Types or specifiers for adjustment disorderThe distress is out of keeping with the intensity of the stressor. We all face challenges and crisis in life. However, we don’t all develop Adjustment Disorder each time. To get a diagnosis the distress has to be out of proportion. It must also impact life at home and in the community.
- Anxiety: when the person presents with nervousness, worry or difficulty separating
- Depressed mood: when presenting as teary, low mood or feeling helpless.
- Mixed anxiety and depressed mood: presenting with a combination of the above.
- The disturbance of conduct: when a person presents with aggression, intimidation or law-breaking behaviour
- Mixed disturbance of emotions and conduct: presenting with a combination of emotional symptoms and conduct disturbance
Stress-VulnerabilityBrown in the 1980s took thinking about adjustments a step further by writing about a stress-vulnerability model. They identified concerns like low self-esteem, inferred denial, pessimism as important factors to how someone responds.
However, not everyone who undergoes similar stressors develops adjustment disorder. Experts have suggested the following factors, characters and traits make Adjustment Disorder more likely:
- Childhood – Controlling or abusive parents
- Temperament -Anxiety and avoiding risk
- Education – It’s possible that more schooling may protect against psychological distress.
Deciding which treatment options right depend on a couple of things:
- Extent plus severity of symptoms and type of adjustment disorder.
- Prefered choice and ability to tolerate different types of treatments.
- Practical factors such as travel to a therapist and other health practitioners in your area.
- Cost of online psychologists and psychiatrists.
- Are there any other mental health worries?
- Family and work needs. Getting time away from work and home life to focus on your health
- Your stance towards health and views of those closest to you
Psychology for Adjustment DisorderPsychological treatments (talking therapies) can be provided by health care workers, psychologists and doctors. The shared view is that they are the treatment of choice for adjustment disorder. Adjustment disorders firstly are stressor-related. Secondly, they are short term. Therefore some psychologists use brief solution-focused therapy like problem-solving therapy or interpersonal therapy. Interpersonal therapies focus on the here and now. Look at problems from a relational point of view and explore options for changing not helpful behaviour patterns.
A Dutch study explored returning employees to work by1) understanding the cause, specifically a loss of control, 2) systematically developing problem-solving plans for each stressor, 3) implementing the plan. What they found was putting this plan into action made significantly more people returning to work by the 3-month mark. Family therapy may have a role. It depends on the type of stressor. Agreed time apart is needed when there is conflict. In addition, working on communication skills, planning light-hearted fun times with different family members and addressing practical issues such as money or living arrangements are needed.
MedicationsAdjustment disorder by definition is often a time-limited condition. Antidepressants take weeks to work and have side effects. There are increasing restrictions on the use of sedating medications. Your doctor or psychiatrist may choose to prescribe medication; to help with poor sleep, agitation or anxiety that is part of your adjustment disorder. It is important to follow your doctor’s instructions, especially when coming off medications.
By definition, Adjustment Disorder should resolve after a few months. Often times addressing the stressor leads to a prompt end to symptoms. Rarely symptoms last longer. If this were the case, it’s probably best to re-assess the shared understanding between therapist and client.
Adjustment disorder is less likely to impact work or family life. It is less likely to lead to hospital stays than other psychiatric conditions. If people were to go into hospital their time in is likely to be shorter.
Longer-term, 5 year plus outcomes from Adjustment Disorder suggest less than 10% of people experience relapse. If relapse were to occur; often it is with either depressed mood and or alcohol use. Coming up with ways in the future to tackle stress helps. There is hope for a good long term outcome. This is key because soon after stress, people can feel hopeless. When people feel hopeless, they are less likely to speak up. They are less likely to ask for help.
Adjustment disorder is a common mental health condition. At Epsychiatry our psychiatrists and psychologist have experience working with adjustment disorder. They can diagnose and provide education on the condition. They can suggest lifestyle changes and provide therapy. Speak with our friendly staff to book an appointment today.