Adjustment Disorders and Maladaptive Behaviors

Adjustment Disorder

• Adjustment disorders describe maladaptive emotional and/or behavioral responses to an identifiable psychosocial stressor.
• The response is disproportionate to the severity of the stressor.
• Key symptoms: emotional or behavioral changes after a stressful event.

Maladaptive Behaviors

• Maladaptive behaviors are actions geared toward a specific goal.
• These actions are not adaptive or healthy.
• Actions may be aimed at stopping or starting something (like experiencing pain or trying to feel good).
• Maladaptive behaviors become habitual and affect feelings, thoughts, and interactions with others.

Negative Thinking and Self-Talk

• Examples include: "I'm a loser," "I'm unlucky," "No one cares/understands," "Nothing works out for me," "Nothing will ever change," "It has to be this way."

DSM-5-TR Classification

• The DSM-5-TR classifies adjustment disorders within the category of trauma- and stressor-related disorders.
• Diagnosis requires exposure to a traumatic or stressful event.

Diagnostic Criteria (DSM-5)

• Symptoms develop within three months of the stressful event.
• Symptoms are clinically significant, evidenced by:
  • Marked distress disproportionate to the stressor.
  • Significant impairment in social, occupational, or other important areas of functioning.
• The stress-related disturbance isn't another mental disorder or simply worsening of an existing one.
• Symptoms don't represent normal grieving.
• Symptoms resolve within six months after the stressor is gone.

Specifiers for Adjustment Disorders

• Depressed mood: low mood, tearfulness, or hopelessness.
• Anxiety: nervousness, worry, jitteriness, separation anxiety.
• Mixed anxiety and depressed mood: a combination of both.
• Conduct disturbance: behavioral problems.
• Mixed disturbance of emotions and conduct: emotional and conduct problems.
• Unspecified: maladaptive reactions not fitting other subtypes.

Differential Diagnosis

• PTSD is frequently comorbid (occurring together) with other psychiatric disorders, including anxiety, acute stress, obsessive-compulsive, depressive, and substance abuse disorders.

Adjustment Disorder vs. PTSD

• Both can have overlapping symptoms.
• Adjustment disorder symptoms are generally less severe than PTSD.
• PTSD symptoms can last for months or years, while adjustment disorder typically resolves within six months.
• PTSD is linked to life-threatening events, while adjustment disorder is often linked to life changes or transitions.

Psychological Vulnerabilities

• Weak ego strength.
• Feelings of inadequacy.
• Impaired self-efficacy.
• Learned helplessness.
• Adverse childhood experiences can shape cognitive styles, making one feel their life is out of their control.
• Maladaptive responses/coping mechanisms emerge from negative coping schemas.

Different Perspectives on Adjustment Disorders

• Biological: Structural or functional brain patterns, genetic predispositions.
• Humanistic: Lack of a positive self-regard leading to difficulty achieving self-actualization.
• Psychodynamic: Unconscious, unresolved conflicts from early childhood that interfere with id, ego, and superego development, preventing maturity
• Cognitive-behavioral: Dysfunctional thinking, and ineffective coping mechanisms.

Need to Pathologize

• Question of whether normal responses to challenges should be categorized as a disorder.
• People with adjustment disorders may struggle functioning in society and require interventions.
• Behaviors frequently fall outside of expected socio-cultural norms.

Thamas Szasz's Perspective

• Psychiatrist who argued against the concept of mental illnesses: "The Myth of Mental Illness".
• Argued mental disorders are social constructs, often political in nature, and labeling them is problematic.
• Saw mental difficulties as challenges in living rather than diseases.

Counter Arguments against Szasz

• Psychiatric labels sometimes address real problems.
• Determining if a deviation from a "premorbid" state (normal baseline) is justified and results in significant distress.
• Psychiatric diagnoses can offer valuable insights into understanding problematic behaviors.

Criteria for Defining Maladjustment

• Help-seeking behavior
• Irrationality
• Degree of Deviance.
• Emotional Distress
• Significant Impairment

Definition of Adjustment

• Feldman (1989): the effort to meet demands and challenges; inability to adjust.
• APA (2022): any method humans use to modify attitudes and behaviors in response to environmental demands; inability to modify these.

The Transition Cycle

• A model depicting the emotional stages experienced during a significant life event (positive or negative).
• Stages include: initial shock, excitement, honeymoon period, inner contradictions, inner crisis, reconstruction and recovery.