Adjustment disorder is an abnormal and excessive reaction to an identifiable life stressor. The reaction is more severe than would normally be expected and can result in significant impairment in social, occupational, or academic functioning. Symptoms must arise within three months of the onset of the stressor and last no longer than six months after the stressor has ended.
The response may be linked to a single event (a flood or fire, marriage, divorce, starting school, a new job) or multiple events (marital problems or severe business difficulties). Stressors may be recurrent events (a child witnessing parents constantly fighting, chemotherapy, financial difficulties) or continuous (living in a crime-ridden neighborhood).
Adjustment disorder often occurs with one or more of the following: depressed mood, anxiety, disturbance of conduct (in which the patient violates rights of others or major age-appropriate societal norms or rules), and maladaptive reactions (i.e. problems related to work or school, physical complaints, social isolation).
Adjustment disorders are associated with high risk of suicide and suicidal behavior, substance abuse, and the prolongation of other medical disorders or interference with their treatment. Adjustment disorder that persists may progress to become a more severe mental disorder, such as major depressive disorder.
Adjustment disorder is sometimes referred to as Situational Depression.
- Depressed mood
- Impaired occupational/social functioning
- Trembling or twitching
- Physical complaints (e.g. general aches and pains, stomachache, headache, chest pain)
- Conduct disturbances (e.g. truancy, vandalism, reckless driving or fighting)
- Anxiety, worry, stress and tension
Note: Symptoms may vary widely. The person may or may not be aware of the stressor causing the disturbance.
Diagnosis depends on the following:
- The reaction clearly follows a life stressor. Within three months of stressor onset, emotional and behavioral symptoms develop in response to stressor.
- Symptoms seem excessive compared to what would normally be expected in relation to stressor and/or symptoms significantly impair occupational, school, or social functioning.
- Symptoms are not explained by another diagnosis.
- Symptoms are not part of bereavement.
- Symptoms do not last longer than six months after end of stressor.
- The diagnosis may be acute (symptoms last less than six months) or chronic (symptoms last six months or longer as when stressors are chronic or have lasting effects).
The cause of adjustment disorder is a life stressor. In adults, adjustment disorder is commonly a result of stressors related to marital discord, finances, or work. In adolescents, common stressors include school problems, family or parents’ marital problems, or issues around sexuality. Other types of stressors include the death of a loved one, life changes, unexpected catastrophes, and medical conditions such as cancer and subsequent treatments.
Factors that influence how well a person reacts to stress may include economic conditions, availability of social supports, and occupational and recreational opportunities. Susceptibility to stress may include such factors as social skills, intelligence, genetics and existing coping strategies.
The primary goal of treatment is to relieve symptoms and help the person achieve a level of functioning comparable to that prior to the stressful event.
Recommended treatments include individual psychotherapy, family therapy, behavior therapy, and self-help groups. Realistic short-term goals should be made at the start of therapy, as the course of adjustment disorder is short-term in nature.
Goals of therapy will often center around social supports available to the individual in the form of family, friends, and community. The individual’s coping and problem-solving skills will be explored and developed. Relaxation techniques might be explored to deal with feelings of stress. Treatment will include eliciting the patient’s concern and helping the individual understand his or her role in the stressors, reviewing and reinforcing positive steps the patient has taken to deal with the stress, teaching ways to cope or avoid stressors in the future, helping the individual place stressors in perspective to overall life, helping the individual to understand his or her reaction to the stressors, and helping the individual view stressors as a chance for positive change or improvement.
Family therapy, as well as effective communication and coping-with-stress skills, may be recommended for cases in which the patient is younger (child, adolescent). When medication is used, it is typically in addition to psychotherapy. Prescription medication may be helpful in easing the depression or the anxiety associated with adjustment disorder. However, treatment of adjustment disorders usually excludes use of medication.
Most people recover from adjustment disorder without any remaining symptoms if they have no previous history of mental illness and have access to stable social support. Individuals suffering from adjustment disorder should work to develop and maintain a healthy diet and sleep patterns, as well as a strong social support system.