Adjustment Disorders

When a major life change occurs, it is normal for people to need some time for adjustment – regardless of whether the change is positive or negative.  If a person is unable to cope with the stress of change, it could be that the person is suffering from the psychological condition of adjustment disorder.

What is an adjustment disorder?

A psychological adjustment disorder occurs after an identifiable stressor occurs in the life of the patient.  The person is unable to cope well with the stressor and experiences emotional and/or behavioral symptoms.  These symptoms are disproportional to what can be expected as a result of the stressor.  Adjustment disorders are always short-term psychological problems.  They appear within 3 months of the stressor and symptoms will diminish within 6 months of when the stressor is removed.

Adjustment disorders are similar to anxiety disorders in that they both occur as a reaction to a stressor.  With both adjustment disorders and anxiety disorders, the reaction to the stressor is excessive to what can be normally expected.  However, an adjustment disorder differs greatly from an anxiety disorder in several ways.  Firstly, an adjustment disorder always occurs from an identifiable stressor.  According to the ICD definition, for a condition to be diagnosed as an adjustment disorder, it must be evident that the symptoms would not have been caused without the stressor.  Further, an adjustment disorder only occurs in patients with no other underlying psychological problems. Finally, an adjustment disorder is short term.  If the symptoms from the stressor persist more than 6 months after the stressor has been removed, then the symptoms may be diagnosed as another psychological problem.

How prevalent is adjustment disorder?

Adjustment disorder is considered to be a very common problem.  However, there have been few conclusive studies on the prevalence of adjustment disorder. In some studies, as much as 22.6% of clinical patients are suffering from adjustment disorder.  Note that these studies do not include the amount of people suffering from undiagnosed and untreated adjustment disorder.

Studies show that adjustment disorder is equally prevalent amongst men and women and also equally prevalent amongst age groups. However, children are considered more vulnerable to adjustment disorder than adults.  If adjustment disorder is left untreated in children, it could lead to further psychological problems.  In adults, the prognosis of adjustment disorder is positive.

What are the symptoms of adjustment disorder?

The symptoms of adjustment disorder vary greatly and can include symptoms of depressive or anxiety disorders.  These symptoms may include:

Adjustment Disorders

Exhaustion and feeling hopeless are common symptoms of an adjustment disorder.

  • Feeling hopeless
  • Feeling suicidal or like harming oneself
  • Crying frequently
  • Feeling nervous or worrying excessively
  • Head or stomach pains
  • Withdrawing from social situations, including school and work
  • Engaging in destructive behaviors like fights or vandalizing
  • Troubles with sleep
  • Exhaustion
  • Lack of appetite or binge eating

What Causes Adjustment Disorder?

Adjustment disorder is always caused by a specific stressor.  The stressor can be anything from the loss of a loved one through death or divorce or moving to a new home.  It is important to realize that the severity of a stressor is relative.  What constitutes as a major stress for one person (such as leaving home to go to college) may not be stressful for another person.  Further, a stressor does not have to be a negative experience to cause adjustment disorder.  Positive experiences (such as getting married or winning the lottery) can also lead to adjustment disorders.

How is Adjustment Disorder Diagnosed?

According to the DSM-IV, an adjustment disorder must meet these criteria:

  • The emotional or behavioral symptoms appear within 3 months of an identifiable stressor
  • The symptoms of the stressor are either in excess of what would be normally expected from the stressor or they disrupt normal functioning
  • The symptoms do not meet the criteria of another psychological disorder
  • The symptoms are not the worsening of another underlying psychological disorder
  • The symptoms are not due to bereavement
  • When the stressor is eliminated, the symptoms diminish within 6 months

Where can help be found?

In many cases, support from family or friends may be adequate to help a person through adjustment disorder.  However, if the symptoms become severe (such as the person becomes suicidal or engages in destructive activities) and the symptoms do not lessen, then it is best to seek help from a licensed psychologist or psychiatrist.  If the patient is suffering from a specific shared stressor, then he or she may be able to join local group therapy meetings to help deal with the stress.  For example, there are many local group therapy meetings for people going through divorce.

What is the Treatment for adjustment disorder?

Adjustment disorder is most commonly treated with psychotherapy or counseling.  During treatment, the therapist will be able to help the patient understand how the stressor is negatively impacting his/her life.  The goal of the therapy is to help the patient develop better coping skills and also to give the patient an outlet for expressing his/her feelings.  Group therapy can be useful for patients who are dealing with a common shared stressor, such as the loss of a loved one.  Some schools have been known to organize group counseling sessions for new students where they can talk about their emotions related to the chance.

A strong support foundation, whether through family, friends or social means, is important for coping with the stressor causing adjustment disorder.  Treatment for adjustment disorder may focus on helping the patient build up a better support foundation to deal with stressors and prevent adjustment disorder in the future.

Regardless of the severity of adjustment disorder, it is important for people suffering from it to seek help.  If adjustment disorder is not dealt with, it could lead to a chronic psychiatric disorder like depression or anxiety.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.

Strain JJ, Smith GC, Hammer JS, et al. “Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting.” Gen Hosp Psychiatry 20.3 (May 1998):139-49.

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