Adjustment Disorder: Types, Symptoms & Treatment

Change is never easy. Be it from small changes like getting a new haircut to moving to a new city, change is uncomfortable. So when there is a sudden unexpected change in your life, a big blow that you did not anticipate, how do you deal with it? Life is never stagnant. It keeps changing. And coping with those changes can be challenging. It takes time to accept and adapt to it. Some people deal with it pretty well, showing little discomfort initially which is perfectly normal for anyone. But some people show excessive reaction to a stressful change in their life. These extreme reactions are diagnosed as adjustment disorders. Let’s learn more about adjustment disorder.

What is Adjustment Disorder?

Adjustment disorder is characterized by excessive emotional and behavioural disturbance arising from significant stressors like physical illness, stressful life events or any change in a person’s life. It is also called as ‘stress response syndrome’ and ‘situational depression’. The International Statistical Classification of Disease and Related Health Problems (ICD-11) classifies adjustment disorder under “Disorders specifically related to stress.”

Types of Adjustment Disorder

The American Psychological Association to Mental Health Conditions which is the Diagnostic and Statistical Manual of Mental Illnesses (DSM – 5) classifies adjustment disorder into six different subtypes based on the symptoms. The subtypes are:

1. Disturbance of conduct: destructive and reckless behaviour. They become rebellious.
2. With anxiety and depressed mood: present with a combination of symptoms from the above two subtypes.
3. With mixed disturbance of emotions and conduct: it is the combination of symptoms of the above two subtypes.
4. With anxiety: feeling anxious and overwhelmed. Difficulty in concentrating and separation anxiety (seen in children).
5. Unspecified: doesn’t fit the above subtypes but they could show withdrawal from usual activities and few physical symptoms.
6. Adjustment disorder with depressed mood: feeling depressed, having no hope, unable to enjoy hobbies they usually enjoy and crying spells. 

Adjustment Disorder vs Anxiety

For people with (GAD), Generalized Anxiety Disorder is a long-standing symptom whereas people with adjustment disorder experience worry and anxiety only during stress or change. 

Adjustment Disorder vs Depression

The physical symptoms are relatively less and emotional symptoms are not as severe as in clinical depression. Suicidal thought is very common in major depression but it’s not so common in adjustment disorder. Though they are very similar in presenting symptoms and treatment options, they are two distinct conditions with separate diagnostic criteria. 

Predominance

It is diagnosed more commonly in children and adolescents. However, adults can also be affected. Among children and adolescents, both genders are equally affected. However, in adults, females are more prone to suffer from this disorder. It is diagnosed in all parts of the world, but the stressors, their severity, signs and symptoms may vary because of cultural differences. Adjustment disorder is common and its prevalence is around 21% in adults. Within five years of original diagnosis, 20-30% of patients go on to develop more serious psychiatric disorders. 

Precipitating Factors of Adjustment Disorder

A person usually learns to deal with stress over time. They would develop a healthy coping mechanism to face the changes. But when a person’s defence mechanisms fail to reduce the stress, adjustment disorder is precipitated. The stressors may include:

• Accidents.
• Retiring.
• Loss of a pet.
• Birth of a sibling.
• Divorce or breakup.
• Death of a spouse.
• Financial troubles.
• Natural disasters.
• Moving to a new place.
• Sudden chronic illness.
• Difficulty at school or work.
• Parents divorce or separation.
• Getting married and having a baby.

Symptoms of Adjustment Disorder

Symptoms vary depending on the individuals, their age, background and experiences in life. Adjustment disorder affects the way one thinks and feels. It also affects their Actions or behaviour. Some symptoms can be listed as follows:

• Loss of appetite.
• Suicidal ideation.
• Disturbances in sleep.
• Feeling sad and crying often.
• Feeling anxious and nervous.
• Drowning is sadness and feeling hopeless. 
• Isolation and distancing from family and friends.
• Low concentration and difficulty in doing daily tasks. 
• Not able to enjoy things they previously enjoyed doing.
• Unable to handle anything. Feeling irritable most of the time.

These symptoms typically start within 3 months of the stressful event. It could last up to 6 months unless the stressor continues.  

Diagnosis of Adjustment Disorder

A psychiatrist or a mental health professional usually makes the diagnosis of an adjustment disorder after a detailed psychiatric evaluation and an interview with the kids and their parents. The interview delves into the details of life events and behaviours seen. Some signs and symptoms are important for diagnosis and should not be confused with other underlying disorders or behaviours that are a normal part of grieving. The diagnosis is usually made if the symptoms last for 3 months from the stressful event and if they cause problems at work, school or at home. A mental health care professional may diagnose it as either an acute or chronic adjustment disorder.

• Acute: symptoms lasting less than six months.
• Chronic: symptoms last more than six months. 

Treatment of Adjustment Disorder

Healthcare providers may recommend a combination of medications and therapy. 

• Psychotherapy: Talk therapy is the first line of treatment.
• Group therapy: peer group helps in bettering social and interpersonal skills.
• Family therapy: helps to improve communication and family interactions. It also aids in increasing family support.
• Cognitive Behavioural Therapy (CBT): focuses on stress and anger management. It improves problem-solving skills and impulse control.
• Medications: Based on the patient’s symptoms, a psychiatrist may prescribe antidepressants and anti-anxiety medications. Some medication may also be suggested for sleep.

Prevention of Adjustment Disorder

It’s not possible to control what happens in your life. Many things are out of our control. For example, the natural death of a grandfather or a landslide is not something one can control. It’s beyond your locus of control. But we sure can control the way we react to these situations. We can take steps to reduce stress and adapt to changes. 

• Practising a healthy lifestyle.
• Having a strong support system. 
• Self-care must be given high priority.

Apart from professional help, parents can help their children navigate through changes by offering support and understanding. Reassuring the child and also keeping them engaged helps them cope with stress. If you’re feeling overwhelmed and unable to make it through the day, seek professional help immediately without any hesitation. Early diagnosis makes things easier for you to bounce back in your life and face the challenges confidently.