ADJUSTMENT D/O short term maladaptive rxns to a “personal calamity”  aka PSYCHOSOCIAL STRESSOR  everyday events > catastrophic must appear

w/in 3 mo resolve w/in 6 mo  after the stressor ceases  longer if chronic stressor or w/ long lasting consequences 2-8% of general population ♀ 2x boys = girls (children & aolescent) freq in adolescents  school problems  parental rejection & divorce  subst abuse in adults  marital problems, divorce  new environment  financial the severity of the stressor does NOT always predict the severity of the d/o stressor severity is a complex fxn of  degree  quantity  duration  reversibility  environment  personal context  loss of parent is diff for a 10 y/o & 40 y/o stressors may be…  single / multiple  recurrent / continuous  intrafamilial  crime victim  physical illness Patient tend to blame a particular event, when a less obvious event may have had more meaning Current events may awaken past traumas or disappointments Some children have less mature defensive constellations than other children Resilience  determined by nature of children’s early relationships w/ their parents Response to traumatic life events is partially under genetic control physical s/s most common in children and the elderly Diagnosis and Clinical Features ADJUSTMENT d/o … w/ DEPRESSED MOOD  in adolescents (↑ risk for MDD)  Depressed mood,  Tearfullness  Hopelessness w/ ANXIETY  palpitations, jitteriness, agitation w/ MIXED ANXIETY and DEPRESSED MOOD w/ DISTURBANCE of CONDUCT  rights of others are violated  age appropriate societal norms and rules are disregarded  truancy, vandalism, reckless driving, fighting w/MIXED DISTURBANCE of EMOTIONS and CONDUCT UNSPECIFIED  Maladaptive rxns to stress  Inappropriate responses to the dx of physical illness  Massive denial  Severe noncompliance w/ tx  Social withdrawal  W/O depressed or anxious mood ICD 10 adjustment d/o is in same category as rxns to severe stress  acute stress rxn  post-traumatic stress d/o onset: within one month of event duration: no more than 6 months maladjustment features:  regressive behaviors  bed wetting  baby-ish speech  thumb sucking DDX: px w/ adjustment d/o are impaired in social or occupational functioning and show s/s beyong the normal and expectable reaction to the stressor Acute & posttraumatic stress d/o  More severe & longer lasting when stressor is of human origin (rape) than when it is not (floods)  Most patients return to their previous level of fxning w/in 3 mos  Adolescents usually req longer time Psychotherapy  Treatment of choice  Group therapy  Individual therapy  Family therapy  Crisis Intervention

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@ community  nat’l disaster/ persecution developmental stages  leaving home, getting married, retiring

Psychodynamic factors 3 FACTORS  NATURE of stressor  MEANING (conscious & unconscious) of stressor  (preexisting) VULNERABILITY of patient  personality d/o  organic impairment  loss of parent during infancy  reared in dysfunctional family  support from key relationships the same stress can produce a range of responses A person’s capacity to respond to stress is greatly influenced by …  Mother  Good enough mother  D. Winnicott  A person who adapts to the infants needs and provides enuf support to tolerate the frustrations in life   Rearing environment

Pharmacotherapy  not as a primary modality  Diazepam  Psychostimulant  Anti psychotics  SSRI

DSM IV Diagnostic Criteria for Adjustment d/o the dvlpt of emotional/behavioral symptoms in response to an identifiable stressor occuring w/in 3 months of the onset of stressor these symptoms or behaviors are clinically significant as evidenced by either of the ff:  marked distress that is in excess of what would be expected from exposure to the stressor  significant impairment in social or occupational (academic) fxning the stress related disturbance does NOT meet the criteria for another specific Axis I d/o and is not merely an exacerbation of a preexisting Axis I or II d/o the symptoms do NOT represent bereavement once the stressor (or it’s consequences) has terminated, the symptoms do not persist for more than an additional 6 months Acute : <6months Chronic >/=6 months Classify to subtype

L’08

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