An adjustment disorder is an unhealthy or excessive emotional or behavioral reaction to a stressful event. It occurs within three months of exposure to the stressor.
Adjustment disorder sometimes gets referred to as “stress response syndrome.” And, because adjustment disorder can present with some of the symptoms of depression, such as feelings of hopelessness, crying, and loss of interest in activities or work, it is sometimes called “situational depression.”
Symptoms of adjustment disorders can be disturbance of emotions and conduct, anxiety, depressed mood, or some combination of these. The disorder lasts no more than 6 months from the ceasing of the stress. Adjustment disorders are associated with an increased risk of suicide attempts and completed suicide.
There are six types of adjustment disorders, each with distinct symptoms. Adjustment disorders can affect both children and adults. An adjustment disorder differs from post-traumatic stress disorder (PTSD) in that PTSD occurs at least 1 month after the event, and its symptoms last longer than those of adjustment disorders.
The percentage of individuals in outpatient mental health treatment with adjustment disorder ranges from 5% to 20%. In a hospital psychiatric consultation setting, it is often the most common diagnosis, often reaching 50%.
Treatments for adjustment disorders include individual / family / group therapy, medication, or a combination of the two.
Symptoms of Adjustment Disorders
Symptoms of adjustment disorders can be any of the following:
- Sadness or depressed mood
- Feelings of hopelessness
- Bouts of crying
- Not enjoying things you once enjoyed
- Loss of self-esteem
- Nervousness or anxiety
- Jitteriness and worry
- Fear of separation from major attachment figures
- Stomachaches or headaches
- Unpleasant sensation of heartbeat (palpitations)
- Decreased socialization
- Lack of concentration
- Frequent absence from school or work
- Destructive behavior, such as reckless driving, fighting, and vandalism
- Appetite changes
- Trouble sleeping
- Tiredness or lack of energy
- Increased use of alcohol or drugs
- Suicidal thoughts
Children experience more behavioral symptoms, such as skipping school, fighting, or acting out. Whereas, adults tend to experience more emotional symptoms, such as anxiety and sadness.
Types of Adjustment Disorders
- Adjustment disorder with depressed mood: Prominence of low mood, tearfulness, or feelings of hopelessness.
- Adjustment disorder with anxiety: Prominence of nervousness, worry, jitteriness, or separation anxiety.
- Adjustment disorder with mixed anxiety and depressed mood: Prominence of a combination of depression and anxiety.
- Adjustment disorder with disturbance of conduct: Prominence of disturbance of conduct.
- Adjustment disorder with mixed disturbance of emotions and conduct: Presence of both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct.
- Adjustment disorder unspecified: Maladaptive reactions that are not classifiable as one of the above specific subtypes.
Causes of Adjustment Disorders
Adjustment disorders are caused by significant changes or stressors in your life. The likelihood of developing an adjustment disorder is influenced by genetics, life experiences, and temperament. The stressful event that can lead to adjustment disorders can include:
- Going away to school
- Parents’ separation or divorce
- Family move to a new place
- Loss of a pet
- Birth of a sibling
- Death of a loved one
- Marked business difficulties
- Changing or losing job
- Getting married or becoming a parent
- Marital problems
- Developing a chronic illness
- Having an accident
- Exposure to a natural disaster, such as a hurricane, flood, or fire
Diagnosis of Adjustment Disorders
DSM-5 lists the following diagnostic criteria for adjustment disorders:
- Emotional or behavioral symptoms in response to an identifiable stressor, within 3 months of the onset of the stressor.
- These are clinically significant, with one or both of the following:
- Marked distress that is out of proportion to the severity or intensity of the stressor, given the external and cultural context.
- Significant impairment in social, occupational, or other important areas of functioning.
- The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
- The symptoms are in excess of normal bereavement.
- Once the stressor is no longer present, the symptoms last less than an additional 6 months more.
Treatment of Adjustment Disorders
Treatment is with either therapy or medication, or a combination of the two.
The primary treatment for an adjustment disorder is therapy. In therapy, you get emotional support and develop an understanding of the cause of your adjustment disorder. This could help you develop skills to cope with the adjustment disorder and future stressful situations. These therapies include:
- Individual psychotherapy
- Cognitive behavioral therapy (CBT)
- Interpersonal psychotherapy (IPT)
- Crisis intervention
- Family and group therapies
Medications can lessen some of the symptoms, such as depressed mood, anxiety and insomnia. These medications include:
- Anti-anxiety medication, such as lorazepam (Ativan), alprazolam (Xanax), gabapentin (Neurontin)
- Antidepressant, such as sertraline (Zoloft) or venlafaxine (Effexor XR)