Adjustment disorders

Abstract Becoming incarcerated and the physical, social, and psychological challenges associated with incarceration typically constitute major life stressors. The development of psychiatric disorders such as acute adjustment disorder is common in these settings. This chapter attempts to give guidance to clinicians who are on the front lines and are presented with difficult circumstances in relation to managing patients with adjustment disorders. They are often dealing with patients who are overwhelmed by significant adverse life events, whose personal histories reveal evidence of trauma and who respond to emotional disturbances by acting out, or who have struggled with substance use for many years. The risk of suicide is a substantial concern for clinicians working with incarcerated persons and may be elevated in the presence of an adjustment disorder. Patients present with complex comorbidities, often complicated by substance use disorder and withdrawal, posttraumatic stress disorder, and personality disorder. Clinicians may have very little information at their disposal yet will have to make difficult decisions under pressure, requiring the keen application of a wide variety of clinical skills. This chapter discusses the presentation, assessment, and management of adjustment disorders in jails and prisons.