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Adjustment disorders 

Adjustment disorders
Adjustment disorders

Graham D. Glancy

and Stefan R. Treffers

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date: 17 January 2019

Becoming incarcerated and the challenges associated with incarceration are for most people major life stressors. The development of acute adjustment disorders is very common in these settings. This chapter attempts to give guidance to clinicians who are on the front line in very difficult circumstances. They are often dealing with patients who are overwhelmed with significant adverse life events, whose history reveals that they have dealt with emotional disturbances by acting out, or have struggled with substance abuse for many years. The risk of suicide is a substantial concern, and may be substantially elevated in the presence of an adjustment disorder. Patients present with complex comorbidities, often complicated by substance use disorder and withdrawal. Clinicians often have very little information at their disposal, yet will have to make difficult decisions under pressure. For example, it is often not possible to collect collateral information or previous clinical records. Clinicians are required to balance an empathic approach while maintaining clear boundaries. In addition, the clinician is also required to bear in mind the security constraints of the institution. Often the clinician is working in relative isolation, without the added resources of a multidisciplinary team. In our view, treatment of adjustment disorders in correctional settings requires a keen application of the whole complement of clinical skills. This chapter discusses the presentation, assessment issues, and management concerns of adjustment disorders in jails and prisons.

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