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Adjustment Disorder.

Adjustment disorder is considered to be more straightforward than dissociative disorders because of the case if identifying triggers & relatively good prospects of recovery. A person with adjustment disorder is someone who has not adapted as well as the average person to one or more stressors might involve a developmental transition like marriage, divorce, child birth or menopause, or they might be situational like changing of school, getting a new boss, having been socially rejected etc. Or there might be multiple stressors that have recently accumulated.

DSM-IV-TR deals with bereavement reactions as a special condition & does not categorize them, despite several similarities, as adjustment disorders. Most of the time a person's maladaptive reactions to these stressors tend to disappear when the stressful circumstances dissipate or when the person learns how to live with new conditions. Depression, anxiety, disturbances in conduct like truancy, fighting, reckless driving etc., disrupted sleep patterns, deterioration of performance at workplace or school, social withdrawals are typical behaviors of individual who have adjustment disorder.

Severity of this disorder is not directly proportional to the severity of stressor, because personality characteristics and cultural or group norms both contribute to how well an individual copes with a given set of circumstances. However one characteristic of adjustment disorder is that the behavior displayed is in excess of what would normally be expected under the circumstances. A return to pre-stressor functioning within 6 months can be expected & chances of complete recovery when the stress level comes down are good. Adjustment disorder usually doesn't involve extremely bizarre behavior & is not a part of life long pattern of maladaptation.

One of the most important question clinicians must answer is evaluating the possibility of an adjustment disorder is, "What is the patient having trouble adjusting to?" When there is no stressor, no diagnosis made. Most adjustment disorders are transient, & in time people heal themselves. At the same time, it must be recognized that what is observed in adjustment disorders could also be a part of another more long lasting condition like mood disorder. The level of resistance & patients rigidness with that resistance may be deciding factor.

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