Adjustment Disorder

Adjustment Disorder is a disorder that occurs within three months of a distressing event and lasts up to six months. In the past, it was sometimes referred to as a “situational depression.” An Adjustment Disorder is categorized as a trauma and stressor-related disorder. However, the event that triggered the Adjustment Disorder is not as extreme as those triggering posttraumatic stress disorder (PTSD), for which diagnosis may occur after serving in combat or experiencing a severe physical or sexual assault.

Some examples of events that may cause Adjustment Disorder in some people are the loss of a job, a spouse asking for a divorce, or a person receiving a diagnosis of a serious physical illness. The person with Adjustment Disorder has an intense reaction to the event that is considered to be out of the range of how most people would react. On a continuum, Adjustment Disorder lies about midway between a normal reaction to a stressful event and a pathological reaction. Some researchers report that many people with suicidal symptoms in hospital emergency rooms have symptoms consistent with Adjustment Disorder.

Sometimes even positive events may trigger Adjustment Disorder. For example, a person may receive a promotion but then may worry greatly about the changes that will occur with this promotion. If they worry too much, this may rise to the level of an Adjustment Disorder.

It’s also important to understand that people with Adjustment Disorder frequently develop symptoms of depression and/or anxiety, and if so, these conditions should be identified and treated by a healthcare provider. In addition, if the Adjustment Disorder persists beyond six months of the end of the stressful experience, the condition might meet the criteria of a more severe diagnosis, such as major depressive disorder (MDD).

Who develops Adjustment Disorder?

Both men and women develop Adjustment Disorder about equally. In some studies, the prevalence of Adjustment Disorder in the general population is about 2 percent. However, among people who recently were terminated from their jobs, the rate is as high as about 30 percent. In addition, up to 20 percent of individuals receiving outpatient mental health treatment may have Adjustment Disorder. Not everyone who experiences a significant life change will go on to develop an adjustment disorder. Whether or not someone’s stressful event develops into Adjustment Disorder often depends on their environment, support system, and knowledge of coping mechanisms, among other factors.

Uncovering what triggered the Adjustment Disorder

Struggles with infertility can be a common trigger for adjustment disorder in women. In one study of 386 women who dealt with infertility, over half had symptoms of adjustment disorder.

With Adjustment Disorder, the healthcare provider considers whether there was a precipitating event that may have triggered the psychological reaction of the individual. Some, but not all people with Adjustment Disorder know what they are very upset about and can describe it to the healthcare provider. In other cases, the healthcare provider may elicit the information by asking the person if any changes have occurred recently, such as the end of a marriage, the loss of a job, or another distressing event.

Fortunately, there are effective treatments such as psychotherapy, which can usually facilitate a return to normal life.

What it looks like

People with Adjustment Disorder have experienced a very upsetting event.

Symptoms of Adjustment Disorder may include the following:

Repeated dreams about the event
Recurrent distressing memories of the event
Depressed or anxious mood
Frequent, unwanted thoughts about the distressing event, also referred to as “ruminating”
Physical complaints such as feeling tired or jittery
Struggling to complete daily activities at at work or school
Possible suicidal thinking
Lack of appetite
Difficulty concentrating
Withdrawing from normal activities or self-isolation

Different types of Adjustment Disorder

There are also different types of Adjustment Disorder, according to the American Psychiatric Association. These include the following types:

Adjustment Disorder with a depressed mood. This person may be teary-eyed and unable to experience pleasure from activities they formerly enjoyed.
Adjustment Disorder with anxiety. This person may feel worried or overwhelmed. They may ruminate over the past stressful event for extended periods.
Adjustment Disorder with mixed anxiety and depressed mood. The individual has both depressive and anxious symptoms in addition to the symptoms of the Adjustment Disorder.

Adjustment Disorder with disturbance of conduct. This individual may exhibit reckless or rule-breaking behavior

Adjustment Disorder with mixed disturbance of emotions and conduct. This person may have depression and anxiety and lash out with bad behavior.
Adjustment Disorder Unspecified. This person’s symptoms do not fit the other categories but the individual may have issues at school or work or with their family or may have physical problems.

Many people with an Adjustment Disorder have ruminative thoughts, such as “Why did this happen to me? It’s so unfair!” and these thoughts may become intrusive and problematic. Others may suffer from a cognitive dissonance; for example, when a person highly values her job and considers herself a valuable employee, and then is fired, she may struggle to reconcile her view of the job and herself with her termination from the job. Basically, it doesn’t make sense to her and she may also engage in ruminative thoughts.

Having an Adjustment Disorder is Nobody’s Fault

Sometimes people with Adjustment Disorder blame themselves for not being able to “shake off” their feelings. The person who is distressed about being laid off from a job may think that she should not be so upset, and yet she is very disturbed about the layoff anyway. An adjustment disorder is no one’s fault and most of the time, it is highly treatable. Blaming oneself for these symptoms achieves nothing. Instead, the person should contact a therapist to receive assistance in coping with their reactions to the distressing event.

Comparing and contrasting Adjustment Disorder and PTSD

PTSD is a longer-term and otherwise different diagnosis than Adjustment Disorder, and while some of the symptoms are similar, there are differences in how they present.

Adjustment Disorder

- Symptoms occur within three months of the distressing event and usually resolve within six months

Person may have bad dreams
Many people would not respond as severely to the distressing event, such as getting fired or one’s partner asking for a divorce. Most people would have a reaction, but it would be less severe than the person with Adjustment Disorder.
Person may feel guilty
Person may feel actively distressed, upset, or angry
Most people remember the stressful event, but not as a flashback
People may feel on edge and sometimes may behave self-destructively

PTSD

- Symptoms may occur months after the traumatic event and persist for much longer than three months

Person may have recurrent severe nightmares
Many people would respond in this manner to the distressing event, which is an extreme event such as experiencing combat in a war zone, or facing extreme weather such as a category five hurricane.
Person may blame self for the traumatic event or for their reaction to the event.
Person may feel emotionally numb
Person may feel flashbacks of the traumatic event. A flashback feels like re-experiencing the trauma in real time.
Person may feel edgy and behave self-destructively

Outlook

While living with Adjustment Disorder can present unique obstacles, the majority of people who are properly diagnosed and treated often gain transformative results.

The current thinking on what causes Adjustment Disorder

The causes of Adjustment Disorder are complex. Some people respond to serious life crises with temporary distress but are able to propel themselves toward accepting and dealing with the stressful situation. Others find it extremely difficult or impossible to cope with challenging life situations. The precise reasons for these differences are unknown.

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