Types, causes, symptoms and treatment

Adjustment Disorder (AD) is a mental health condition in which a person develops emotional and behavioral symptoms in response to a stressful event. These responses may be disproportionately harsher than expected. Symptoms develop within three months of the stressful trigger and usually resolve six months after the stressor subsides.

Although AD is a common disorder, it is vastly understudied. There is a lack of quality research, clarity in diagnostic criteria, and consensus among researchers and mental health professionals. Further research has been proposed to find more accurate and reliable ways to diagnose and treat AD.

Read on to learn more about AD and its management.

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Types of Adjustment Disorders

the Diagnostic and Statistical Manual of Mental Disordersfifth edition (DSM-5), the American Psychiatric Association’s manual for the diagnosis of mental disorders, identifies six subtypes under the title of MA:

  • With depressed mood
  • With anxiety
  • With mixed anxiety and depressed mood
  • With conduct disorder
  • With mixed emotional and behavioral disorders
  • Unspecified

Adjustment Disorder Symptoms

AD is characterized by a maladaptive (negative) reaction to a stressful event, such as preoccupation with the event or its consequences. This may include excessive worry and repeated distressing thoughts about the stressor.

While everyone experiences and reacts to stressful things, people with AD have a disproportionately extreme response relative to the severity of the stressor, the person’s prior functioning, and the expected reaction of the typical person. Difficulty adapting to the stressor can lead to serious functional impairments in several areas, such as at home, at work, at school or in personal life.

The specific and predominant symptoms associated with AD depend on the subtype present.

With depressed mood:

  • Tears
  • A feeling of despair
  • Low/depressed mood

With anxiety:

With mixed anxiety and depressed mood:

  • Combination of anxiety and depression symptoms

With conduct disorder:

  • Reckless or destructive behavior
  • Violating the rights of others
  • Violating societal norms and rules (such as skipping school, vandalism, fighting, reckless driving, etc.)

With mixed disturbance of emotions and conduct:

  • Combination of emotional symptoms (such as anxiety and depression) and a behavioral disorder

Unspecified:

  • Maladaptive reactions that do not fit one of the specific subtypes
  • May include social withdrawal or difficulty engaging in regular activities, such as work or school

Symptoms may differ

Symptoms are subjective and may vary from person to person. There may also be differences in the symptoms, severity, duration, and outcome of AD between adolescents and adults. Children and teens tend to have more behavioral symptoms (like “acting out”), while adults often have more emotional symptoms, like depression.

Duration of symptoms

AD symptoms begin within three months of the stressful trigger. However, acute stressors (such as losing a job) tend to cause symptoms quickly.

AD usually disappears six months after the removal of the stressor (and its consequences). If the stressor is continuous, the reaction may also last longer.

If symptoms last longer than this, another condition may be present, such as an anxiety or mood disorder, and a new diagnosis should be explored.

In some cases, AD has been associated with an increased risk of suicide.

Causes of Adjustment Disorder

A 2018 review compares AD to a flu analogy. While most people experience short-term flu symptoms and then recover, some people develop serious and/or long-lasting complications when they catch the flu.

Although influenza is a very different condition from Alzheimer’s disease, the analogy fits. Everyone experiences stressful events and most people respond proportionately with coping strategies. People with AD have an overactive and maladaptive response to a stressor.

With AD, the stressor is identifiable and the reaction corresponds to a specific event or trigger. This could include:

  • Divorce or breakup
  • Diseases
  • Disability
  • Financial/socioeconomic difficulties
  • Problems at work
  • Job Loss
  • Conflicts with others
  • Moving
  • Retirement

For children and adolescents, examples of stressors may include:

Adjustment Disorder Risk Factors

The risk factors for AD are not well known and further research is needed.

Some studies suggest that it is more common in women, while others indicate that it occurs equally in men and women.

Some findings indicate that it is more common in older people, while others show that it is common in children and adolescents.

AD occurs in all cultures, but stressors and symptoms are influenced by cultural factors that need to be considered.

Diagnosing Adjustment Disorder

There are no widely accepted diagnostic tools currently specifically used for AD. It is considered a subthreshold condition, which means that if the symptoms meet the diagnostic criteria for another disorder, AD cannot be diagnosed.

AD is also sometimes considered a transient diagnosis, used to identify early or temporary mental states that do not yet meet all the criteria for a major mental disorder.

To explore a diagnosis of AD, a health care provider or mental health professional may:

  • Discuss symptoms
  • Discuss medical and family history
  • Do a physical exam
  • Run tests, such as blood labs, to look for a physical reason for the symptoms
  • Take a mental status exam

Adjustment Disorder Treatment

The treatment of AD has not been well studied.

Although AD tends to get better on its own, it can cause significant disruption while it is present. Treatments, such as psychotherapy (talking therapy), can help manage AD.

Psychotherapy

Psychotherapy is the treatment of choice for AD. The person with AD and their healthcare provider or mental health professional will decide together which type will be most beneficial.

Cognitive-behavioral therapy (CBT) is a common choice. With the help of a therapist, CBT helps the person with AD recognize maladaptive thoughts and feelings, then helps teach them how to transform them into healthy coping thoughts and behaviors.

Other forms of psychotherapy that may be used include:

  • Solution-focused therapy (a goal-oriented, collaborative approach that focuses on the solution rather than the stressor)
  • family therapy
  • couple therapy
  • Long term therapy
  • Self-help or support groups

Medication

Medications are generally not recommended for the treatment of AD.

When medication is warranted, it is used alongside psychotherapy to manage specific symptoms, such as:

  • Insomnia and sleep disorders
  • Significant symptoms of anxiety or depression

Online therapy

Research shows promise for the use of self-help and/or internet-based interventions for AD. These programs vary according to the degree of involvement of the therapist. This model can make therapy accessible to more people.

Coping with Adjustment Disorder

In addition to seeking care from your health care provider or a mental health professional, some ways to cope with AD include:

  • Develop and maintain supportive relationships with friends and family
  • Have plenty of sleep
  • Exercise
  • Eat nutritious foods
  • Practice mindfulness techniques, such as meditation and yoga

Summary

Adjustment disorder is a common but understudied mental health problem. It is characterized by a disproportionate response to a stressful event.

AD belongs to subsets of symptom groups, namely symptoms of anxiety, symptoms of depression, behavioral disorders, or a combination of these symptoms.

Research on the treatment of AD is lacking, but psychotherapy, such as CBT, is most often recommended. AD usually resolves within six months.

A word from Verywell

If you’re having trouble managing your reaction to a stressful event, it’s worth discussing this with your healthcare provider to see if Alzheimer’s disease may be present. If you have AD, chances are it will go away within six months, but treatment can help you feel better and gain valuable coping skills.

Frequently Asked Questions

  • How do you help someone with an adjustment disorder?

    The greatest thing you can do for someone with Alzheimer’s disease is to offer support. Be there to listen to them, support them in their treatment (including going to therapy with them if you wish) and encourage them.

  • What is the difference between adjustment disorder and PTSD?

    The main difference between AD and post-traumatic stress disorder (PTSD) is the nature of the stressful event involved. AD stressors tend to be less severe and less traumatic than stressful events associated with PTSD.

  • How common is adjustment disorder?

    There are few data on the prevalence of AD. Some studies estimate that AD affects around 1-2% of the general population, but this number appears to increase significantly in clinical settings.

About Antoine L. Cassell

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