Adjustment disorders are stress-related conditions. An adjustment disorder is a short-term condition that occurs when a person has great difficulty coping with or adjusting to, a particular source of stress, such as a major life change, loss, or event. The reaction is more severe than would normally be expected and can result in significant impairment in social, occupational, or academic functioning. An adjustment disorder/stress response syndrome is not the same as post-traumatic stress disorder (PTSD). Adjustment disorder/stress response syndrome is very common and can affect anyone, regardless of gender, age, race, or lifestyle.
Adjustment Disorder Defined
The presence of emotional or behavioral symptoms in response to an identifiable stressor is the essential feature of adjustment disorders. The stressor may be a single event, or there may be multiple stressors. Stressors may be recurrent or continuous. Adjustment disorders may be diagnosed following the death of a loved one when the intensity, quality, or persistence of grief reactions exceeds what normally might be expected when cultural, religious, or age-appropriate norms are taken into account. Some stressors may accompany specific developmental events (e.g., leaving the parental home, and going to school). Symptoms must arise within three months of the onset of the stressor and last no longer than six months after the stressor has ended. Symptoms in children and adolescents tend to be more behavioral in nature, such as skipping school, fighting, or acting out. Adults, on the other hand, tend to experience more emotional symptoms, such as sadness and anxiety.
Different Types of Adjustment Disorders
There are six different subtypes of adjustment disorders listed in the Diagnostic and Statistical Manual of Mental Disorders-V.
- With depressed mood- Low mood, tearfulness, or feelings of hopelessness are predominant.
- With anxiety- Nervousness, jitteriness, worry, or separation anxiety is predominant.
- With mixed anxiety and depressed mood- A combination of depression and anxiety is predominant.
- With the disturbance of conduct- The disturbance of conduct is predominant.
- With mixed disturbance of emotions and conduct- Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
- Unspecified- For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
Adjustment Disorder Causes
Adjustment disorders are caused by life stressors. Factors that influence how well a person reacts to stress cause an individual to be more susceptible to an adjustment disorder. These factors may include economic conditions, availability of social support, and occupational and recreational opportunities. Susceptibility to stress may include such factors as social skills, intelligence, genetics, and existing coping strategies.
Adjustment Disorder Symptoms
Symptoms Include:
- Feeling sad, hopeless, or not enjoying things you used to enjoy
- Frequent crying
- Worrying or feeling anxious, nervous, jittery, or stressed out
- Trouble sleeping (insomnia)
- Lack of appetite
- Difficulty concentrating
- Feeling overwhelmed
- Loss of self-esteem
- Impulsive actions
- Difficulty functioning in daily activities
- Withdrawing from social supports
- Body pain or soreness
- Indigestion
- Avoiding important things such as going to work or paying bills
- Suicidal thoughts or behavior
How to Approach a Loved One:
There is no perfect way to approach a loved one that you assume or know is struggling with an adjustment disorder. If a family member or friend displays symptoms of an adjustment disorder, urge them to talk to a mental health professional. If a child or adolescent is struggling with an adjustment disorder, seek out an evaluation. Offer support and encouragement as much as possible is also helpful. Even though there is no known way to prevent adjustment disorder, strong family and social support can help a person work through a particularly stressful situation or event.
Types of Adjustment Disorder Treatment
The best prevention is early treatment, which can reduce the severity and duration of symptoms, and teach new coping skills. The primary goal of treatment is to relieve symptoms and help the person achieve a level of functioning comparable to that prior to the stressful event. Treatments for adjustment disorders include psychotherapy, medications, or both.
Psychotherapy
Psychotherapy, also known as talk therapy or psychological counseling is used to identify the patterns of behaviors, thoughts, beliefs, etc. that may impact individuals with adjustment disorder. Therapy helps the person understand how and why the stressor has affected his or her life. It also helps the person develop better coping skills and stress management to deal with stressful events. Therapy can provide emotional support, help return to a normal routine, place stressors in perspective to overall life, and help the individual view stressors as a chance for positive change or improvement.
Support Groups
Support groups can be helpful by allowing the person to discuss their concerns and feelings with people who are coping with the same stress. Through support groups, individuals can also learn from their peers how others deal with stressful life events and how they have made progress in dealing with their adjustment disorders.
Medications
Some people with adjustment disorders benefit from taking medications. Medications are used to lessen some of the symptoms of adjustment disorders, such as insomnia, depression, and anxiety. These medications include benzodiazepines, nonbenzodiazepine anxiolytics, SSRIs or SNRIs. If an individual is taking medications, it is important to know the side effects of the medication and consult a psychiatrist.
Resources
American Psychiatric Association (2019). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.
Mayo Clinic. (2019). Adjustment Disorders.
