Adjustment disorder: A situational reaction to a stressful event

Some people aren’t the best when it comes to dealing with large amounts of stress. They simply have a really difficult time adjusting to it. When they feel stressed, they begin to feel down, depressed, anxious, and their behavior can completely change. Those feelings and behaviors are what medical professionals call adjustment disorder. What is an adjustment disorder (AD)? What are the different types of adjustment disorders? What are the symptoms causes, and risk factors? How does it affect the body? What about the effects on the brain? How does it relate to depression, anxiety, and PTSD? How is it diagnosed and treated? What is its prognosis? What are tips to deal with AD?

Adjustment disorder (symptoms) can look similar to those of depression

What is an adjustment disorder?

An adjustment disorder (AD), also known as a situational reaction or an adjustment reaction is a group of disorders and conditions that happen when someone has issues and difficulty adjusting to and coping with a stressful life event. The definition also includes having an excessive, abnormal reaction to an identifiable stressor. For instance, being fired from work, relationship issues such as divorce, or the death of a loved one. Due to the fact that the reaction is more intense than normal, there is an impact on social, academic, and occupational functioning.

Adjustment disorders can affect both adults and children alike. They are treated with therapy and medication- sometimes a combination of both. Adjustment disorder can also be diagnosed as endogenous depression, reactive depression, and situational depression as well as several anxiety disorders. It applies to people who haven’t met the criteria to be diagnosed with major depressive disorder or dysthymia, but still have difficulty coping with stress. It’s different from major depressive disorder because AD is caused by an outside stressor and can often be resolved once the person is able to cope and adapt to the stressful situation. People also may relate it to an anxiety disorder or post-traumatic stress disorder. However, anxiety disorders lack the presence of a stressor and post-traumatic stress disorder is associated with an incredibly intense stressor.

Among the population, AD is actually quite commonly diagnosed. There is an estimated 5%-21% of adults who go for a psychiatric consultation and receive a diagnosis of AD. Adult women are diagnosed with AD twice as often as men. However, among children, both boys and girls equally are likely to receive this diagnosis.

Types of adjustment disorder

There are six types of adjustment disorders.

• AD with depressed mood means that the person feels sad and hopeless. People who experience this often cry a lot and no longer enjoy the activities they once did.
• AD with anxiety means that the person feels anxious, worried, or overwhelmed. People who experience this might also have issues with memory and concentration. When it happens to children, AD with anxiety usually is associated with separation anxiety.
• AD with depressed mood and mixed anxiety means that the person feels both depression and anxiety.
• AD with disturbance of conduct means that the person has behavioral issues such as starting fights and driving recklessly. When it occurs in teens, it may manifest itself in ways such as stealing, vandalizing, or skipping lots of school.
• AD with mixed disturbance of conduct and emotions means that the person experiences behavioral issues as well as anxiety and depression.
• AD unspecified means that the person has symptoms that aren’t associated with the other five types of adjustment disorders. These unspecified symptoms are often physical and involve issues with family, work, friends, and/or school.

Symptoms of adjustment disorder

The symptoms of AD, both mental and physical, often occur during or right after you experience a stressful event. Although the disorder itself doesn’t often last more than six months, the symptoms of the disorder can continue if the stressor isn’t removed or taken care of. Some people experience any symptoms while others may only experience one.

Common mental symptoms of adjustment disorder are:

• Feeling anxious
• Lack of concentration
• Feeling/being withdrawn
• Being rebellious
• Doing impulsive actions
• Crying often
• Lowered, loss of self-esteem
• Feeling trapped, hopeless, and/or sad
• Suicidal thoughts. It’s theorized that about ⅕ of adults who attempt suicide suffer from AD.

Common physical symptoms include:

• Muscle twitches or trembling muscles
• Insomnia
• Extreme fatigue
• Indigestion and issues with digestion
• Feeling sore
• Body pain

Causes of adjustment disorder

In adults, the biggest cause of adjustment disorder is a stressful event in one’s life. For example, the death of a close friend or family member, moving to a new place, health issues (with you or a loved one), major relationship changes such as divorce, or money issues. Statistically, it’s been proven that the stressors one faces while suffering from adjustment disorder are ½ related to parental issues and ⅓ related to peer issues and problems socially.

In teenagers and children, the cause is often due to problems in school, anxiety (over sexuality especially), and family issues.

How does adjustment disorder affect the body?

The cardiovascular system is greatly affected by adjustment disorder. When the body is constantly feeling depressed, uncomfortable, and stressed due to the disorder (or any big life stressor for that matter), it gets big releases of the stress hormone, cortisol, as a response to our feeling stressed. When cortisol is released, the heart is affected immensely. Our blood vessels have to pump twice as hard and our blood pressure rises, which can lead to hypertension. If our bodies are constantly releasing neurotransmitters such as cortisol, our heart, and the cardiovascular system never actually get the chance to rest- they become overloaded.

Adjustment disorder- Adult women are diagnosed with AD twice as often as men

How does adjustment disorder affect the brain?

Adjustment disorder is highly connected with traumatic brain injuries (TBIs) because the stress put on the brain from a TBI can cause the brain to have difficulty adjusting. TBIs, when the head it hit and concussed, cause the brain to rewire itself.

The nervous system is greatly affected by adjustment disorder. Our nervous system is what commands our fight-or-flight mode from our sympathetic nervous system and our rest-and-digest mode from our parasympathetic nervous system. When our stress-response system is activated, our brains become overexposed to the stress hormones and neurotransmitters. This overexposure can actually cause memory problems.

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Risk factors for adjustment disorder

Considering that anyone and everyone can develop an adjustment disorder, there’s no sure-fire way to tell who’s really at risk. However, one’s ability to cope with stress and their social skills might help determine if they are likely to develop an AD or not. Other risk factors include:

• Increased suicidal behavior
• Younger age
• Identifiable problems- both psychosocial and environmental

A study done between 1990 and 1994 found that on the 89 psychiatric outpatient adolescents that suffered from AD and participated in the study, 87.5% had symptoms of anxiety, 87.5% had aggressive behavior, 12.5% had learning disabilities, and 25% had attempted suicide (of that 25%, 37.5% had misused alcohol).

Adjustment disorder and depression

Depression and adjustment disorder are two different conditions that are categorized differently, but they can have the same or similar symptoms. Depression is having all criteria met for having Major Depressive Disorder while adjustment disorder is a major depressive episode that happens due to a psychosocial stressor such as a loss of a family member, a job, or a major disaster. The type of AD known as adjustment disorder with a depressed mood can also occur but doesn’t mean that the person is suffering from clinical depression. While they may have the signs of depression such as the low mood and feelings of hopelessness, there is an identifiable stressor in the person’s life, as well. Furthermore, the symptoms will have gone away roughly six months after the stressor began.

Adjustment disorder

Adjustment disorder and anxiety

It makes sense that AD and anxiety would get mixed up considering that they can both be related to changing circumstances in one’s life that invokes a big reaction to the change. That said, Generalized Anxiety Disorder (GAD) and adjustment disorder aren’t the same diagnoses. For people who suffer from GAD, they often have a long history of having anxiety, worry, and restlessness about a number of things. People who suffer from AD have these symptoms only during times of significant change or stress. People who suffer from both disorders can actually make it worse by changing routines while having these feelings. Anxiety is continual for people with GAD while anxiety for people with AD will be largely reduced after a period of time.

Adjustment disorder and PTSD

PTSD and AD are two conditions that stem from the same branch. However, PTSD is known for being a reaction that occurs long-term (or at least over the six-month period that AD has) after a life-threatening event. Adjustment disorder is just a reaction that occurs short-term (six months or less) after a stressful event.

Diagnosis of adjustment disorder

To be diagnosed with adjustment disorder, a person must meet the following:

• Symptoms that aren’t due to another diagnosis (such as social anxiety disorder).
• Feeling more stress than normal in response to a stressor, or feeling stress to the point that it interferes with relationships, work, or school.
• Going through behavioral and psychological symptoms within three months of when the identifiable stressor occurred.
• Improvement of symptoms within six months after the stressor(s) was removed.  If there is no improvement, it’s probably a different disorder such as depression.

Essentially, the symptoms must occur within three months of the stressor and have left/resolved themselves after six months.

Adjustment disorder can occur in both adults and children

Adjustment disorder was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) around 30 years ago. However, there were similar syndromes that were known years before that. The Diagnostic and Statistical Manual of Mental Disorders classifies Adjustment Disorder as Axis I. According to the manual, a diagnosis involves a complete evaluation of one’s medical history (both physical and psychiatric).

The International Classification of Diseases (ICD) which is done by the World Health Organization (WHO) classified adjustment disorder in their 10th catalog under stress-related, neurotic, and somatoform disorders (F40-F48).

If the symptoms go away within six months of starting, the AD is considered acute adjustment disorder. If the symptoms last longer than six months, it’s considered chronic adjustment disorder.

Treatments for adjustment disorder

Some people only require a short-term treatment plan while others require a longer treatment. It all depends on each individual case. Adjustment disorder is treated using two different ways: therapy and medication. However, the overall treatment can also include a combination of both.

        Therapy is the primary treatment used for AD. The therapist is there to offer their emotional support and help the patient to understand their cause of AD. They can also help the patient in developing skills to help cope with a future stressor. This technique is known as stress inoculation. The most common types of therapies used to treat the different types of adjustment disorders are:

• Family therapy
• Group therapy
• Crisis intervention, emergency psychological care
• Talk therapy, also known as psychotherapy and counseling
• Interpersonal psychotherapy (IPT). This therapy is just a short-term treatment using psychotherapy.
• Support groups
• Cognitive behavioral therapy (CBT) which helps the patient focus on solving the problem of being affected by the stressor by changing their thinking and behaviors to be more productive.

Medication can also be beneficial to come people. It’s used to weaken and lessen the symptoms that the adjustment disorder causes such as anxiety, depression, and insomnia.

Common medications include:

• Anti-anxiety medication. Nonbenzodiazepine anxiolytics such as Neurontin (gabapentin) and benzodiazepines such as Xanax (alprazolam) and Ativan (lorazepam).
• Antidepressants both SSRIs and SNRIs such as Effexor XR (venlafaxine) and Zoloft (sertraline).

Prognosis for adjustment disorder

The prognosis for adjustment disorder is good since it doesn’t last more than six months for most people. However, in order for a good prognosis and outlook, it’s best to get the adjustment disorder treated as quickly as possible.

Tips to prevent adjustment disorder

While sadly there is no way to prevent adjustment disorder 100%, there are ways to cope and help deal with stressors that might lessen the severity of the disorder.

• Try developing a strong network of people to help support you. Support systems are incredibly important.
• Live healthily. Eat well and live long, right? It’s important to have a healthy body to have a healthy mind and vice versa.
• Create a good self-esteem.
• Be optimistic and try to find the humor and the positive in difficult, stressful situations.

Have you ever gone through adjustment disorder? Let us know what you think in the comments below!

Anna Bohren

Anna is a freelance writer who is passionate about translation, psychology, and how the world works.