Adjustment Disorder

Background

Adjustment disorder is one of the most commonly diagnosed mental health conditions. Especially in clients presenting in crisis. It is a broad term for when life’s challenges or stressors impact our mental health and wellbeing. It impacts us at home, work and our studies. However, there is little in the research about Adjustment Disorder. In this article, we hope to create an easily understood breakdown and guide to managing adjustment disorder

 

Defining Adjustment Disorder

It is thought of as a passing state of distress occurring within 6 months of a stressful event. Adjustment disorders can impact an individual or society. The stressors which acted as a trigger could be a stressful life event or change, loss or onset of an illness. 

Our individual temperament plays a part. However, without the stressful trigger, the adjustment disorder would not have occurred. 

 

Types or specifiers for adjustment disorder

The 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.

 

Different types of Adjustment Disorder

There are different types or specifiers for adjustment disorder. Each with the following:

  • 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
 

Clinical Features of Adjustment Disorder

Anger, isolative behaviour, self-harm, anxiety can all be clinical features of adjustment disorder. The type of stress, presence of other mental health issues, a person’s nature and other supports all impact how adjustment disorder is felt.

 Age plays a part. Teens are more likely to act out or be behaviorally disturbed; whilst adults present with more depressive symptoms. 

Symptoms usually arise within a month or two of the stressor. The disorder rarely lasts more than 6 months. 

 

Stress and Adjustment Disorder

The stressors or event does not need to be of exceptional severity. This helps differentiate it from PTSD and acute stress responses. 

Paykel wrote a key paperback in the 1970s on life stressors. He broke them into desirable vs undesirable, such as career promotions or illness. Wanted and unwanted change. He broke others into entrances vs escapes, examples of which are births and deaths. We fall face these changes in our lives. However, different people react in their own ways. So, why is that?

 

Stress-Vulnerability

Brown 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. 

 

How common is Adjustment Disorder?

Very, in a single word. Doctors come across adjustment disorders mostly in GP clinics and on medical and surgical wards. Hospital stays are likely in the context of a recent diagnosis of a serious health condition.

 

Overlaps

There appears to be quite some overlap between Adjustment Disorder and personality disorder. This might time into Brown’s stress-vulnerability model, where certain traits make Adjustment Disorders more likely. 

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. 

Substance use, likely to numb and cope with the stressor, are also commonly seen together with Adjustment Disorder. It appears that both hamper recovery.

 

How is Adjustment Disorder diagnosed?

There is no blood test or tick box sheet that can be filled out to make a diagnosis of Adjustment Disorder. Instead, doctors and psychologists make a diagnosis based on answers to questions they ask. Firstly, they will inquire about childhood, life events and emotions they triggered, recent stressors and the impact it has had. Secondly, they will want to know about past mental health problems. What helped and what didn’t. Finally, they may speak to a friend or support person. 

 

Criticisms of Adjustment Disorder diagnosis

Some experts feel that the diagnosis is an attempt to “medicalize” the ups and downs of life. Separating adjustment disorder from life stressors is challenging. 

Research however seems to support the view that is a distinct diagnosis. There is evidence to medically support, help people who meet the diagnostic criteria.

 

Treating Adjustment Disorder

After a diagnosis is made your therapist or doctor will discuss with you treatment options. Together weighing up the pros and cons of each choice. Sometimes you may decide to try life changes first before looking at psychology. Another option would be to wait and see. Adjustment disorders by their definition shouldn’t last more than 6 months. 

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 Disorder

Psychological 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 by

1) 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. 

 

Medications

Adjustment 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.

 

Outcomes

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. 

 

Seek 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.