Adjustment Disorders

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Adjustment disorders have been defined in the ICD-10 as states of subjective distress and emotional disturbance, usually interfering with social functioning and performance, and arising in the period of adaptation to a significant life change or to the consequences of a stressful life event (including the presence or possibility of serious physical illness). The stressor may have involved the individual or his community.

The DSM-IV suggests that the essential feature of an adjustment disorder is the development of clinically significant emotional or behavioural symptoms in response to an identifiable psychosocial stressor or stressors.

The distress suffered by a person should be in excess of what is expected as a normal reaction to the stressor. It may be manifested as predominantly depressive or anxiety symptoms, a mixture of depressive and anxiety symptoms, or disturbances of conduct or emotion. As pointed out by the ICD-10 categorization under which adjustment disorder is incorporated— "reaction to severe stress, and adjustment disorders"—stress is the hallmark of this group of disorders.

For the refugee population, stress may be experienced at every step, starting from the destruction of life and property as a result of war, the problems faced in shifting from one place to another and often to a new country, the pressures of coping with a new culture and language, the difficulties in relocation and ultimate absorption into another country, and the daily hardships faced in temporary refugee camps.

As a result of this continuous series of stresses, refugees manifest many emotional problems, like frequent quarrels, frustration, despair, sadness, anxiety and bereavement. What may start as bereavement and sadness for the loss of life and property may eventually change to an adjustment disorder or a depressive disorder. Sometimes the initial trauma can be strong enough to lead to a transient disorder of significant severity called acute stress reaction, which gradually develops into a more prolonged adjustment disorder.

During the course of the disorder, the person may have temporary difficulties in maintaining a relationship, have problems in rationalizing and reaching a decision, or have periods of depressive and anxiety symptoms. Depressive symptoms in the face of prolonged stress can be severe enough to lead to suicide. Generally, adjustment disorders last for a maximum of 6 months, but the disorder may be prolonged if the symptoms are predominantly depressive in nature of if the stressors continue.

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