Adjustment Disorder

Adjustment Disorder

Adjustment Disorder

Adjustment disorder (AjD) is diagnosed when a person starts showing an excessive, extreme reaction to a stressful life event such as the death of a loved one, a job loss, or divorce.

While each of these examples can cause considerable distress, having AjD means the person can’t function at an expected level in a job, learning environment, social setting, or other important area of functioning.

Characteristics

Adjustment disorder is a type of anxiety disorder. It’s characterized by:

  • emotional and behavioral disturbances such as feeling sad, anxious, overwhelmed, and social withdrawal,
  • difficulties with activities of daily living such as washing, cleaning, and cooking

Prevalence

Adjustment disorder is a common condition that has a prevalence that ranges from 3 – 10% in regular healthcare settings. It is often undiagnosed by family doctors. Adjustment disorder can be diagnosed in both children and adults; however, children with AjD tend to show it through their behavior (acting out) rather than through their emotional state (a depressed mood). Adult women are diagnosed with adjustment disorder twice as often as adult men.

It is a significant contributor to problems at home, at work, and/or at school since this stress-related condition results in abnormal levels of stress experience because of unexpected or stressful events. Common triggers include major life changes or events like the death of a family member or close friend, the loss of a job, problems at work, moving house, or moving for school.

While these events can be stressful for most people, many find ways to adjust within a few months, but for those with an adjustment disorder, the transition may not be as short or as smooth. When untreated, AjD may cause reactions which result in prolonged depression or anxiety. Treatment is available, and AjD can often come to a fruitful conclusion in a short time frame, drastically reducing or eliminating the debilitating symptoms.

Symptoms of Adjustment Disorder:

Adjustment disorder impacts how we think and feel about the world and about ourselves, and symptoms vary by the type of adjustment disorder and by the person. 

Symptom duration:

Symptoms can surface within three months of a trigger event, and the length of time a person may have symptoms of AjD typically falls into one of two categories:

  • Acute. Symptoms can last up to six months and generally diminish when stressors are removed.
  • Persistent (chronic). Symptoms last beyond six months and continue to cause disruption and stress.

Examples of Adjustment Disorder symptoms include:

  • Reduced desire to eat
  • Increased feelings hopelessness or sadness
  • Reduced capacity to enjoy or have an interest in hobbies
  • Increased likelihood of crying
  • Increased feelings of anxiety, nervousness, worry or stress
  • Spending less time around friends or family
  • Reduced capacity to focus
  • Problems sleeping
  • Problems performing everyday functions
  • Feeling overwhelmed
  • Difficulty carrying out daily activities
  • Letting bills go past due
  • Missing work
  • Thoughts of suicide

Causes of Adjustment Disorder:

Causes of Adjustment disorder include genetics, an individual’s temperament, major life changes, or stressful events. Life events which can contribute to an increased chance of developing an Adjustment Stress Disorder may either be positive or negative.

Examples include:

  • Abuse or relationship issues
  • Marriage problems
  • Divorce
  • Moving house or moving for school
  • Problems at school
  • Starting a new job, losing a job, problems at work, retirement
  • Birth of a child, loss of a child
  • Experiencing extreme circumstances like a natural disaster, being in combat, or being the victim of an assault
  • Death of a loved one or a friend
  • Financial problems

In addition to singular triggers or stressors, events can also be ongoing — like medical issues for oneself of loved ones, feeling unsafe in one’s neighborhood, etc.

Types of Adjustment disorders:

The American Psychiatric Association lists six different types of adjustment disorders in its evidence-based manual for the assessment and diagnosis of mental disorders called the DSM-5.

DSM stands for “Diagnostic and Statistical Manual of Mental Disorders” and it lists the unique signs and symptoms that are related to Adjustment disorders.

Disorder types and their symptoms include:

  • Adjustment disorder with depressed mood – Feeling hopeless, sad, and tearful; and experiencing reduced or no pleasure in things previously enjoyed.
  • Adjustment disorder with anxiety – Worry, nervousness, reduced ability to focus, increased forgetfulness, and sensations of being overwhelmed. Increased separation anxiety may also present in children with an adjustment disorder.
  • Adjustment disorder with mixed anxiety and depressed mood – Combined depression and anxiety.
  • Adjustment disorder with disturbance of conduct – Problems with behavior like careless driving, fighting, vandalizing property, or skipping school.
  • Adjustment disorder with mixed disturbance of emotions and conduct – Combined anxiety and depression and the potential for problems with behavior.
  • Adjustment disorder unspecified – Symptoms outside those common with the other types of disorder symptoms, but regularly include physical problems, relationship problems, problems at work or at school

Treatment for Adjustment Disorder:

The duration of treatment is often brief but can last for longer in people with persistent or chronic adjustment disorder, particularly if the stressor is ongoing.

Treatment for adjustment disorder can be highly effective and includes therapies such as:

  • Cognitive-behavioral therapy
  • And/or medications such as selective serotonin reuptake inhibitors

Cognitive-behavioral therapy (CBT) or talk therapy, as it is also called, is the main treatment and can be a source of emotional support. Therapy includes education about the condition, how and why it impacted the client, what successful coping mechanisms look like, and how to get back on one’s feet. Sessions are available as family, group, or individual therapy.

To treat symptoms of anxiety and/or depression, medications such as antidepressants and anti-anxiety drugs may be included for a time as part of a more comprehensive treatment plan for AjD. If prescribed, their use, dosage, and a plan for how and when to come off them must be followed strictly

Diagnosis of Adjustment Disorder:

For a diagnosis of adjustment disorder to be made, a stressful life event causing the disorder is necessary. AjD symptoms start showing up within three months of a stressful life event, and they last for fewer than six months providing the stressor is gone; but if the stress is ongoing, adjustment disorder can persist and become chronic.

AjD is not considered as a potential diagnosis when symptoms are more in line with bereavement or grief processing.

AjD is considered as a potential diagnosis when:

  • Valid diagnoses of other new conditions, or worsened pre-existing conditions, have been ruled out.
  • Symptoms present within three months of stressor event.
  • Symptoms represent uncommon levels of stress, emotional distress, or they impact work or relationships

Adjustment Disorder complications:

The complications of adjustment disorder include:

  • Suicidal behavior (up to one-fifth of adolescent suicide victims may have an adjustment disorder).
  • Progression to a more serious mental illness such as major depressive disorder or post-traumatic stress disorder.

Medications for Adjustment Disorder:

Medications such as antidepressants and anti-anxiety drugs may be added to help with symptoms of depression and anxiety.

As with therapy, medications may only be needed for a few months, but stopping any medication without talking with a doctor first must be avoided. If stopped suddenly, some medications, such as certain antidepressants, may cause withdrawal-like symptoms.

Symptoms of Adjustment Disorder:

Adjustment disorder impacts how we think and feel about the world and about ourselves, and symptoms vary by the type of adjustment disorder and by the person. 

Symptom duration:

Symptoms can surface within three months of a trigger event, and the length of time a person may have symptoms of AjD typically falls into one of two categories:

  • Acute. Symptoms can last up to six months and generally diminish when stressors are removed.
  • Persistent (chronic). Symptoms last beyond six months and continue to cause disruption and stress.

Examples of Adjustment Disorder symptoms include:

  • Reduced desire to eat
  • Increased feelings hopelessness or sadness
  • Reduced capacity to enjoy or have an interest in hobbies
  • Increased likelihood of crying
  • Increased feelings of anxiety, nervousness, worry or stress
  • Spending less time around friends or family
  • Reduced capacity to focus
  • Problems sleeping
  • Problems performing everyday functions
  • Feeling overwhelmed
  • Difficulty carrying out daily activities
  • Letting bills go past due
  • Missing work
  • Thoughts of suicide

Causes of Adjustment Disorder:

Causes of Adjustment disorder include genetics, an individual’s temperament, major life changes, or stressful events. Life events which can contribute to an increased chance of developing an Adjustment Stress Disorder may either be positive or negative.

Examples include:

  • Abuse or relationship issues
  • Marriage problems
  • Divorce
  • Moving house or moving for school
  • Problems at school
  • Starting a new job, losing a job, problems at work, retirement
  • Birth of a child, loss of a child
  • Experiencing extreme circumstances like a natural disaster, being in combat, or being the victim of an assault
  • Death of a loved one or a friend
  • Financial problems

In addition to singular triggers or stressors, events can also be ongoing — like medical issues for oneself of loved ones, feeling unsafe in one’s neighborhood, etc.

Types of Adjustment disorders:

The American Psychiatric Association lists six different types of adjustment disorders in its evidence-based manual for the assessment and diagnosis of mental disorders called the DSM-5.

DSM stands for “Diagnostic and Statistical Manual of Mental Disorders” and it lists the unique signs and symptoms that are related to Adjustment disorders.

Disorder types and their symptoms include:

  • Adjustment disorder with depressed mood – Feeling hopeless, sad, and tearful; and experiencing reduced or no pleasure in things previously enjoyed.
  • Adjustment disorder with anxiety – Worry, nervousness, reduced ability to focus, increased forgetfulness, and sensations of being overwhelmed. Increased separation anxiety may also present in children with an adjustment disorder.
  • Adjustment disorder with mixed anxiety and depressed mood – Combined depression and anxiety.
  • Adjustment disorder with disturbance of conduct – Problems with behavior like careless driving, fighting, vandalizing property, or skipping school.
  • Adjustment disorder with mixed disturbance of emotions and conduct – Combined anxiety and depression and the potential for problems with behavior.
  • Adjustment disorder unspecified – Symptoms outside those common with the other types of disorder symptoms, but regularly include physical problems, relationship problems, problems at work or at school

Treatment for Adjustment Disorder:

The duration of treatment is often brief but can last for longer in people with persistent or chronic adjustment disorder, particularly if the stressor is ongoing.

Treatment for adjustment disorder can be highly effective and includes therapies such as:

  • Cognitive-behavioral therapy
  • And/or medications such as selective serotonin reuptake inhibitors

Cognitive-behavioral therapy (CBT) or talk therapy, as it is also called, is the main treatment and can be a source of emotional support. Therapy includes education about the condition, how and why it impacted the client, what successful coping mechanisms look like, and how to get back on one’s feet. Sessions are available as family, group, or individual therapy.

To treat symptoms of anxiety and/or depression, medications such as antidepressants and anti-anxiety drugs may be included for a time as part of a more comprehensive treatment plan for AjD. If prescribed, their use, dosage, and a plan for how and when to come off them must be followed strictly

Diagnosis of Adjustment Disorder:

For a diagnosis of adjustment disorder to be made, a stressful life event causing the disorder is necessary. AjD symptoms start showing up within three months of a stressful life event, and they last for fewer than six months providing the stressor is gone; but if the stress is ongoing, adjustment disorder can persist and become chronic.

AjD is not considered as a potential diagnosis when symptoms are more in line with bereavement or grief processing.

AjD is considered as a potential diagnosis when:

  • Valid diagnoses of other new conditions, or worsened pre-existing conditions, have been ruled out.
  • Symptoms present within three months of stressor event.
  • Symptoms represent uncommon levels of stress, emotional distress, or they impact work or relationships

Adjustment Disorder Complications:

The complications of adjustment disorder include:

  • Suicidal behavior (up to one-fifth of adolescent suicide victims may have an adjustment disorder).
  • Progression to a more serious mental illness such as major depressive disorder or post-traumatic stress disorder.

Medications for Adjustment Disorder:

Medications such as antidepressants and anti-anxiety drugs may be added to help with symptoms of depression and anxiety.

As with therapy, medications may only be needed for a few months, but stopping any medication without talking with a doctor first must be avoided. If stopped suddenly, some medications, such as certain antidepressants, may cause withdrawal-like symptoms.

Sources MEDLINE – Symptoms[ | MAYO CLINIC – Causes | PSYCHOLOGY TODAY – Treatment | HOPKINS MEDICINE – Risk Factors | NIH – Diagnostic Status