Adjustment Disorders
Essential Concepts
Screening Questions
Has there been something that happened recently that has caused you to feel particularly upset?
What was it? When did it happen?
What type of response have you had to that event?
Every new adjustment is a crisis in self-esteem
—Eric Hoffer
Clinical Description
Life is full of events that cause upset and stress. At times a particular stress may precipitate a significant decline in ability to cope. When this happens, a child, adolescent, or adult may experience extreme distress, depression, anxiety, or behavioral symptoms as a consequence. We diagnose an adjustment disorder when the symptoms are not specifically related to bereavement and do not meet criteria for another Axis I or II disorder, but have resulted in significant impairment in functioning within 3 months of the stressor. In children and adolescents, divorce or separation of parents, a move to a new school or home, or being teased at school may result in a distress reaction. When the reaction is excessive and interferes with daily life tasks, it becomes an adjustment disorder.
Clinical Vignette
Brittany is a 13-year-old seventh-grade girl presenting with symptoms of anxiety, crying spells, and recent shoplifting, which was quite uncharacteristic, as she was described by her parents as an honor student who had been very well behaved. Her parents have been arguing a great deal, and last month announced to Brittany and her 7-year-old sister that they are divorcing. Her father will be taking a new job and moving 2 hours away. Brittany speaks freely to you and relates that she “had a perfect life, and now it is totally ruined!” She is quite close to her father and feels abandoned by his move. Her parents, although well meaning, tried to shield the issues from the children by stating, “It will all work out.” They subtly and not so subtly let the children know that this was not a topic for discussion. Brittany tells you that she has begun to hang out “with other kids from broken homes, since I am one now.” The shoplifting and other behaviors are a manifestation of her distress (and possibly an attempt to reunite her family).

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