Adjustment disorders
An adjustment disorder happens when a stressful event or life change causes an unhealthy emotional or behavioral reaction, one that disrupts your daily life or ability to function. This response usually happens within three months of the event or change taking place, and it tends to be short-term (lasting less than 6 months).
Adjustment disorders can affect anyone at any age, but they are often diagnosed in children and adolescents.
Adjustment disorders: causes and risk factors
What are the common causes of adjustment disorders?
An adjustment disorder may be triggered by:
- A major move.
- Death of a parent, sibling, grandparent, or another significant person.
- Financial problems.
- Long-lasting (chronic) illness in the child or a family member.
- Problems in an important relationship.
- Sudden sickness, of yourself or someone in your family.
- Trouble at work or school.
Of course, not everyone who goes through one of the above changes will experience an adjustment disorder. People have different personalities, past experiences, vulnerabilities, and coping skills, all of which can impact how they respond to stress.
For children and adolescents, where they are in their development affects their ability to deal with a stressor. There is no one cause of adjustment disorders.
What are the risk factors of adjustment disorders?
Adjustment disorders happen at all ages and are quite common in children and teens. They happen equally in boys and girls.
They also happen in all cultures, although the stressors and symptoms may vary across cultures.
Types and symptoms of adjustment disorders
Adjustment disorders are characterized by an extreme reaction to a stressor. However, adjustment disorder symptoms can vary widely from person to person. There are six main types of adjustment disorders, based on the major symptoms that you experience:
Adjustment disorder with anxiety
This subtype has symptoms like:
- Feeling jittery.
- Nervousness.
- Unexplainable worry.
- Separation anxiety. This is especially common in children after a stressor event.
- Physical symptoms like a racing heartbeat, sweating palms, and being unable to sleep.
Adjustment disorder with depressed mood
This subtype is common in adults. It has symptoms like:
- Being unable to enjoy things that previously brought joy.
- Feeling hopeless.
- Having a depressed mood.
- Tearfulness.
- Physical symptoms like feeling excessively tired or sick and being unable to sleep.
Adjustment disorder with anxiety and depression
A mix of symptoms from these conditions.
Adjustment disorder with disturbance of conduct
This is common in children or adolescents. Symptoms include:
- Acting impulsively, like driving recklessly or getting into fights.
- Destroying property and committing acts of vandalism.
Adjustment disorder with mixed disturbance of emotions and conduct
Symptoms are a mix of emotional symptoms (anxiety and depressed mood) and behavioral symptoms.
Adjustment disorder unspecified
The reaction to the stressor is excessive, but the symptoms don’t quite fit into any of the above descriptions. Symptoms may include withdrawing from friends, skipping work, and being unable to pay bills or engage in normal activities.
While most adjustment disorders last less than 6 months, some can become chronic, or long-lasting, especially if the stressor is persistent or the disorder goes untreated.
Chronic adjustment disorders can develop into other serious mental health conditions like:
- Anxiety disorder.
- Depressive disorder.
- Self-harm.
- Substance abuse disorder.
- Suicidal thoughts.
How do adjustment disorders differ from other mental health conditions?
Symptoms of adjustment disorders can resemble other mental health problems or psychiatric disorders. But there are a few key differences to keep in mind.
Adjustment disorder vs PTSD
Post-traumatic stress disorder (PTSD) is a disorder that sometimes develops in the months following an overwhelming or life-threatening event, like war or a major car accident. People with PTSD may have intense or disturbing thoughts or feelings about the event that disrupts their life. Whereas adjustment disorder tends to resolve in 6 months, PTSD can continue for much longer, sometimes years.
Adjustment disorder vs depression
Major depressive disorder is a mood disorder characterized by persistent feelings of sadness, numbness, or loss of interest. Adjustment disorders share several symptoms with major depressive disorder. However, major depression tends to have more physical and emotional symptoms, like loss of appetite and changes in sleep patterns. Depression may also have a higher degree of symptom severity. Additionally, depression can last much longer and may come and go over years. It is not always related to a life stressor.
Adjustment disorder vs general anxiety
Generalized Anxiety Disorder (GAD) is a mental health condition that is characterized by excessive and persistent worry or fear about various aspects of life that are not necessarily linked to a specific event or stressor, like adjustment disorders are. While both conditions can involve anxiety-like symptoms, their origins and diagnostic criteria differ, leading to distinct treatment approaches.
The only way to know for sure whether you are experiencing an adjustment disorder or another condition is to see your healthcare provider.
How is adjustment disorder diagnosed?
Your diagnosis
If you have symptoms of an adjustment disorder, you should talk to your doctor. Your doctor may suggest doing a few lab tests to make sure your symptoms are not caused by something else, like a head injury or physical illness. This may involve blood tests or a CT scan.
If your doctor suspects you are experiencing an adjustment disorder, they will refer you to a licensed mental health expert, like a psychiatrist. The psychiatrist will do an evaluation, which usually involves talking to you about your symptoms and your experiences.
Your child’s diagnosis
If your child is experiencing symptoms of an adjustment disorder, they will need to take to a psychiatrist who specializes in working with children or adolescents. This psychiatrist will talk with your child about their symptoms and experience. They may also talk with you and your partner to get a fuller picture.
Criteria for diagnosis
The DSM-5 is a manual used by healthcare professionals to diagnose mental health conditions. According to the DSM-5, diagnostic criteria for adjustment disorders include:
- Symptoms develop within 3 months of an identifiable stressor, or a specific life event like a major move.
- Symptoms cannot be explained by another underlying health condition or by grief.
- The response is out of proportion to the severity of the stressor.
- The response causes problems with daily life, like school, work, and socializing.
Based on this evaluation, the psychiatrist can diagnose you and work with you on a treatment plan.
How is adjustment disorder treated?
It is important to get treatment if you are diagnosed with an adjustment disorder. Left untreated, an adjustment disorder can become chronic or develop into other severe problems, like major depression.
Psychotherapy or talk therapy
Treatment for adjustment disorders often involves psychotherapy or talk therapy. There are different types of therapy, such as:
- Cognitive behavioral therapy. This type of therapy is designed to help you develop coping skills. It focuses on improving communication skills, anger management, stress coping skills, and problem-solving skills.
- Family therapy. Family therapy involves the whole family and focuses on improving things like communication and family support.
- Peer group therapy. Peer group therapy can be especially useful for children and adolescents. It focuses on increasing interpersonal and social skills within a peer group.
You or your child may only need therapy for a few weeks or months. Additionally, therapy provides tools to help you better deal with the next stressful life event.
Medications
Usually, medications are not used to treat adjustment disorders because they can take several weeks to take effect, and they can have side effects.
However, medications can be helpful in some cases, especially if your symptoms are severe and prevent you from fully engaging in other forms of treatment. Your doctor may prescribe:
- Anti-anxiety medicines (benzodiazepines).
- Antidepressant medicines. Selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI).
- Medication to help you sleep.
You may only need these medications for a few months. However, always talk to your doctor before stopping medications. Some, like antidepressants, can cause withdrawal if stopped suddenly.
Post-treatment outlook for adjustment disorders
Most people with adjustment disorders can recover completely, especially if the disorder is diagnosed and treated early. Reaching out for help is a necessary first step in your recovery.
In addition to getting professional help, there are various things you can do in your daily life to help build your resilience:
- Eat well, exercise, and get a good night’s sleep.
- Find activities that give you purpose.
- Recognize and develop your strengths.
- Stay in touch with your friends, family, and support network.
- Plan to address problems when they occur, rather than avoiding them.
FAQs about adjustment disorders
Adjustment disorders are relatively common short-term mental health conditions, often triggered by significant life changes or stressors. They are generally considered to be among the more common mental health diagnoses, affecting up to 10% of the general population.
Adjustment disorders are more common in children and adolescents than compared to adults. Children and adolescents are more vulnerable to experiencing emotional and behavioral challenges in response to life changes, such as moving to a new school, parental divorce, or other major stressors. However, adjustment disorders can still occur in adults, especially during significant life transitions or stress-inducing events.
In most cases, the symptoms of an adjustment disorder typically start within three months of the stressor and can last up to six months after the stressor has ended, or the person has learnt to use healthy coping strategies.
Yes, in most cases, an adjustment disorder can go away on its own without specific treatment. As the person adapts to the stressor or the stressor’s effects diminish, the symptoms tend to resolve naturally over time. Seeking support from friends, family, or a mental health professional can help facilitate the healing process and provide coping strategies during this time.
The main difference between adjustment disorder and anxiety disorder lies in their underlying causes and triggers. While adjustment disorder is an emotional or behavioral reaction to significant life stressors or changes, anxiety disorder is characterized by excessive and persistent worry or fear that is not necessarily linked to a specific event or stressor. While both can involve anxiety-like symptoms, their origins and diagnostic criteria differ, leading to distinct treatment approaches.
No, PTSD (Post-Traumatic Stress Disorder) and adjustment disorder are two distinct and separate mental health conditions with different diagnostic criteria and characteristics. PTSD is a specific psychiatric disorder that develops following exposure to a traumatic event, which can lead to intrusive memories, flashbacks, avoidance of reminders of the trauma, and negative changes in mood and thinking that can last for years. On the other hand, adjustment disorder is a short-term emotional and behavioral response to a significant life stressor or change, and typically goes away when the stressor is removed.
Chronic adjustment disorder is when symptoms persist for an extended period beyond the typical duration of 3-6 months and continue to disrupt your life. In such instances, mental health professionals may reevaluate the diagnosis or consider other underlying factors contributing to the ongoing distress.
In most cases, medications are not necessary to treat adjustment disorders. As adjustment disorders are typically short-term and often resolve on their own as the person adapts to the stressor or the stressor’s effects diminish, medication is not usually the first-line treatment. Instead, talk therapy (psychotherapy) and support from friends, family, or a mental health professional are often recommended to help the individual cope with the stressor and its impact on their emotional well-being.
References
National Center for Biotechnology Information (NCBI): National Library of Medicine. Adjustment Disorder: Current Diagnostic Status (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701359/)
MedlinePlus: National Library of Medicine. Adjustment disorder (https://medlineplus.gov/ency/article/000932.htm)