Adjustment Disorder

Adjustment Disorder

Verified by World Mental Healthcare Association

Adjustment disorder is a short-term mental health condition characterized by emotional and behavioral symptoms in response to a stressful life event or change. It can cause difficulty coping with daily tasks, socializing, and can lead to depression and anxiety.

What Is An Adjustment Disorder?

Adjustment disorder is a mental health condition in which a person displays an extreme emotional response or exaggerated reaction to a stressful or traumatic event. It is a state of extreme emotional distress in the course of adapting to a negative life event, significant life changes, a serious physical illness, or the possibility of a severe illness. It is also referred to as situational depression 1 O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment Disorder: Current Developments and Future Directions. International journal of environmental research and public health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537 or stress response syndrome.

An individual with this condition lacks the ability to develop coping mechanisms to face the negative or positive circumstances that life presents. The inability to cope with stressful situations poses one or more severe psychological symptoms and sometimes even physical symptoms.

Prevalence Of Adjustment Disorder

An untreated adjustment disorder may develop into extreme mental health disorders such as major depressive disorder, anxiety disorders, or substance abuse.

Adjustment disorder statistics show that prevalence rates fall between 11–18% 2 Carta, M. G., Balestrieri, M., Murru, A., & Hardoy, M. C. (2009). Adjustment Disorder: epidemiology, diagnosis and treatment. Clinical practice and epidemiology in mental health : CP & EMH, 5, 15. https://doi.org/10.1186/1745-0179-5-15 for those who attend primary care. The rates may be higher or underdiagnosed in other groups.

Case example

Kiran, who recently transferred from Kolkata to Mumbai for his new job, had grown up in a close-knit joint family and never experienced living away from home. This sudden change left him feeling lonely and helpless, struggling to manage daily chores and his work responsibilities. His anxiety and sadness persisted, affecting his ability to focus at the office and socialize with colleagues.

He often experienced indigestion, unrest, and nervousness while juggling his schedule, leading to tearful phone calls with his mother about quitting his job and returning home. Despite feeling conflicted, Kiran didn’t want to give up such a valuable opportunity, leaving him in a state of confusion and stress.

Case analysis

The new change in Kiran’s lifestyle sometimes made him feel extremely low, and sometimes very overwhelmed and anxious in anticipation.

He was also suffering from a lack of concentration and indigestion. From the above instance, it seems apparent that Kiran was experiencing symptoms of adjustment disorder due to a major change in his life (moving to a new city).

Symptoms Of Adjustment Disorder

The signs 3 Strain J. J. (2019). The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology. International journal of environmental research and public health, 16(23), 4645. https://doi.org/10.3390/ijerph16234645 and symptoms of adjustment disorder usually depend on the severity of the circumstance or the individual concerned.

The adjustment disorder symptoms set in within 3 months of the stressful event and usually do not persist for more than six months after the stressor has ended.

The symptoms of adjustment disorder include:

  1. Rebellious or impulsive acts
  2. Anxiety
  3. Feeling sad or hopeless
  4. Not enjoying the things usually enjoyed
  5. Frequently weeping without reason
  6. Jittery
  7. Lack of concentration
  8. Feeling overwhelmed
  9. Excessive use of alcohol, drugs, and other substances
  10. Sleep disorders
  11. Lack of appetite
  12. Body aches
  13. Heart palpitations
  14. Sweating hands
  15. Indigestion
  16. Suicidal ideations and tendencies

Types Of Adjustment Disorder

There are six 4 Dragan, M., Grajewski, P., & Shevlin, M. (2021). Adjustment disorder, traumatic stress, depression, and anxiety in Poland during an early phase of the COVID-19 pandemic. European journal of psychotraumatology, 12(1), 1860356. https://doi.org/10.1080/20008198.2020.1860356 types of adjustment disorders, including:

1. With a depressed mood

People who are diagnosed with this type of anxiety disorder usually experience symptoms such as feelings of sadness or hopelessness. They may also cry for not being able to cope with stressful situations. They may also no longer enjoy activities that they used to enjoy.

2. With Anxiety

In adjustment disorder with anxiety, people tend to experience extreme anxiety, overwhelmed feelings, and worry. They may also experience a lack of concentration and memory problems.

Read More About Anxiety Here

3. With anxiety and depressed mood

Individuals suffering from this type of adjustment disorder experience both symptoms of depression and anxiety.

Read More About Depression Here

4. With conduct disturbances

Symptoms of this type of anxiety disorder usually include behavioral issues such as reckless driving, starting fights, or misbehaving with other people. Teens suffering from this condition may steal or vandalize property. They may also start missing school or misbehaving with teachers.

5. With mixed disturbances in emotional regulation and conduct

Symptoms of this condition include depression, anxiety, and behavioral issues.

6. Unspecified

People who are diagnosed with this type of anxiety disorder usually experience symptoms that are not associated with the other types. They are often physical symptoms or problems with friends, family, or work.

Causes Of Adjustment Disorders

Stressful situations 5 Zelviene, P., & Kazlauskas, E. (2018). Adjustment disorder: current perspectives. Neuropsychiatric disease and treatment, 14, 375–381. https://doi.org/10.2147/NDT.S121072 whether positive or negative may contribute to the risk of developing adjustment disorder. However, it’s not always clear why some individuals adjust to stressful circumstances more easily than others.

Even when an entire family or a group of children are exposed to the same stressful situation, some may develop adjustment disorders while others may not.

Stressors can be single events (like a bad breakup) or can be multiple events (like work problems, struggles at school, or financial issues). Such stressors can happen to an individual, a family, or an entire group (such as disaster survivors).

These can also be recurrent (like factors associated with the seasonal business) or with specific “milestone” events (like going to school, getting married, or retiring).

Risk Factors Of Adjustment Disorder

The risk of developing adjustment disorder depends on the age group and type of stressor. For instance, adjustment disorders in children may spring from factors such as parental separation or difficulties at school. On the other hand, adults cope with adjustment issues when they face situations like a bitter divorce, unemployment, etc.

However, certain common stressors 6 Lotzin, A., Krause, L., Acquarini, E., Ajdukovic, D., Ardino, V., Arnberg, F., Böttche, M., Bragesjö, M., Dragan, M., Figueiredo-Braga, M., Gelezelyte, O., Grajewski, P., Anastassiou-Hadjicharalambous, X., Javakhishvili, J. D., Kazlauskas, E., Lenferink, L., Lioupi, C., Lueger-Schuster, B., Tsiskarishvili, L., Mooren, T., … Adjust Study Consortium (2021). Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic – First results of the ESTSS COVID-19 pan-European ADJUST study. European journal of psychotraumatology, 12(1), 1964197. https://doi.org/10.1080/20008198.2021.1964197 are associated with the onset of adjustment disorder symptoms—including:

  • Genetic factors
  • Relationship or interpersonal problems
  • Financial stress like loss of employment, debt, etc.
  • Stress and conflict at the workplace
  • Situational changes (like moving houses, jobs, schools, countries, etc.)
  • Grief over the death of a loved one
  • Life-threatening experiences such as physical assault, combat, or natural disaster
  • Illness
  • Anxiety regarding sexual identity
  • Death, illness, conflict, or trauma in the family

Diagnosing Adjustment Disorder

The diagnosis of adjustment disorder usually involves:

  • The identification of major life events
  • The symptoms the individual is experiencing associated with the event
  • How the symptoms are impacting his/her ability to function daily

A mental health professional (MHP) diagnoses the patient following some specific criteria outlined in psychiatric manuals 7 Appart, A., Lange, A. K., Sievert, I., Bihain, F., & Tordeurs, D. (2017). Le trouble de l’adaptation et le DSM-5 : une revue de la littérature [Adjustment disorder and DSM-5: A review]. L’Encephale, 43(1), 41–46. https://doi.org/10.1016/j.encep.2015.06.007 . An MHP also delves into the patient’s medical, mental, and social history.

After careful evaluation, the mental health professional devises a treatment plan to ease the symptoms of this disorder.

Treatment For Adjustment Disorder

Adjustment disorder is typically treated 8 Strain, J. J., Smith, G. C., Hammer, J. S., McKenzie, D. P., Blumenfield, M., Muskin, P., Newstadt, G., Wallack, J., Wilner, A., & Schleifer, S. S. (1998). Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting. General hospital psychiatry, 20(3), 139–149. https://doi.org/10.1016/s0163-8343(98)00020-6 with therapy, medications, or a combination of both. Some of the most effective adjustment disorder treatment methods 9 Schatzberg A. F. (1990). Anxiety and adjustment disorder: a treatment approach. The Journal of clinical psychiatry, 51 Suppl, 20–24. include:

1. Cognitive-behavioral therapy (CBT)

CBT in treating adjustment disorder evaluating the negative thoughts and patterns that govern the behavior of the individual. The therapist offers emotional support and assists in gaining greater insights into the causes of the symptoms.

Such sessions usually help patients reorient themselves with positivity and goal-driven approaches, as well as develop healthy coping mechanisms for any future stressful situations.

Read More About CBT Here

2. Family and group therapy

This type of therapy involves one or more therapists working with a group of individuals at the same time. Group therapy can help improve mood, ease the symptoms of adjustment disorder, and achieve stability.

Such sessions may take place with a group of patients suffering from the same mental health conditions or with the patient and his/her family.

3. Interpersonal psychotherapy

This therapy is focused on treating mood disorders associated with adjustment disorder. The therapist helps the patient navigate stressful situations with his/her family, friends, or co-workers in a healthy manner.

4. Pharmacotherapy

Medications may also be prescribed to treat patients with adjustment disorders. Pharmacological therapy associated with adjustment disorder treatment is used to ease symptoms such as insomnia, depression, or anxiety. Some of the medications can include

  • Benzodiazepines such as lorazepam (Ativan) and alprazolam (Xanax)
  • Non-benzodiazepines anxiolytics such as gabapentin (Neurontin)
  • Serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as sertraline (Zoloft) or venlafaxine (Effexor XR)

Read More About Insomnia Here

Coping Tips For Adjustment Disorder

Consider the following measures 10 Strain J. J. (2019). The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology. International journal of environmental research and public health, 16(23), 4645. https://doi.org/10.3390/ijerph16234645 to cope with the adjustment issues:

  1. Develop a strong support network and communicate openly with them
  2. Look for positivity in difficult situations
  3. Follow a healthy diet and sleep regime with adequate exercise and socialization
  4. Establish good self-esteem and confidence
  5. Practice mindfulness
  6. Learn from past experiences
  7. Recognize your personal weaknesses and develop your strengths
  8. Face your fears and accept new challenges that will help you grow
  9. Develop healthy coping mechanisms that will help you deal with stressful situations in the future

At A Glance

  1. Adjustment disorder is the chronic inability to cope with a life-changing or stressful event.
  2. It is known as stress response syndrome.
  3. Symptoms of this condition start to set in within three months of the stressful event and last no longer than six months after the end of the event.
  4. Stressful situations whether positive or negative may contribute to the risk of developing this disorder.
  5. The “failure to adapt” triggers significant impairment in social, interpersonal, occupational, educational, or other areas of functioning.
  6. Adjustment disorder can be easily treated with therapy, medication, and developing healthy coping mechanisms.

Frequently Asked Questions (FAQs)

1. What is the difference between adjustment disorder and major depression?

Adjustment syndrome/stress response syndrome has some symptoms that overlap with those of major depression. Unlike major depression, an adjustment disorder doesn’t involve as many of the physical and emotional symptoms of clinical depression (such as changes in sleep, appetite, and energy) or high levels of severity (such as suicidal thinking or behavior).

2. What is the difference between adjustment disorder and posttraumatic stress disorder?

An adjustment disorder/stress response syndrome is not the same as posttraumatic stress disorder (PTSD). PTSD is a reaction to a life-threatening event, with symptoms setting in at least 1 month after the event. PTSD symptoms tend to last longer than in adjustment disorders OR stress response syndromes. By comparison, adjustment disorder symptoms rarely last longer than 6 months.

3. How can we prevent an adjustment disorder?

There are no guaranteed ways to prevent adjustment disorders. But developing healthy coping skills and learning to be psychologically resilient in stressful situations can reduce the risks of such disorders.

References:

  • 1
    O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment Disorder: Current Developments and Future Directions. International journal of environmental research and public health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537
  • 2
    Carta, M. G., Balestrieri, M., Murru, A., & Hardoy, M. C. (2009). Adjustment Disorder: epidemiology, diagnosis and treatment. Clinical practice and epidemiology in mental health : CP & EMH, 5, 15. https://doi.org/10.1186/1745-0179-5-15
  • 3
    Strain J. J. (2019). The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology. International journal of environmental research and public health, 16(23), 4645. https://doi.org/10.3390/ijerph16234645
  • 4
    Dragan, M., Grajewski, P., & Shevlin, M. (2021). Adjustment disorder, traumatic stress, depression, and anxiety in Poland during an early phase of the COVID-19 pandemic. European journal of psychotraumatology, 12(1), 1860356. https://doi.org/10.1080/20008198.2020.1860356
  • 5
    Zelviene, P., & Kazlauskas, E. (2018). Adjustment disorder: current perspectives. Neuropsychiatric disease and treatment, 14, 375–381. https://doi.org/10.2147/NDT.S121072
  • 6
    Lotzin, A., Krause, L., Acquarini, E., Ajdukovic, D., Ardino, V., Arnberg, F., Böttche, M., Bragesjö, M., Dragan, M., Figueiredo-Braga, M., Gelezelyte, O., Grajewski, P., Anastassiou-Hadjicharalambous, X., Javakhishvili, J. D., Kazlauskas, E., Lenferink, L., Lioupi, C., Lueger-Schuster, B., Tsiskarishvili, L., Mooren, T., … Adjust Study Consortium (2021). Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic – First results of the ESTSS COVID-19 pan-European ADJUST study. European journal of psychotraumatology, 12(1), 1964197. https://doi.org/10.1080/20008198.2021.1964197
  • 7
    Appart, A., Lange, A. K., Sievert, I., Bihain, F., & Tordeurs, D. (2017). Le trouble de l’adaptation et le DSM-5 : une revue de la littérature [Adjustment disorder and DSM-5: A review]. L’Encephale, 43(1), 41–46. https://doi.org/10.1016/j.encep.2015.06.007
  • 8
    Strain, J. J., Smith, G. C., Hammer, J. S., McKenzie, D. P., Blumenfield, M., Muskin, P., Newstadt, G., Wallack, J., Wilner, A., & Schleifer, S. S. (1998). Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting. General hospital psychiatry, 20(3), 139–149. https://doi.org/10.1016/s0163-8343(98)00020-6
  • 9
    Schatzberg A. F. (1990). Anxiety and adjustment disorder: a treatment approach. The Journal of clinical psychiatry, 51 Suppl, 20–24.
  • 10
    Strain J. J. (2019). The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology. International journal of environmental research and public health, 16(23), 4645. https://doi.org/10.3390/ijerph16234645
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