Adjustment Disorder

What is Adjustment disorder?

Adjustment disorder is an excessive or abnormal short-term reaction to a stressful life event. The reaction is more severe than expected and can result in significant impairment in occupational, academic or social functioning.

Symptoms arise within three months of the stressor occurring and last no longer than six months after the event has ended.

There are six types of adjustment disorders and each type has distinct signs and symptoms. Adjustment disorders can affect children and adults, and they are often associated with high risk of suicidal behaviour, substance abuse and the prolongation of other mental issues.

Also referred to as situational depression, adjustment disorder may develop into a more severe mental health problem.

Types of adjustment disorder

There are six different adjustment disorders. Each one is associated with different symptoms:

1. Adjustment disorder with depressed mood

People with this type of adjustment disorder experience feelings of hopelessness and sadness. It is also associated with crying. Individuals may also find they no longer enjoy their hobbies or regular activities.

2. Adjustment disorder with anxiety

Symptoms include feeling worried, anxious and overwhelmed. Individuals with this disorder may also struggle to concentrate. For children and teenagers, this diagnosis is normally associated with separation anxiety from a parent or loved one.

3. Adjustment disorder with mixed anxiety and depressed mood

Individuals with this disorder experience both anxiety and depression.

4. Adjustment disorder with disturbance of conduct

People with this type of adjustment disorder have behavioral issues i.e. starting fights and driving recklessly. Teenagers may skip school, steal or vandalize property.

5. Adjustment disorder with mixed disturbance of emotions and conduct

Symptoms here include anxiety, depression and behavioral issues.

6. Adjustment disorder unspecified

Those diagnosed with this type have symptoms that aren’t associated with the other adjustment disorders. These often include the physical symptoms listed above or problems with family, depression, school or work.

Adjustment Disorder Symptoms

Although symptoms for each of the six disorders vary, there are general physical and mental symptoms to look out for. These symptoms usually occur during or straight after an individual experiences a stressful event.

Although the disorder lasts no longer than six months, symptoms can continue if the stressor hasn’t been removed. Some individuals only have one symptom, whereas others experience many.

Mental symptoms may include:

  • Acting anxious
  • Rebellious or impulsive behaviour
  • Crying
  • Feeling trapped, hopeless or sad
  • A withdrawn attitude
  • Loss of self-esteem
  • Struggling to concentrate
  • Suicidal thoughts

Physical symptoms may include:

  • Fatigue
  • Insomnia
  • Body soreness or pain (headache, stomach ache, chest pain)
  • Indigestion
  • Muscle trembling or twitches
  • Palpitations
  • Lack of appetite

Adjustment Disorder Causes

Life stressors are normally the cause of adjustment disorders. However, these stressors can be different for adults and children.

In adults, the causes of adjustment disorder include:

  • The death of a family member or friend
  • Relationship issues, including divorce
  • An illness or health issue
  • Moving house or to a new place/country
  • Sudden, unexpected disasters (floods, hurricanes)
  • Money worries or troubles
  • Work concerns or unemployment
  • Having a baby
  • Retirement
  • Being a victim of crime or abuse

In children, causes can include:

  • Family problems or fights
  • Problems at school or college
  • Anxiety over sexuality

Factors that influence how well an individual reacts to stress may include the availability of social support, economic conditions, and recreational and occupational opportunities.

The susceptibility to stress can be influenced by factors such as intelligence, social skills, genetics and coping strategies.

Effects of adjustment disorder

The effects of adjustment disorder can touch various aspects of life, no matter how long an individual has been suffering for. These effects are social, physical and mental.

Adjustment disorder can be physically draining because the body is attempting to cope with traumatic circumstances or stressors. Equally, adjustment disorder can have a big impact on mental health.

Some of the physical, social and mental effects include:

  • Weight changes
  • Memory issues
  • Extreme mood swings
  • Panic attacks
  • Increased withdrawal and isolation from friends and loved ones
  • Decreased performance in school or work
  • Marital conflicts
  • Familial conflicts

Adjustment disorder complications

These complications include:

  • Depression
  • Risk of self-injury or suicide
  • Drug or alcohol addiction
  • Bipolar disorder
  • Antisocial personality disorder
  • Schizophrenia

The development of adjustment disorder in children

Although the development of adjustment disorder in children is similar to the development of the condition in adults, there are four main factors to consider.

Children adjustment disorder factors include:

  • The nature of the stressor
  • The vulnerabilities of the child
  • Intrinsic factors (sex, age, emotional development, ego development, temperament, coping skills and past experiences)
  • Extrinsic factors (expectations, understanding, parents and support systems, maturity, skills, and support available from the child’s wider environment)

The most important factor in the development of adjustment disorder in an adolescent or child is his/her degree of vulnerability. This depends on the child’s environment and the characteristics of the child.

How is adjustment disorder diagnosed?

A doctor will diagnose the condition after a complete evaluation of the individual’s medical history. The doctor will also complete a full physical and psychiatric examination.

In order to be diagnosed with an adjustment disorder, a patient must meet the following criteria:

  • Experiencing behavioral or psychological symptoms within the first three months of an identifiable stressor or stressors occurring
  • Feeling more stressed than normal in response to a particular stressor, or stress that causes problems with relationships, at work or in school, or meeting both of these criteria
  • The improvement of any symptoms within the first six months after the stressor or stressors have been removed
  • Symptoms that are not the result of a different diagnosis

Adjustment Disorder Treatments

Treatment is often required for adjustment disorder. For some, treatment is only required on a short-term basis, whereas other individuals may require treatment over an extended period of time. Typically, adjustment disorder is treated with medications, therapy, or a combination of both.

Therapy

Therapy is the main treatment option and a doctor or healthcare provider will recommend a mental health professional. If the doctor believes medication is required, they will refer the patient to a psychiatric nurse or psychiatrist. Therapists offer emotional support and help individuals understand the cause of their adjustment disorder.

There are several types of therapies used for adjustment disorder.

Adjustment disorder therapy types include:

  • Crisis intervention
  • Psychotherapy
  • Specific support groups for the type of adjustment disorder experienced
  • Family and group therapies
  • Interpersonal psychotherapy
  • Cognitive behavioral therapy
  • Mindfulness-based therapy
  • Internet-based therapy

Psychotherapy

Also known as talk therapy, psychotherapy is the main treatment for adjustment disorder. This can be delivered as group, individual or family therapy. It provides emotional support, helps individuals get back to their normal routines, teaches stress-management and coping skills, and enables the individual to understand why the stressful event affected them so much.

Family therapy

Family therapy is often recommended for cases in which the patient is a child or a teenager. Family members can also benefit from this session after the patient has begun individual psychotherapy meetings. During these sessions, the family therapist will reassure parents or family members, guaranteeing they understand that the adjustment disorder is short-lived and their support will be important to help the patient overcome their issues.

Group therapy

Many adjustment disorder patients often benefit from attending group sessions with other people who have also experienced the same stressor. Within the group, members can exchange advice and coping strategies, as well as provide encouragement and support. Often, group therapy sessions provide new social networks and circles for those that have lost loved ones or family members through divorce or death.

Medication

Some people also benefit from taking medication. These medications are used to improve the symptoms experienced with adjustment disorder i.e. insomnia, anxiety and depression.

Medications include:

  • SSRI or SNRI (such as venlafaxine or sertraline)
  • Nonbenzodiazepine anxiolytic (such as gabapentim)
  • Benzodiazepines (such as alprazolam or lorazepam)
  • Sedating plant extracts (such as valerian and kava-kava)
  • Anxiolytic antihistamines (such as hydroxazine)
  • Time-limited or intermittent use of sedatives related to benzodiazepines (such as zolpidem)

Self-help methods

Self-help methods and techniques for the treatment of adjustment disorders are regularly overlooked. People with this disorder can gain help without seeking treatment or advice from a doctor. Finding social groups related to a particular stressor is now easier than ever before. These groups can be anything, ranging from meeting up with someone who was diagnosed with a similar illness, someone who just got divorced, to dealing with redundancy or unemployment etc.

Adjustment Disorder Prevention

There is no guarantee that an adjustment disorder can be prevented. However, learning to cope and be resilient with certain stressors can help. For example, individuals should develop a strong support network, live healthily, establish a good self-esteem and look for the positives in difficult situations.

Who is at risk?

Anybody can develop an adjustment disorder. There is no way of knowing who will experience an adjustment disorder and who won’t out of a group of people in the same situation.

When to see a doctor

Usually, stressors are temporary and an individual will cope better with them as time goes on. This means the symptoms of adjustment disorder will mostly improve by themselves. However, for some people, the stressor remains a part of their lives or the situation comes up again.

Individuals who continue to struggle or find it tough to get through the day should contact their doctor or physician to inquire about necessary treatment options.

Adjustment Disorder Outlook

The outlook for recovering from an adjustment disorder is good if an individual is treated swiftly and correctly. If this is the case, the patient will recover quickly. The disorder very rarely lasts longer than six months in most people.

Adjustment disorder statistics

The most recent statistics show:

  • Adult women are diagnosed twice as often as adult men. However, adjustment disorder can affect both genders and all ages
  • There are no reports of distinct ethnic or racial predilection for this condition
  • Among children and teenagers, boys and girls are equally as likely to receive an adjustment disorder diagnosis
  • Suicidal behavior is prominent in individuals of all ages with an adjustment disorder. Up to one-fifth of child suicide victims may have an adjustment disorder
  • Between 20 and 50% of sufferers of an adjustment disorder go on to be diagnosed with a psychiatric disorder within five years. This disorder is usually more serious in nature
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Last Reviewed:
September 12, 2017
Last Updated:
September 12, 2017
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