Adjustment Disorder: Symptoms, Causes, and Treatment

What is Adjustment Disorder?

Adjustment disorder is a condition characterised by an excessive emotional or behavioural response to a stressful event, known as ‘the stressor’. It is triggered by both positive and negative life events, such as problematic marriage, divorce, or the loss of a loved one. While everyone experiences stress differently, an individual with adjustment disorder struggles to adapt to a new situation.

Symptoms

Adjustment disorder’s signs and symptoms vary from person to person, depending on the nature of the stressor and individual coping mechanisms. However, some common symptoms include —

• Emotional symptoms:

Feelings of sadness, depression, anxiety, hopelessness, nervousness, irritability, or anger. You may also experience feelings of being overwhelmed or excessively worried.

• Behavioural changes:

Social withdrawal, neglect of responsibilities, difficulty concentrating, alterations in sleep or eating patterns, impulsive or reckless behaviour

• Physical symptoms:

Fatigue, headaches, stomach aches, irregular heartbeats, muscle tension, sleep disturbances

It’s crucial to note that these symptoms typically begin within three months of the stressor, leading to a considerable impairment in daily functioning, such as difficulty working, attending school, or maintaining relationships. The intensity of these symptoms usually lessens within six months. But in some cases, they can persist longer, leading to what is known as chronic adjustment disorder.

Causes

Adjustment disorder can be triggered by a wide range of stressors. These may include significant life changes, such as retirement, marital problems, breakup or divorce, childbirth, the death of a loved one, health issues, and natural disasters. Not all stressors are negative; even positive changes can lead to adjustment disorder if you find it difficult to cope with the transition. The underlying cause is often your inability to cope with the stressor, leading to overwhelming feelings of distress. Pre-existing mental health conditions, personality traits, and a lack of social support can also influence the susceptibility to developing adjustment disorder.

Types of Adjustment Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) classifies adjustment disorder into several types based on the predominant symptoms —

• Adjustment disorder with depressed mood:

Feelings characterised by hopelessness, sadness, and a lack of interest in daily activities

• Adjustment disorder with anxiety:

Involves excessive worry, nervousness, a racy mind, and a feeling of being overwhelmed.

• Adjustment disorder with mixed anxiety and depressed mood:

Features a combination of symptoms from both depression and anxiety.

• Adjustment disorder with disturbance of conduct:

Includes behaviours such as aggression, reckless driving, or vandalism.

• Adjustment disorder with mixed disturbance of emotions and conduct:

Involves symptoms of both emotional distress and behavioural disturbances.

• Unspecified adjustment disorder:

When the symptoms do not fit neatly into any of the other subtypes but still cause significant distress and impairment.

Diagnosis

Diagnosing adjustment disorder involves a comprehensive evaluation by a mental health professional. The diagnostic process typically includes a thorough medical and psychological history, as well as an assessment of the presenting symptoms. Within three months of the onset of a stressor, symptoms must appear, and they should not last more than six months. The severity of the symptoms must also be taken into account. These should be more intense than what would typically be expected in response to the stressor, leading to impairment in social, occupational, or other areas of functioning.

The mental health professional will conduct an extensive evaluation, which may include —

• Detailed clinical interview:

This includes discussing the stressor, symptoms, medical history, family history, and psychosocial functioning.

• Psychological testing:

Standardised tests can help assess mood, anxiety, and overall functioning.

• Physical examination:

This may be done to rule out any underlying medical conditions that mimic the symptoms.

Treatment

With effective treatments and coping mechanisms, you can manage and recover from adjustment disorder and enhance your resilience to future stressors. Most individuals recover within six months. Here are some common evidence-based treatment options —

• Psychotherapy:

This is the first-line treatment for adjustment disorder. Interpersonal therapy (IPT), cognitive behavioural therapy (CBT), and other therapy modalities can help you develop healthier coping mechanisms, address negative thought patterns, improve communication skills, and manage stress more effectively.

• Medication:

Medication may be helpful in some cases, particularly if symptoms of anxiety or depression are severe. Anti-anxiety and anti-depressant medications can be prescribed to alleviate these symptoms and improve overall functioning.

• Support groups:

Taking part in support groups where other persons face similar challenges can provide a sense of community, understanding, and shared experiences.

Coping Strategies

In addition to professional treatment, several coping strategies can help you manage adjustment disorder. These include —

• Building a strong support network:

Surround yourself with supportive friends and family members who can provide emotional comfort and practical assistance.

• Practising self-care:

Engage in activities that promote physical and mental well-being, such as regular exercise, healthy eating, and sufficient sleep.

• Avoiding substance abuse:

Stay away from alcohol, drugs, and other addictive substances.

• Mindfulness and relaxation techniques:

Practices such as meditation, yoga, and deep-breathing exercises can help reduce stress and improve emotional regulation.

• Setting realistic goals:

Breaking down big tasks into manageable ones can help prevent feelings of overwhelm and promote a sense of accomplishment.