Chapter 35. Adjustment Disorder

James J. Strain, M.D.; Kimberly G. Klepstein, M.D.
DOI: 10.1176/appi.books.9781585622986.259788



The overriding conceptual issue that underlies treatment intervention is the knowledge that an adjustment disorder emanates from a psychological reaction to a stressor. The etiological vector in the genesis of the disorder—the stressor—needs to be identified, described, and shared with the patient, and plans must be made to mitigate the stressor, if possible. The maladaptive response may be attenuated if the stress can be eliminated, reduced, or accommodated. Therefore, the initial approach to treatment is to identify the stressor. Popkin et al. (1990) demonstrated that in medically ill persons, the most common stressor precipitating an adjustment disorder diagnosis is the medical illness itself. In children, of whom up to 70% in psychiatric inpatient and ambulatory settings may receive this diagnosis, the stressor may be developmental demands, school problems, family conflicts, peer difficulties, cognitive and/or emotional inability to master expected tasks, and so on (D. Schaffer, personal communication, September 1990). Fifty-five percent of child psychiatrist respondents to a questionnaire regarding DSM-III-R (American Psychiatric Association 1987) admitted to diagnosing adjustment disorder to avoid the stigma associated with other disorders (Setterberg et al. 1991).

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