ADJUSTMENT DISORDER: Introduction,

Introduction: Adjustment disorder

Adjustment disorder is a short term condition in response to some sort of stressful situation in life. It is also called ‘stress response syndrome’. The individual has a difficult time coping and adjusting to the event that has induced stress. People experience stress in their lives due to a variety of reasons. If the stress is due to some major life event or change, then it is much severe. But it becomes a disorder when the maladaptive response involving normal emotional and behavioural responses causes marked distress and difficulty in functioning.

Adjustment disorder was first added in the DSM III in 1980. It is defined as, “emotional or behavioural symptoms occurring within 3 months in relation to an identified stressor, reactions of marked distress, and significant impairment in daily functioning”. It was added in the ICD as ‘transient situational disturbances’. In ICD-10 it is defined as, “a maladaptive reaction to identified stressor, including significant life change or stressful event”.

Causes: Adjustment disorder

Adjustment disorder is caused by a major life event or change which induces extreme stress. If a person experiences repeated trauma, even if it in the past, it can lead to adjustment issues later in life. These are all different stressors, which if chronic, can lead to disorder. The stressors can be both positive and negative. Some of the more specific causes of adjustment disorder are listed below.

Adulthood:

Marital conflict
Financial issues
Unemployment or problems at work
Health problems of self or family member
Death or loss
Accidents/ crime
Loss/ end of a relationship
Major life change such as having a baby, divorce, etc.
Experiencing a natural disaster
Life altering experience such as assault

Childhood and adolescence:

Family conflicts
Death of a family member
Death of a pet
Parental conflicts, divorce/ separation
New sibling
Problems at school
Sexuality issues

To make a diagnosis of adjustment disorder, a causal stressor has to be identified. The stressful reactions to the adverse situation have to happen within 3 months of experiencing it.

Symptoms: Adjustment disorder

What does adjustment disorder look like? A person has a behavioural or emotional response to a stressor that is more than normal levels that would be expected. The characteristics that are common are mild depressive symptoms, anxiety and traumatic stress symptoms. The way one perceives the stressful situation influences how it is reflected in a person’s behaviour. The common symptoms (physical and psychological) are listed below.

Frequent crying
Feelings of hopelessness and sadness
Anxiousness and worry
Insomnia
Loss of appetite
Difficulty in concentrating
Suicidal thoughts
Stomach aches, headaches
Fatigue
Body soreness
Loss of self-esteem
Withdrawing from social support
Rebelliousness/ recklessness
Difficulty in daily functioning and avoiding responsibilities

Most adults manifest the symptoms of this disorder through their emotions. Adolescent manifestation of this disorder is through behavioural symptoms.

Types: Adjustment disorder

For the disorder to be diagnosed, the symptoms should be visible within 3 months of exposure to the stressful event and should not persist more than 6 months. If it does, then the condition is chronic. This happens due to ongoing or persistent stressors such as unemployment.

Adjustment disorder is of 6 types-

Adjustment disorder with depressed mood– People experience extreme sadness and hopelessness. There is frequent crying and a loss of interest in activities.
Adjustment disorder with anxiety- The person feels extremely anxious, worried and overwhelmed. It also includes trouble in concentrating and problems with memory.
Adjustment disorder mixed with anxiety and depressed mood- In this type, people experience both anxiety and depression.
Adjustment disorder with disturbance of conduct- It includes behavioural issues such as stealing, vandalism, recklessness, starting fights, etc.
Adjustment disorder with mixed disturbance of emotions and conduct- This includes depression, anxiety and behavioural issues.
Adjustment disorder unspecified- In this, the symptoms do not fall into any of the above categories. They’re typically manifested physically and are associated with problems in family, friends, school or work.

Diagnosis: Adjustment disorder

As mentioned earlier, for a person to be diagnosed with adjustment disorder, the psychological or behavioural symptoms should be visible within 3 months of the stressful event which is identifiable. They should experience stress above the normal expected levels, which hampers with their functioning and relationships.

Visiting a professional when the stress become too difficult to cope with is advisable. Conducting physical exams and taking medical histories help with the diagnosis. Blood or imaging tests are done to rule out the possibility of a physical illness. A mental health professional is recommended to help identify whether there exists any other psychological problems such as PTSD, Major depressive disorder or anxiety disorder.

Treatment: Adjustment disorder

The treatment methods available for adjustment disorder is therapy and medications.

Therapy- Therapy helps to regulate and manage stress better. The therapist can provide emotional support and help to tap into internal resources effectively, and seek help from external sources when required. The therapies available include psychotherapy, support groups, family therapy, group therapy, cognitive behavioural therapy, interpersonal therapy, etc.
Medication- Some people benefit better from a combination of medication and therapy. The medications available are benzodiazepines, SSRIs, SNRIs, non-benzodiazepine anxiolytics. These help curb the symptoms of insomnia, depressions, and anxiety.

Conclusion

If treatment is taken at the right time, the prognosis for the disorder is good. Learning effective and healthy coping mechanisms, along with developing resilience to stressors help in overcoming such stressful situations and adapting to them. Building a strong social support and developing help seeking behaviour can help in preventing the situation from getting worse. Whenever possible, prepare for the oncoming event and have a positive outlook towards life can be helpful. Maintaining a healthy life style and having a strong self-esteem can be protective factors against any adverse and stressful changes or events. The best solution is to seek early treatment and not prolong suffering from the symptoms.