Which adjustment is not typically included among external, internal, mental, and spiritual?

• A. External
• B. Internal
• C. Spiritual
• D. Physical

Answer: (D)

The adjustment framework here focuses on how a person changes across four domains after a loss: external, internal, mental, and spiritual. External adjustments involve changes in behavior, environment, and social roles—things you can observe in daily life. Internal adjustments are about the inner emotional experience and how you cope with those feelings. Mental adjustments cover thinking patterns, beliefs, problem-solving, and planning. Spiritual adjustments relate to meaning, purpose, values, faith, and ritual.

Physical does not fit this set because it refers to the body and bodily processes, which are not typically categorized as one of these adjustment domains. Grief can produce somatic symptoms, but the framework groups bodily aspects separately from these four dimensions of adjustment. So physical is the one that doesn’t belong in that quartet.