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 in 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 development events (e.g., leaving a parental home, 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 sub-types 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 disturbance of conduct- 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, causing an individual to be more susceptible to an adjustment disorder. These factors may include economic conditions, availability of social supports, and occupational and recreational opportunities. Susceptibility to stress may include such factors as social skills, intelligence, genetics and existing coping strategies.
Adjustment Disorder Symptoms
To be diagnosed with an adjustment disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:
A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:
- Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
- Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
D. The symptoms do not represent normal bereavement.
E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.
- 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
- Avoiding important things such as going to work or paying bills
- Suicidal thoughts or behavior
How to Approach a Loved One:
There is not a 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, 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 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 in how others deal with stressful life events and how they have made progress to dealing with their adjustment disorders.
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.
Differences Between Common Disorders
There are other possible causes that resemble adjustment disorder but do not qualify as an adjustment disorder. Listed below are common disorders and the differences between them and adjustment disorder.
- Major depressive disorder- If an individual has symptoms that meet criteria for a major depressive disorder in response to a stressor, the diagnosis of an adjustment disorder is not applicable.
- Personality disorders- Some personality features may be associated with a vulnerability to situational distress that may resemble an adjustment disorder.
- Post traumatic stress disorder and acute stress disorder- In distinguishing adjustment disorders from post traumatic stress disorder (PTSD) and acute stress disorder, the timing is important to consider in the symptoms. Also, in adjustment disorders, the stressor can be of any severity rather than of the severity and type required for acute stress disorder and PTSD.
- Psychological factors affecting other medical conditions- In psychological factors affecting other medical condition, specific psychological entities (e.g., psychological symptoms, behaviors, other factors) exacerbate medical conditions. These factors put individuals at risk for mental disorders, but adjustment disorders are a reaction to the stressor (e.g., having a medical illness).
- Normative stress reactions- When bad things happen, most people get upset. This is not an adjustment disorder. The diagnosis should only be made when the magnitude of the distress exceeds what would normally be expected or when the adverse event precipitates functional impairment.
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(5th ed.) Arlington, VA: American Psychiatric Association.
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