk factors for adjustment disorder? (Select all that apply)

Vulnerability of a child
Biological factors of a child
Stressful event
Disadvantaged life circumstances

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Six subtypes of adjustment disorder, based on the major symptoms experienced in adults with:

1. A depressed mood

2. Anxiety

3. Depressed mood and anxiety

4. The disturbance of conduct

5. Mixed disturbance of emotions and conduct

6. Unspecified

Adjustment Disorder Classifications

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(Virginia Commision on Youth, 2017)

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Symptoms of minor depression

Depressed mood

Tearfulness
Feelings of hopelessness

Symptoms with anxiety

Symptoms of anxiety are dominant

Nervousness, worry, jitteriness
Fear of separation from major attachment figures

Subtypes of Adjustment Disorders

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(Virginia Commision on Youth, 2017)

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With depressed mood and anxiety

A combination of depression and anxiety

Symptoms from both the depressed and anxiety subtypes

With the disturbance of conduct

Behaviors that break societal norms or violate the rights of others

Violation of the rights and societal norms and rules
Truancy
Destruction of property
Reckless driving
Fightings

Subtypes of Adjustment Disorders (Continued)

(Virginia Commision on Youth, 2017)

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With mixed disturbance of emotions and conduct

Combined affective and behavioral characteristics with mixed emotional features and a disruption of conduct

Depressed mood and anxiety and with disturbances of conduct

Unspecified

Maladaptive reaction is not classified under other adjustment disorders but occurs in response to stress

Reactions to stress that do not fit into other subtypes

Subtypes of Adjustment Disorders (Continued)

(Virginia Commision on Youth, 2017)

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The DSM-5 specific diagnostic criteria to diagnose adjustment disorder
Emotional or behavioral symptoms in response to an external stressor
Stress that is unproportional to the stressor
Stress-related symptoms do not meet the criteria for another disorder
Symptoms do not last longer than six months after the stressor is removed

Diagnosis

(Virginia Commision on Youth, 2017)

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Critical Thinking Question

Which of the following are the criteria to diagnose adjustment disorder? (Select all that apply)

Symptoms do not last more than six month
Symptoms last more than six months
Symptoms do not meet the criteria for another disorder
Symptoms are not part of a normal grieving process

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The most widely accepted treatment process involves
Identifying the stressor and communicating that stressor effectively
Psychotherapy (treatment of choice)
To reduce or remove the stressor or improve coping ability
Interpersonal psychotherapy (IPT) has the most support for treating depressed adolescents with this disorder

Treatment

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(Virginia Commision on Youth, 2017)

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During psychotherapy, the following should occur:

Analyze stressors affecting the client
Clarify and interpret the meaning of the stressor
Attempt to reframe stressor
Illuminate concerns of the client
Configure a plan to reduce stressors
Increase coping skills of client

Psychotherapy

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(Virginia Commision on Youth, 2017)

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Interpersonal-psychotherapy (IPT)
Helps children and adolescents address problems to relieve depressive symptoms
Cognitive behavioral therapy (CBT)
Improves:

Age-appropriate problem-solving skills
Communication skills
Stress management skills

Supports the individual’s emotional state and support systems to enhance adaptation and coping

Psychotherapy

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(Virginia Commision on Youth, 2017)

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Stress management
Particularly beneficial in cases of high stress
Helps youth learn how to manage stress in a healthy way
Group therapy
Among like minded/afflicted individuals can help group members cope with various features of adjustment disorders

Psychotherapy

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(Virginia Commision on Youth, 2017)

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Family therapy
Helpful for identifying needed changes within the family system
These changes may include

Improving communication skills
Improving family interactions
Increasing support among family members

Psychotherapy

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(Virginia Commision on Youth, 2017)

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Medication is seldom used as a single treatment because the individual requires assistance in coping with the stressors
A few accepted medication options:
Benzodiazepines
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin–norepinephrine reuptake inhibitors (SNRIs)
Plant extracts (kava kava or valerian)
Short-term use of anxiolytics and hypnotics may be beneficial

Pharmacotherapy

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(Virginia Commision on Youth, 2017)

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Critical Thinking Question

A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be:

A. fluvoxamine (Luvox)

B. benztropine (Cogentin)

C. amantadine (Symmetrel)

D. diphenhydramine (Benadryl)

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Assist clients in identifying aspects of the change that they like and dislike
Instruct the client to make a list of the factors identified
Explore with the client’s ways in which they might view the differences more constructively

“What are some things you always wanted to do if you had more time?”

Give positive feedback for expressing negative feelings

Nurse’s Role in Treatment of Adjustment Disorders

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(Videbeck & Schultz, 2013)

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Help client identify strengths
Help client identify past methods of successful coping and encourage them to apply them to present situations
Teach problem-solving process:
Identify the problem
Examine alternatives
Weigh the pros and cons of each alternative
Select and implement an approach
Evaluate it
Encourage client to ask for the help of family or friends

Nurse’s Role in Treatment of Adjustment Disorders

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(Videbeck & Schultz, 2013)

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References

Mental Health Foundation, (2021). Adjustment Disorder. https://mentalhealthfoundation.org/health-conditions/anxiety-disorders/adjustment-disorder/?gclid=CjwKCAiAhreNBhAYEiwAFGGKPCizA3NLLX_bvFT4i2qkcfmLHJpR_tJzZcfxVqIpLvLuNPBoZvKxkRoCTy8QAvD_BwE

Videbeck, SL, & Schultz, JM, (2013). Psychiatric Nursing Care Plans. 9th edi. Wolters Kluwer Health.

Virginia Commision on Youth, (2017). Adjustment Disorder.

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