Definition
Adjustment disorder is an excessive, prolonged reaction to a stressful event or situation. The stressor could be a single one or a combination of stressors affecting one single person or a group of individuals. This reaction seriously impairs social and occupational functioning.
There are several subtypes of the disorder, including adjustment disorder with:
- Depressed mood
- Anxiety
- Mixed anxiety and depressed mood
- Disturbance of conduct
- Mixed disturbance of emotions and conduct
Causes
Adjustment disorders develop in reaction to stressful life events or major life changes. Some common stressors are:
- Relationship problems
- Financial difficulties
- Family conflict
- School issues
- Work changes
- Major life changes
- Health problems
- Divorce
- Death of a close loved ones
- Moving
- Sexuality issues
In some cases, ongoing problems (such as living in an unsafe, crime-ridden neighborhood) may cause the development of an adjustment disorder over a longer period of time.
Risk Factors
Certain individuals may have a predisposition or vulnerability that can play a part in the risk of occurrence and how the disorder presents. Individuals susceptibility can be affected by factors such as:
- Genetics
- Flexibility
- Intelligence
- Social skills
- Coping strategies
- Sex: women are thought to be at higher risk than men (boys and girls are even)
People who face certain stressors like medical problems or living in challenging environments may be at increased risk. In these populations, adjustment disorder has been diagnosed in up to 50% of the people.
The stressor itself may also interfere with an individual’s support network.
Certain early-childhood family history factors seem to contribute to the chance that an individual may suffer from an adjustment disorder in the future. These include:
- Frequent moves as a child
- Abusive family of origin
- Overprotective family of origin
- Coming from a disadvantaged background
- Prior exposure to extreme trauma (such as war) without having previously developed either an adjustment disorder or post-traumatic stress disorder (PTSD)
Individuals who are at higher risk for adjustment disorders also often have other conditions, such as a history of anxiety, depression, bipolar disorder, or eating disorders.
Symptoms
Adjustment Disorder symptoms are expected to disappear within 6 months after the causing stressor and/or its consequences have been removed. In the case of chronic adjustment disorder, the symptoms may linger beyond the six-month mark and in general they are related to ongoing persistent stressors like a chronic medical disability or enduring existential conditions.
Symptoms may vary, but are similar in that the reaction is worse or more excessive than expected to the stressor. In order for a diagnosis of adjustment disorder to be made, symptoms must interfere with an individual’s social or work functioning.
Symptoms include:
- Depressed mood , sadness
- Difficulty breathing
- Chest pain
- Anxiety or worry
- Feeling of inability to cope
- Feeling of inability to plan ahead
- Feeling of inability to continue in present situation
- Some degree of disability in the performance of daily routine
- Conduct disorders
- Disturbance of other emotions and conduct
Diagnosis
Your doctor will perform an evaluation to assess whether your symptoms follow a recent stressful event, and if the symptoms are more severe than what is normal for you. You will also be evaluated to make sure there is no underlying disorders or disease, such as depression, an anxiety disorder, or post-traumatic stress disorder. Your doctor may refer you to a psychiatrist for diagnosis and treatment.
Treatment
The main goal of treatment is to resolve symptoms, and return the individual to his or her normal level of functioning. Treatment is important so that the disorder doesn’t become a larger illness, like major depression. Treatment options include the following:
Psychotherapy
Psychotherapy, or counseling, is the primary treatment for adjustment disorders. Therapy is used to help individuals understand why the stressful event caused the symptoms, and to develop coping mechanisms for future stressors. Therapy is generally short-term and can take any of the following forms: individual therapy, family therapy, behavior therapy, or group therapy.
Medications
Medications may be used in combination with therapy to alleviate common symptoms. Antidepressants or anti-anxiety medications may be prescribed on a short-term basis until the symptoms resolve.
Prevention
While there is no known way to prevent adjustment disorders, the prognosis is good. Adjustment disorders generally resolve with treatment and time without remaining symptoms.
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