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What is Adjustment Disorder?

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Adjustment disorder is a group of stress-related symptoms that occurs as a reaction to a traumatic or stressful life event. These events may include the death of a loved one, losing a job, or relationship issues. Often, the reaction is disproportionate to the precipitating event. Adjustment disorder is most commonly noted in children and adolescents; however, it can also affect adults.

Adjustment disorder is also referred to as "situational depression" as many of the symptoms of adjustment disorder, such as feelings of sadness, crying spells, and loss of interest in activities once enjoyed, are similar to depressive disorder. However, unlike a depressive disorder, adjustment disorder is the result of the effect of an outside stressor and tends to resolve when the individual starts to adjust to the situation.

What Happens If Adjustment Disorder is Left Untreated?

If left untreated, the effects of adjustment disorder can seriously impact an individual’s life. Children and teens can particularly face long-term problems of adjustment disorder. Some of the most common effects of chronic, untreated adjustment disorder include:

  • Anxiety disorders
  • Depressive disorders
  • Suicidal thoughts and behaviors
  • Alcohol or drug addiction
  • Self-harm tendency

Types of Adjustment Disorder

Adjustment disorder can be categorized into 6 types based on their symptoms:

  • Adjustment disorder with anxious mood: The main symptomatology of this type includes anxiety-related issues, such as a comprehensive negative view of possibilities, feeling overwhelmed, and excessive worry.
  • Adjustment disorder with depressed mood: Individuals diagnosed with this type tend to experience symptoms of depression, including lack of motivation, low mood, and loss of self-esteem.
  • Adjustment disorder with mixed anxiety and depressed mood: The symptomatology of this type reflects a combination of anxiety and depression.
  • Adjustment disorder with disturbance of conduct: Dominating symptoms of this type include behavioral issues, such as picking fights, stealing or vandalizing property, reckless driving, and efforts to seek revenge on others.
  • Adjustment disorder with mixed disturbance of conduct and emotions: The prevalent symptoms in this type include behaviors related to disturbances of conduct and emotional symptoms.
  • Adjustment disorder unspecified: Individuals with this type exhibit symptoms that are not related to other types of adjustment disorders. These often include physical symptoms or problems with school, work, family, or friends.

Causes and Risk Factors of Adjustment Disorder

Adjustment disorder affects individuals differently at different ages and can occur at any age. The causes and risk factors of adjustment disorder likely involve a complex interplay of physical, environmental, and genetic risk factors working together. Common forms of stressors or events that can cause adjustment disorder include:

  • Relationship or interpersonal issues
  • Marriage/divorce issues
  • Changing or losing jobs
  • Bereavement or loss of a loved one
  • Health issues or chronic illness in yourself or a loved one
  • Family conflicts or problems
  • Sexuality issues
  • Problems at school or work
  • Financial issues
  • Moving to a different city or home
  • Unexpected disasters, such as a fire, accident, hurricane, or flooding
  • Major life changes, such as marriage or having a baby

Risk factors for developing adjustment disorder may include:

  • Lack of support system
  • Mental health disorders
  • Family disruptions during childhood
  • Traumatic events as a child
  • Sexual or physical abuse/assault
  • Abusive or overprotective parenting
  • Chronic life stressors
  • Difficult life circumstances

Signs and Symptoms of Adjustment Disorder

Signs and symptoms of adjustment disorder can be classified into:

Psychosocial Symptoms:

  • Hopelessness
  • Loss of self-esteem
  • Sadness
  • Feelings of isolation
  • Inability to feel pleasure or joy
  • Nervousness and anxiety
  • Feelings of being overwhelmed
  • Self-harm
  • Suicidal thoughts

Behavioral Symptoms:

  • Frequent crying spells
  • Outbursts of anger
  • Being argumentative
  • Avoiding family, friends, and loved ones
  • Poor school or work performance
  • Frequent lack of punctuality to school or work
  • Excessive absenteeism
  • Deliberate destruction of property

Cognitive Symptoms:

  • Difficulty concentrating
  • Difficulty in making decisions

Physical Symptoms:

  • Changes in sleeping patterns
  • Trouble eating

Diagnosis of Adjustment Disorder

A qualified mental health professional or a child and adolescent psychiatrist generally makes the diagnosis of an adjustment disorder after a complete physical and mental health examination and an interview with the child or adolescent and their parents. In order to be diagnosed with adjustment disorder, one will have to meet the following five criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association:

  • Your behavioral or emotional symptoms developed within 3 months of the beginning of the stressful event in your life.
  • Your symptoms do not meet the criteria of another mental disorder and are not a worsening or a flare-up of an existing mental health problem.
  • Your symptoms do not last more than 6 months after the stressor or stressors/ triggering event has been removed.
  • Your level of distress is more intense than what would typically be expected in response to a specific stressor or triggering event.
  • Your symptoms are not part of a normal grieving process to an event or stressor.

Treatment for Adjustment Disorder

Therapy is the main treatment for an adjustment disorder. The main objective of therapy is to alleviate symptoms and enable you to return to your normal level of functioning as before the stressful event occurred.

Most mental health professionals will suggest some type of talk therapy, also known as counseling. This type of therapy can assist you to identify or change responses to the triggering event or stressors in your life.

Cognitive-behavioral therapy (CBT) is a form of talk therapy that can enable you to deal with your feelings:

  • First, your therapist will help you to recognize the negative thoughts and feelings that occur in response to a stressor.
  • Then your therapist will teach you to develop skills to cope with the stressful situation and how to change these negative thoughts and feelings into healthy thoughts and actions.

Other types of therapy may include:

  • Long-term therapy, where you will explore your feelings and thoughts over several months or more to work through deep-rooted issues or insecurities.
  • Family therapy, where you will meet with your therapist along with your family to address specific issues that are affecting the psychological health of the family.
  • Self-help groups, where members share the same situation, condition, or issue and thus are in a position to provide help and support to each other.

Medicines may be utilized, but only along with talk therapy. These medicines may assist if you are:

  • Very sad or depressed
  • Not sleeping very well
  • Nervous or anxious most of the time

Other Conditions and Therapies

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