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5.8: Acute Stress Disorder and Adjustment Disorders

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    Learning Objectives
    • Describe the diagnostic symptoms of acute stress disorder
    • Explain the symptoms and treatment options for adjustment disorders

    Acute Stress Disorder

    Acute stress disorder is similar to post-traumatic stress disorder (PTSD), but describes a disorder that lasts between three days and one month after a traumatic event. After one month, a diagnosis of acute stress disorder would be considered PTSD. The diagnostic symptoms are similar to that of PTSD, although diagnosis requires at least nine of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred.

    Watch It

    Watch this video to learn more about how acute stress disorder differs from PTSD.

    You can view the transcript for “Acute Stress Disorder | Mood Disorders” here (opens in new window).

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    Adjustment disorder (AD) represents an abnormal stress response that is different from normal adaptive reactions (Casey, 2014) that occurs within three months of the onset of a stressor. Adjustment disorder (AD) usually follows a stressful event such as losing a job, ending a relationship, financial conflict, changing environments, feeling overwhelming school or job stress, living in a dangerous situation, death of friends or family, illness, etc. According to DSM-5, adjustment disorder (AD) is characterized by

    • (A) emotional or behavioral symptoms in response to an identifiable stressor that
    • (B) are of clinical significance and
    • (C) do not meet the criteria for another mental disorder, and
    • (D) do not represent normal bereavement.

    Typically, AD remits within six months if the stressor is terminated; however, a persistent form of AD has been described if the stressor persists (First, 2013; Maercker and Lorenz, 2018). Furthermore, untreated AD poses the risk of persistent AD, and may pave the way for psychiatric disorders other than AD, particularly major depressive disorder and anxiety disorders (O’Donnell et al., 2016).[1]

    Some emotional signs of adjustment disorder are sadness, hopelessness, lack of enjoyment, crying spells, nervousness, anxiety, desperation, feeling overwhelmed, thoughts of suicide, performing poorly in school/work, etc. Common characteristics of AD include mild depressive symptoms, anxiety symptoms, and traumatic stress symptoms or a combination of the three. According to the DSM-5, there are six types of AD, which are characterized by the following predominant symptoms: depressed mood, anxiety, mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct, and unspecified. However, the criteria for these symptoms are not specified in greater detail.

    Watch It

    This video summarizes the six main types of adjustment disorders and discusses some of the symptoms and treatment options for adjustment disorders.

    You can view the transcript for “What is Adjustment Disorder? (Symptoms Occurring from a Stressful Life Event)” here (opens in new window).

    Unlike major depression, adjustment disorder is caused by an outside stressor and generally resolves once the individual is able to adapt to the situation. The condition is different from an anxiety disorder, which lacks the presence of a stressor, or post-traumatic stress disorder and acute stress disorder, which usually are associated with a more intense stressor and involve different experiences, such as flashbacks. AD is a result of subjective and emotional distress triggered as consequences of a meaningful change in life.[2]

    Case Study: Adjustment Disorder

    Selena recently moved several states away from home to live on campus as a freshman. She grew up in a tight-knit family in a small, rural community where she had close friends and positive relationships. She’d chosen this university because it hadn’t seemed overwhelmingly large but now that she’s here, in a new living situation, surrounded by people she doesn’t know, she feels overwhelmed anyway. Always a straight-A student, Selena is halfway through the semester and having difficulty with her courses. She had a panic attack right before a mid-term exam and was referred to counseling by her professor. At the counseling center, she talks to a therapist about her feelings of sudden depression, anxiety, and the physical symptoms that she can’t explain: chest pain, fatigue, and frequent headaches. Her therapist explains she is likely having some difficulty adapting to and coping with all the adjustments she’s experienced (moving, starting college, etc.). After working for a while with her therapist, learning new coping strategies, and getting more involved in the campus community, Selena begins to regain confidence. By spring term, her grades are back up and her symptoms have nearly resolved themselves.

    Treatment for Adjustment Disorders

    There has been little systematic research regarding the best way to manage individuals with an adjustment disorder. Because natural recovery is the norm, it has been argued that there is no need to intervene unless levels of risk or distress are high. However, for some individuals treatment may be beneficial. AD sufferers with depressive or anxiety symptoms may benefit from treatments usually used for depressive or anxiety disorders. One study found that AD sufferers received similar interventions to those with other psychiatric diagnoses, including psychological therapy and medication.

    Like many of the items in the DSM, adjustment disorder receives criticism from a minority of the professional community as well as those in semi-related professions outside the health-care field. First, there has been criticism of its classification. The DSM has been criticized for its lack of specificity of symptoms, behavioral parameters, and close links with environmental factors. Relatively little research has been done on this condition.[3]

    An editorial in the British Journal of Psychiatry described adjustment disorder as being so “vague and all-encompassing . . . as to be useless,”[4] but it has been retained in the DSM-5 because of the belief that it serves a useful clinical purpose for clinicians seeking a temporary, mild, non-stigmatizing label, particularly for patients who need a diagnosis for insurance coverage of therapy.

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    Glossary

    acute stress disorder: a disorder occurring for three days or one month following a traumatic experience marked by intrusion, negative mood changes, dissociation, avoidance, and changes in arousal

    adjustment disorder: a disorder involving a significant stress response occurring within three months of a stressor and marked by significant impairment but not meeting criteria for other disorders

     
    1. Winter L, Naumann F, Olsson K, Fuge J, Hoeper MM and Kahl KG (2020) Metacognitive Therapy for Adjustment Disorder in a Patient With Newly Diagnosed Pulmonary Arterial Hypertension: A Case Report. Front. Psychol. 11:143. doi: 10.3389/fpsyg.2020.00143 ↵
    2. Carta, M.G., Balestrieri, M., Murru, A. et al. Adjustment Disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemiol Ment Health 5, 15 (2009). https://doi.org/10.1186/1745-0179-5-15↵
    3. Casey, Patricia (January 2001). "Adult adjustment disorder: a review of its current diagnostic status". Journal of Psychiatric Practice. 7 (1): 32–40. doi:10.1097/00131746-200101000-00004. PMID 15990499. ↵
    4. Casey P, Dowrick C, Wilkinson G (December 2001). "Adjustment disorders: fault line in the psychiatric glossary". British Journal of Psychiatry. 179 (6): 479–81. doi:10.1192/bjp.179.6.479. PMID 11731347 ↵
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