What is An Adjustment Disorder?
Adjustment Disorder (also known as Situational Depression) is a stress-borne type of mental illness that involves the development of extreme emotional or behavioral symptoms brought on by major life events. These stressful life events include moving, to losing your job, to getting a divorce, losing a child or other major stressors and life events. It’s important to note that not all of these precipitating events have to be negative life changes; adjustment disorder can be brought about by marriage or having a baby as well.
An adjustment disorder can happen to anyone, at any point in their life. Children and teens are affected at the same rate, while female adults are twice as likely to develop adjustment disorders.
Like other mental illnesses, the cause is generally complex; a mixture of genetics, environment, life experiences, and temperament are involved in the development of adjustment disorder.
What Causes Adjustment Disorders?
Adjustment disorders are caused by a major life stressor which can be any number of things. In children and teens adjustment disorder may be brought on by a number of things, including:
- Problems at school
- Marital problems in parents
- Family problems
- Issues with sexuality
In adults, adjustment disorder may present after any of the following:
- Marital problems
- Economic struggles
- Work problems
All ages may be affected by adjustment disorder after the following events:
- Death of a loved one (especially if it was a sudden death)
- Major life changes
- Major trauma
- Major medical diagnoses
It’s impossible to predict who will develop adjustment disorder, even if the precipitating event is the same, but it’s important to note that the development of adjustment disorder may be brought on by both internal and external factors.
External factors that may lead to the development of adjustment disorder can include social support availability, economic conditions, recreational or occupational opportunities.
Internal factors that may lead to the development of adjustment disorder can include social skills, IQ, coping mechanisms, and genetics.
The development of adjustment disorder is often a combination of internal and external factors in a person’s life.
What Are The Risk Factors For Adjustment Disorder?
While no one cause has been indicated for the development of adjustment disorder, and not everyone reacts the same way to the same stressors, adjustment disorder can be caused by any one of the following:
- Diagnosis of a major, chronic illness
- School problems
- Going away to school
- Relationship breakup
- Becoming unemployed
- Having a baby
- Physical trauma
- Surviving a disaster – tornado, hurricane
- Losing a loved one
- Challenging life circumstances
- Exposure to violence
- Additional mental health issues.
In addition, those who are under constant stress – living in a bad area – may hit a point in which they breakdown and develop adjustment disorder.
Former life experiences may also play a role in the development of adjustment disorder. If changes and adjustments are challenging and you lack social support, you may be more apt to develop adjustment disorder.
Those who experienced stressful situations in childhood – over or under-protective parents, divorce, moving often – may make an adult or adolescent feel as though they have no control over their lives, which means when stressors occur, coping may be more challenging.
What Are The Symptoms of Adjustment Disorder?
Symptoms of adjustment disorder include distress uncharacteristic of what would be expected by the major life event and cause major impairment at work, with one’s social life, or educational abilities and occur within 3 months of the known stressor.
The symptoms for adjustment disorder may not meet the criteria for another mental illness, such as major depression or anxiety disorders, and do not last longer than six months from the onset of the precipitating event.
Symptoms of adjustment disorder, which vary wildly between people, can include the following:
- Agitation and restlessness
- Trembling or twitching of the extremities
- Physical complaints without medical cause
- Heart palpitations
- Depressed mood
- Social withdrawal and decreased social functioning
- Occupational impairment
- Various conduct disorders – stealing, fighting, vandalism.
It is important to note that while these symptoms are the ones most often experienced by those diagnosed with adjustment disorder, adjustment disorder presents itself differently in every person.
What Are The Subsets Of Adjustment Disorders?
Adjustment disorder is often categorized into subtypes based upon the symptoms. These subcategories of adjustment disorders are:
- Adjustment Disorder with Anxiety: Symptoms include feeling nervous, worried, difficulty concentrating, feelings of being overwhelmed. Children may experience intense separation anxiety.
- Adjustment Disorder with Depressed Mood: Symptoms include sadness, feeling tearful and hopeless, and loss of pleasure in previously enjoyable activities.
- Adjustment Disorder, Mixed Type – Anxiety and Depression: Symptoms include depression and anxiety.
- Adjustment Disorder with Conduct Disturbances: Symptoms include problems such as fighting, reckless driving, and not paying bills.
- Adjustment Disorder, Mixed Type, Emotional and Conduct Disturbance: Symptoms include depression, anxiety, and behavioral problems.
- Adjustment Disorder, NOS: For those whose symptoms aren’t better described by the other types of adjustment disorder, often have symptoms that include problems with work, family friends, somatic complaints.
How is Adjustment Disorder Diagnosed?
A diagnosis of adjustment disorder can be acute or chronic, is based upon the following criteria.
- The reaction the person is having is clearly tied to a life stressor (whether or not the person is aware of the root cause).
- Within three months of the stressor, behavioral and emotional symptoms develop.
- The symptoms experienced seem excessive compared to “normal” reactions to the same stressor and/or symptoms cause major impairment in work, social functioning, or school.
- The symptoms are not better explained by another diagnosis.
- The symptoms are not related to grief and grieving.
- The symptoms do not last over six months from the end of the stressor unless the person is suffering complex adjustment disorder, in which case symptoms may last longer than six months.
How is Adjustment Disorder Treated?
Treatment for adjustment disorder, like most mental illnesses, is aimed at managing symptoms to allow the person to reach a level of social and occupational (or scholastic) functioning comparable to what was normal before the precipitating event.
A mental health professional will often recommend that a person suffering from adjustment disorder begin a course of therapy. This type of therapy can be individual, behavioral, family therapy, and self-help groups.
Since adjustment disorder is a relatively short-term mental illness, realistic and attainable short-term goals should be created with the onset of treatment.
The goals set during therapy are generally centered around the social supports available to the person, which includes: friends, family, and the community. While social support is explored, the therapist often works with the person to help with coping skills and abilities to manage stress.
For children and teens, family therapy in addition to teaching the individual how to cope with stressors in his or her life is often recommended.
Occasionally, prescription medication may be utilized to eliminate some of the symptoms of depression and anxiety. Medications may be prescribed in conjunction with therapy.
What Are Complications Associated With Adjustment Disorder?
Generally speaking, most adults who have adjustment disorder recover within six months without complications. People who have other mental health issues, addictions, or chronic adjustment disorder are more likely to develop greater long-term mental health problems. In adults, these problems can include:
- Major depressive disorder
- Addictions to substances or alcohol
- Suicidal behavior and thoughts.
Teenagers who have adjustment disorder – especially chronic adjustment disorder with behavioral problems – are at greater risk for the development of:
- Major depressive disorder
- Suicidal behavior
- Bipolar Disorder
- Antisocial personality disorder
What Is The Prognosis For Adjustment Disorder?
Adjustment disorder, while a challenging disorder in the short-term, is often treated properly and people who have the disorder recover without lingering symptoms. Recovery is often more favorable for those who have no previous history of mental illness and have adequate social support during treatment and recovery.
How Can I Help Myself Heal From Adjustment Disorder?
When you’re suffering from adjustment disorder, it may feel hopeless; like your world has crashed and burned, and you may not see the light at the end of the tunnel. Here are some tips for coping with adjustment disorder:
- Go easy on yourself – allow yourself the time to process your feelings and work through them.
- Don’t let anyone tell you “you’re not getting over this fast enough.” Recovery takes time.
- Don’t engage in negative self-talk while dealing with adjustment disorder. You’re going to be fine.
- In fact, your mantra is “everything is okay. I am okay.” Say that when you’re lowest or most anxious.
- Force yourself to talk to people – adjustment disorder can be very isolating. Don’t isolate yourself, even if it feels good.
- Tell people that you’re hurting. There’s no shame in this. Just make sure the people you tell are those you can trust.
- Find a hobby that brings you joy and throw yourself into it.
- Keep a healthy diet and stick to a regular sleep routine.
- Find a local support group and attend it. There is tremendous strength in numbers.
- Ask others how they cope with stressors and see if you can learn to practice some.
- Do something nice for yourself every day.
- Remind yourself often that you can get through this.
- Utilize and learn proper coping skills and stress management like yoga, meditation and time with loved ones.
- Ask your therapist for some suggestions to manage stress.
If Your Child Has Adjustment Disorder…
Parents who see their children struggle with adjustment disorder are often stuck feeling helpless and hopeless. Here are some tips for helping children with adjustment disorder:
- Tell your child that their feelings are normal; that emotions aren’t wrong.
- Explain that sometimes our emotions can be scary, but that’s okay.
- Remind them that while it hurts now, it won’t always hurt.
- Be supportive and understanding.
- Show your love to your child.
- Talk to your child about his or her feelings.
- Allow your child to choose things he or she likes to do around the home.
- Allow your child to make simple decisions about the things he or she eats or watches on television.
- Make sure the school knows that your child is coping with adjustment disorder and have the teachers let you know how he or she is doing in school.
- Find a hobby or something fun that your child likes to do and encourage participation in that.
Can You Prevent Adjustment Disorder?
It’s important to note that there’s no sure-fire way to prevent the development of adjustment disorder, but the development of healthy coping skills and learning to be resilient may work in your favor during times of adversity, trauma, or tragedies. Some ways to increase your ability to manage stress and become more resilient include the following:
- Laughing and finding things to keep you laughing.
- Maintaining a healthy lifestyle
- Feeling good about yourself
- Having – or creating – a support network.
- Call upon your inner strength if you know a stressful situation in your future.
Additional Resources For Adjustment Disorder:
ChildMind Institute offers information and advice for parents of children with mental disorders
Make The Connection help for veterans who suffer from Adjustment Disorder
Page last audited 7/2018