Curriculum · Mental Health / Psychiatry
Reaction to an identifiable psychosocial stressor: management
What it is
Adjustment disorder follows a stressor, and the nature of that stressor is what places the diagnosis. In adjustment disorder the stressor typically involves financial issues, health-related problems or relationship problems. In post-traumatic stress disorder the nature of the stressor is usually in form of exposure to actual or threatened death, serious injury or sexual violence. In short, the stressor in PTSD is catastrophic.
How it presents
A woman of 27 divorced 5 weeks ago who comes to the psychiatric clinic with one week history of anxiety, worrying thoughts, low mood and fearfulness, and whose functional capacity as a teacher is impaired by her psychological problem, carries the usual picture. The stressor came first, the symptoms followed it, and function has given way.
How it is diagnosed
The clinical hint is that when a patient meets the diagnostic criteria for major depressive disorder in response to a stressor, the diagnosis should be major depressive disorder and not adjustment disorder. The differential runs: 1) adjustment disorder with depressed mood; 2) adjustment disorder with anxiety; 3) adjustment disorder with mixed anxiety and depression; 4) major depressive disorder, for which more history is required regarding the psychological and biological symptoms of depression.