Adjustment Disorders Workup

Updated: Nov 22, 2021
  • Author: Julia B Frank, MD; Chief Editor: David Bienenfeld, MD  more...
  • Print
Workup

Approach Considerations

Allowing the person to talk at length about the nature of a stressor and its effects is important in the workup of adjustment disorders. Free-flowing narrative will often illuminate the meaning of the stressor, as well as the person’s typical coping and its effectiveness or lack of effectiveness. A thorough developmental and social history helps put the stress and its effects into the context of the person’s life. Searching for vulnerability factors, especially head injuries, medical illnesses, material deprivation, and conflicted or impoverished relationships, contributes to both diagnosis and treatment approach. With the patient’s consent, it may be helpful to seek information from a third party, to understand the broader impact of the stress, the degree of the person’s distress, and possible resources for help.

Along with sadness and anxiety, anger and shame are common emotional reactions to stress. As with any therapy, the goal of treatment should be to help the person regain hope and sense of self-efficacy. An evaluating or treating clinician should be especially careful to acknowledge the importance of the precipitating stress and to avoid judging the person’s reactions as inherently pathological. Therapists should be comfortable pointing to avenues of practical help when the nature of the problem justifies it. Expecting and predicting recovery is appropriate and typically has a beneficial impact.

The methods of Psychological First Aid (PFA), developed in the wake of the 9/11 attacks and refined in subsequent large-scale emergencies, embody and expand on these principles. PFA is offered to people after a stress, regardless of whether or not they show signs of mental disorder. It is most often applied in the context of population-based stresses, similar to the ones for which it was originally developed. [44]  Whether this approach has true preventive effects remains a topic for research, but its methods are widely taught to first responders and others who see people during and immediately after a stressful event.

Next:

Mental Status Examination

As in all psychiatric diagnoses, a complete evaluation and mental status examination must be conducted when someone seeks help after a significant stress. The clinician should pay special attention to the potential for suicide and homicide. Identifying the presence of hallucinations and delusions indicates a psychotic process, not an adjustment disorder. Disorientation and memory loss suggest an organic etiology (though dissociation as a psychological response may also compromise cognitive function).

The mental status examination commonly includes the following domains:

  • Appearance

  • Attitude

  • Mood

  • Affect

  • Speech

  • Thought process

  • Thought content

  • Perceptions

  • Cognition (concentration/immediate and long-term memory, capacity for abstraction)

  • Insight

  • Judgment

Previous
Next:

Laboratory Studies

Even in relatively young, healthy people metabolic problems such as anemia or vitamin deficiencies may compromise stress response. Stressed people may under or overeat, or use alcohol or drugs. If someone has anxiety or mood symptoms that are severe enough to prompt a mental health consultation, or if the person does not improve as expected, a complete blood count, comprehensive metabolic panel, vitamin D level, and thyroid function tests may uncover a treatable contributor to the maladaptive stress response.

Previous