Adjustment disorders involve emotional and/or behavioral symptoms in response to an identifiable stressor.
(See also Overview of Trauma- and Stressor-Related Disorders.)
Adjustment disorders are common and are present in an estimated 5 to 20% of people who show up for outpatient mental health visits.
The stressor that provokes an adjustment disorder may be a single, discrete event (for example, losing a job); multiple events (for example, financial hardship followed by a romantic setback); or an ongoing set of problems (for example, caring for a disabled family member). The stressor may have an impact on just one person, an entire family, or a large group of people. The stressor may even be a common developmental milestone that is usually regarded as good (for example, becoming a parent).
Death of a loved one can be a precipitant of an adjustment disorder. However, clinicians must take into account the wide variety of grief reactions considered typical in different cultures and diagnose a disorder only if the bereavement response is beyond what is expected or is not better categorized as prolonged grief disorder.
In evaluating a person, mental health professionals must determine whether the adjustment response is related to a particular stressor. They must also determine whether the response causes the person marked distress or impairs that person's ability to function in social settings, on the job, and/or in other areas.
Symptoms and Signs of Adjustment Disorder
Symptoms of an adjustment disorder typically begin shortly after the stressful event and do not continue beyond 6 months after the stressor has stopped.
There are many manifestations of an adjustment disorder, common ones include
Anxiety
Most people present with a mixture of these symptoms, but some may present with only one especially prominent symptom (for example, feeling nervous and jittery after a physical assault).
There also is an increased risk of suicide attempts and completed suicide.
Diagnosis of Adjustment Disorder
A doctor's evaluation, based on standard psychiatric diagnostic criteria
People must have
Emotional or behavioral symptoms within 3 months of having been exposed to a stressor
Symptoms must be clinically significant as shown by one or more of the following:
Marked distress that is out of proportion to the stressor (taking cultural and other factors into consideration)
The symptoms significantly impair social or occupational functioning
Adjustment disorders frequently occur with other mental health disorders such as obsessive-compulsive disorder (OCD), a personality disorder, or bipolar disorder.
Treatment of Adjustment Disorder
Self-care
Psychotherapy
Sometimes medications to treat certain symptoms
Adjustment disorders must be thoroughly evaluated and treated. However, there is limited evidence supporting any particular treatment for adjustment disorders. A wide variety of individual and group psychotherapies, including brief psychotherapy, cognitive-behavioral therapy, and supportive psychotherapy, have been used successfully (see Treatment of Mental Illness: Psychotherapy). It is not uncommon for therapy to target a specific issue, such as grief.
Interventions are much more likely to be helpful if the person with the adjustment disorder is made to feel safe and is able to provide consistent self-care. Living within an intact family, being part of a healthy social system, and/or having a trauma-sensitive psychotherapist all assist in recovery. People usually recover from an adjustment disorder with time and the help of friends and family.
Medications are often used to treat symptoms such as insomnia, anxiety, and depression.
Self-care
Self-care is crucial during and after a crisis or trauma. Self-care can be divided into 3 components:
Personal safety
Physical health
Mindfulness
Personal safety is fundamental. After a single traumatic episode, people are better able to process the experience when they know that they and their loved ones are safe. It can be difficult, however, to gain complete safety during ongoing crises such as domestic abuse, war, or an infectious pandemic. During such ongoing difficulties, people should seek the guidance of experts on how they and their loved ones can be as safe as possible.
Physical health can be put at risk during and after traumatic experiences. Everyone should try to maintain a healthy schedule of eating, sleeping, and exercise. Medications and substances that sedate (for example, antianxiety medications) and intoxicate (for example, alcohol) should be used sparingly, if at all.
A mindful approach to self-care aims to reduce the feelings of stress, boredom, anger, sadness, and isolation that traumatized people typically experience. If circumstances allow, at-risk individuals should make and follow a normal daily schedule, for example, get up, shower, get dressed, go outside and take a walk, prepare and eat regular meals.
It is useful to practice familiar hobbies (or develop new ones). Engaging in other activities that sound fun and distracting (for example, drawing a picture, watching a movie, or cooking) are also beneficial.
Involvement in family and community affairs can be crucial, even if it is difficult to maintain human connection during a crisis.
It is useful to limit the amount of time spent on news and instead focus on other activities, such as reading a novel or putting together a puzzle.
Psychotherapy
There is limited evidence that psychotherapy is an effective treatment for adjustment disorders. When it is used, psychotherapy can address adjustment disorders in a general way or be used to target specific elements of the disorder (for example, grief, trauma, and role transitions) for improvement.
Medications
There is also limited evidence that medications are effective in treating adjustment disorders. Certain types of antidepressants called selective serotonin reuptake inhibitors (SSRIs) have been successfully used to treat the symptoms of any anxiety or depressive disorder that may have been diagnosed along with the adjustment disorder.
