Life is full of stressors, whether unexpected or planned. Stressful incidents can create overwhelming feelings of uncertainty even in normally resilient people. Instead of adapting and moving on, some people get stuck for a short period of time. People may experience symptoms of depression or anxiety, find themselves not being able to go to work, or lashing out at others. Changes in emotions, mood or behaviors that occur in response to any life stressor may be the sign of an adjustment disorder. Adjustment disorders are on the mild end of the continuum within the broad mental disorder spectrum. They typically do not last longer than a few weeks or months, and the symptoms are not as severe or numerous as those seen in more serious psychiatric disorders.
The incidence of adjustment disorder varies widely, depending on the population studied and assessment methods used. Several studies have indicated rates of about 12%, although rates as high as 23% have been reported in patients with other mental health issues. In a survey of mental health related hospitalizations in active duty military personnel between 2000 and 2012, 38% of hospitalizations were related to adjustment disorder.1
- Finding out your spouse is having an affair
- Being diagnosed with a serious medical condition
- Losing a loved one
- Enduring a natural disaster such as a hurricane or flood
- Going through a significant life transition, such as a job promotion, career change or having a baby
- Being injured in an accident
- Getting a divorce or ending a serious relationship
- Caring for a chronically ill parent (chronic)
- Experiencing a lengthy period of unemployment (chronic)
Types of Adjustment Disorders
There are several types of adjustment disorders. The diagnosis is determined by the presence of specific and pronounced adjustment disorder symptoms.
Adjustment disorder with anxiety: Anxiety is the primary symptom, manifesting as constant or excessive worrying, restlessness, being nervous or on edge.
Adjustment disorder with depressed mood: This is characterized by depressive symptoms such as frequently feeling blue or sad, feeling hopeless or worthless, crying often, low energy, trouble concentrating or making decisions, and finding it difficult to enjoy typically joyful aspects of life.
Adjustment disorder with mixed anxiety and depressed mood: Both anxiety and depression manifest in response to the stressful event or situation. The affected person may feel sad or listless and worry excessively.
Adjustment disorder with disturbance of conduct: This involves a change in behavior that involves acting out in some manner. The affected person may pick fights or fail to show up to work.
Adjustment disorder with mixed disturbance of emotions and conduct: This diagnosis involves symptoms that are both emotional and behavioral. The affected person may feel anxious or depressed and act out by vandalizing somebody’s property.
Unspecified adjustment disorder: This diagnosis is given when it is apparent that symptoms were triggered by a life stressor but do not fit into any of the above categories. Although the affected person may not be clinically depressed, he or she becomes socially isolated, is unusually irritable or tense, or complains of somatic symptoms such as stomach aches or fatigue.
The diagnosis of an adjustment disorder is typically made by a primary care doctor or a mental health professional, such as a psychologist or psychiatrist. A medical examination will be done to rule out the possibility of any underlying medical issues that could potentially cause the symptoms. A thorough assessment should also be done to rule out other potential mental health conditions such as major depressive disorder, acute stress disorder (ASD) and post-traumatic stress disorder.
Clinical Diagnostic Criteria
There are specific clinical diagnostic criteria 2 that must be met to confirm an adjustment disorder diagnosis, such as:
- Emotional or behavioral symptoms develop within three months after the onset of an identifiable stressor and the response is out of proportion to the severity or intensity of the stressor. There also must be significant impairment in social, occupational or other areas of functioning.
- The stress-related symptoms do not meet the criteria for other mental disorders and it has been determined that they are not an exacerbation of preexisting mental disorders.
- The symptoms do not represent typical grief or bereavement.
- After the stressor (or its consequences) have ceased, the symptoms persist for no longer than an additional six months.
Adjustment disorders are highly treatable and often respond well to talk therapy (psychotherapy). Regardless of the triggers, the therapist will work with the patient to identify negative thought patterns or irrational beliefs that may have been contributing factors. In some instances, depending on the severity of the symptoms, a brief course of medication may be beneficial. It is important to keep in mind that medication alone might alleviate troublesome symptoms but will not address the underlying issues that triggered the disorder.
Like many mental health disorders, an adjustment disorder may increase the risk of substance abuse. Troubling symptoms often present a temptation to “self-medicate” with alcohol or other drugs as an escape from dealing with difficult mental issues. Getting timely help is key before substance abuse and addiction compound these problems.
Everybody experiences stressful situations in life, but sometimes the circumstances make these events particularly difficult to handle. If you recently experienced a stressful event or have ongoing stressors that are interfering with your daily life, talk to your doctor or contact a mental health professional as soon as possible. It is the first step in getting you back on track and enjoying life to the fullest.
- Adjustment Disorders. Medscape website. http://emedicine.medscape.com/article/2192631-overview#a5 Updated Dec. 11, 2014. Accessed June 10, 2016.
- Adjustment Disorders. Medscape website. http://emedicine.medscape.com/article/2192631-overview Updated Dec.11, 2014. Accessed June 10, 2016.