Adjustment disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 28, 2016
StartDiseasesAdjustment disorder

Adjustment disorder, which is also known as stress response syndrome or situational depression, is a mental disorder that is related to anxiety and depression. The key characteristic of adjustment disorders is a triggering event that leads to an inappropriately extreme emotional response. The disorder shares some symptoms with depression, but they tend to be less severe and are always linked directly to some incident that initiated the emotions.

Contents

Definition & Facts

Like most other mental disorders, adjustment disorder is defined by a list of symptoms. A person must have enough of these symptoms for a long enough time to meet the diagnostic criteria. These symptoms include anxiety, sadness, sleep disturbances, fatigue, behavioral changes, and others, and they must be a direct and disproportionate response to an inciting incident.

The symptoms persist for six months after the incident which distinguishes the experience from a normal reaction. The symptoms also must be strong enough to interfere with the patient's functioning to warrant a diagnosis. The symptoms of adjustment disorder are generally temporary. A person who exhibits the symptoms for an extended period of time might have depression or a personality disorder, especially if the symptoms lose any connection to the original incident that triggered them.

Symptoms & Complaints

In addition to the symptoms listed above, adjustment disorder involves several more symptoms. While any of these can manifest in a person with adjustment disorder, mental health professionals do not expect to see all of them in a single case. Most people only have a subset of all of these symptoms.

Symptoms include feelings of hopelessness, worry, headaches, heart palpitations, social isolation, changed attendance for regular duties at work or school, a new interest in destructive or impulsive behaviors, appetite changes potentially including either overeating or eating little, and greater use of drugs, including alcohol.

The patient will experience some of these right after some event, and the symptoms will persist for an inappropriate length of time. Symptoms make it harder for those with adjustment disorder to have a daily routine and keep up with their social engagements. The subjective distress is not unique to adjustment disorder: nearly all mental disorders are evaluated based on whether and how much they distress the patient and cause them discomfort.

Causes

Although adjustment disorder is not the same as PTSD, anxiety, or depression, it is similar in that there is no one set of causes. What one person can deal with in a healthy way might be enough to trigger an extreme response in another person. This comes down to personal resilience, timing, and life experience.

Common causes are those related to work and school, such as facing a bad performance review or failed test, getting fired, or changing jobs or schools. The adjustment does not need to be wholly bad; the trigger is that the change is shocking and unsettling. Other causes are not related to work. They include things like the end of a relationship, a death of a close person, an assault or other crime, a disaster, or any other major life event that causes persistent distress and would normally involve a stress response.

Diagnosis & Tests

Diagnosing adjustment disorder entails a conversation during an appointment with a therapist. This might be a social worker, psychologist, or psychiatrist. Adjustment disorder is common, but the mental health practitioner will need time to rule out other disorders that present similarly. For example, adjustment disorder shares many symptoms with depression, but the two have very different treatment paths. That means the practitioner will need to spend time trying to decide which diagnosis is most appropriate.

Different cases of adjustment disorder might look quite different because people experience different symptoms from the greater list. As a result, practitioners need to be ready to adapt their expectations for what adjustment disorder looks like as they encounter new patients. Additionally, the patient might experience the symptoms but not consider them important.

Treatment & Therapy

Treatment for adjustment disorder varies based on the practitioner's preferred mode of therapy. As with many mental disorders, cognitive behavioral therapy is a popular choice for helping the patient deal with the emotional burden of the disorder. In this therapy, the therapist concentrates on teaching the patient skills to help them control their emotions, recognize inappropriate reactions, and defuse them by noting the fact that they are not a healthy response to the situation. This involves frequent meetings and the therapist will often assign homework exercises to the patient for them to work on between appointments.

The course of therapy will last until the patient feels comfortable terminating. This may last beyond the time when they have overcome the adjustment disorder and related symptoms if they still feel that they want to continue talking to the therapist. This evolution of the therapeutic relationship is not uncommon and does not signify a lower level of functioning.

Prevention & Prophylaxis

There is no set way to prevent adjustment disorder because its onset is usually unexpected and unpredictable: there is no way to know which events or stimuli would cause a disproportionate response. A person who is already emotionally fragile can improve their coping skills with regular therapy, and this might help them in case anything does happen.

Still, it is not generally possible to forecast when any given person will experience this disorder, and aside from basic coping skills training, no way to improve their resilience so that they will not experience the disorder.