For anyone who has ever been in a serious automobile accident, it is normal to be anxious or wary of the next trip in a car. Yet most people would probably cross their fingers, buckle their seat belts, and be on their way. In time, thoughts of the accident would recede and have little effect on a person's driving ability.

Yet for some people, it's not so easy. Depression or anxiety after the accident can continue to linger,sometimes so severely that a person cannot even get back into a car.Similar reactions can occur following other stressful or traumatic events. It's more than a case of having the jitters--it's a psychiatric condition known as adjustment disorder.

"Adjustment disorder is really not like any other psychiatric condition. It's more of a transient response, yet it can be devastating to some people," says Dr. Scott Stuart, associate professor of psychiatry at the University of Iowa College of Medicine and a staff physician at the UI Hospitals and Clinics. "The car accident scenario is one example of adjustment disorder. Another would be a grief reaction to the death of a friend or relative that continues for an extended period of time. Both are responses to an acute form of stress that is greater than would be normally expected."

While researchers agree that adjustment disorder occurs as a result of a specific event, Stuart says criteria for diagnosing the condition are non-specific. "The onset of adjustment disorder can happen as late as six months after the event and can last as long as six months after it occurs. But it's unclear whether diagnosing the duration of the symptoms will tell us much more about the condition. We do know it is triggered by a specific event, but adjustment disorder historically has been used as a diagnosis for people who don't meet the criteria for other serious psychiatric problems but clearly need treatment of some kind.

"There appear to be several varieties of adjustment disorder--the condition can occur with changes in mood, or anxiety, or with changes in behavior, like getting into trouble or acting aggressively."

Until researchers learn more about the underlying causes of adjustment disorder, treatment options are limited. "Crisis counseling seems to help those with problems like depression, but it's unclear as to what helps people with anxiety problems or behavioral problems," Stuart says. "Research regarding the use of medications for patients with adjustment disorder is limited and suggests that only the short-term use of drugs may be helpful for those patients with anxiety."