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Adjustment disorders- Yes, Healthy Boundaries are Appreciated!

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Having a mental disorder isn’t easy, and it is harder when people assume you can ‘just get over it’.

Adjustment disorders are primarily stress-related conditions.  Adjustment disorders affect how you feel and think about yourself and the world and in turn affect your actions or behaviour. You experience more stress than would be normally expected in response to an unexpected event, and that stress causes significant problems in your relationships, at work or even at school.

Work place problems, going away to school, an illness, and death of a family member or any number of life changes can cause stress. Most of the time, people do adjust to such changes within a few months. But if you have an adjustment disorder, you will continue to have emotional or behavioural reactions that can contribute towards you feeling anxious or depressed.

You don’t have to deal with it and be tough on your own, though. Treatment can be cursory and it will help you regain your emotional footing.

Symptoms

Signs and symptoms depend on the type of adjustment disorder and can vary from person to person.

Some examples include:

  • Feeling sad, hopeless or not enjoying things you used to enjoy
  • Frequent crying
  • Worrying or feeling anxious, nervous, jittery or stressed out
  • Trouble sleeping
  • Lack of appetite
  • Difficulty concentrating
  • Feeling overwhelmed
  • Difficulty functioning in daily activities
  • Withdrawing from social supports
  • Avoiding important things such as going to work or paying bills
  • Suicidal thoughts or behaviour

Symptoms of an adjustment disorder usually start within three months of a stressful event and last no longer than 6 months after the end of the stressful event. However, chronic adjustment disorders can continue for more than 6 months, especially if the stressor is ongoing, such as unemployment.

When to see a doctor

Usually stressors are temporary, and we learn to cope with them over a period of time. Symptoms of adjustment disorder get better because the stress has eased. But sometimes the stressful event remains a part of your life for a long duration. Or a new stressful situation comes up, and you face the same emotional struggles all over again.

Causes

Adjustment disorders are evidently caused by significant changes or stressors in your life. Genetics, your life experiences, and your temperament may increase your likelihood of developing an adjustment disorder as well.

Risk factors

Some occurrences may make you more likely to have an adjustment disorder:

  • Stressful events: both positive and negative — may put you at risk of developing an adjustment disorder. For example: Divorce or marital problems and/or Relationship or interpersonal problems
  • Changes in situation, such as retirement, having a baby or going away to school
  • Adverse situations, such as losing a job, loss of a loved one or having financial issues
  • Problems in school or at work
  • Life-threatening experiences, such as physical assault, combat or natural disaster
  • Ongoing stressors, such as having a medical illness or living in a crime-ridden neighbourhood

Your life experiences can impact how you cope with stress. For example, your risk of developing an adjustment disorder may be increased if you:

  • Experienced significant stress in childhood
  • Have other mental health problems
  • Have a number of difficult life circumstances happening at the same time

Complications

If adjustment disorders do not resolve, they can eventually lead to more serious mental health problems such as anxiety disorders, substance abuse or depression.

Types of adjustment disorder

Following are the six types of adjustment disorder and their symptoms:

Adjustment disorder with depressed mood

People diagnosed with this type of adjustment disorder tend to experience feelings of sadness and hopelessness. It’s also associated with crying most of the time. You may also find that you no longer enjoy activities that you did formerly.

Adjustment disorder with anxiety

Symptoms associated with adjustment disorder with anxiety include feeling overwhelmed, anxious, and worried. People with this disorder may also have problems with concentration and memory.

For children, this diagnosis is usually associated with separation anxiety from parents and loved ones.

Adjustment disorder with mixed anxiety and depressed mood

People with this adjustment disorder experience both depression and anxiety.

Adjustment disorder with disturbance of conduct

Symptoms of this type of adjustment disorder mainly involve behavioural issues like driving recklessly or even starting fights.

Teens with this disorder may steal or vandalize property. They might also start missing school.

Adjustment disorder with mixed disturbance of emotions and conduct

Symptoms linked to this type of adjustment disorder include depression, anxiety, and behavioural problems.

Adjustment disorder unspecified

Those diagnosed with adjustment disorder unspecified have symptoms that aren’t associated with the other types of adjustment disorder. These often include physical symptoms or problems with friends, family, work, or school.

How is adjustment disorder diagnosed?

In order to be diagnosed with an adjustment disorder, a person must meet the following criteria:

  • experiencing psychological or behavioural symptoms within three months of an identifiable stressor or stressors occurring in your life
  • having more stress than would be ordinary in response to a specific stressor, or stress that causes issues with relationships, in school or at work, or experiencing both of these criteria
  • the improvement of symptoms within six months after the stressor or stressors are removed
  • symptoms that aren’t the result of another diagnosis

Talk to your doctor if you continue to struggle or if you’re having trouble getting through each day. You can get treatment to help you cope better with stressful events and feel better about life again.

If you have concerns about your child’s adjustment or behaviour, talk with your child’s paediatrician.

How is adjustment disorder treated?

If you receive an adjustment disorder diagnosis, you would probably benefit from treatment. You may require only short-term treatment or may need to be treated over an extended period of time. Adjustment disorder is typically treated with therapy, medications, or a combination of both.

Psychotherapy

Psychotherapy, also called talk therapy, is the main treatment for adjustment disorders. This can be provided as individual, group or family therapy.  Therapy can:

  • Provide emotional support
  • Help you get back to your normal routine
  • Help you learn why the stressful event affected you so much
  • Help you learn stress-management and coping skills to deal with stressful events

Individual psychotherapy

Individual psychotherapy may take a cognitive-behavioral therapy (CBT) approach. Because the condition is defined as short-term, this will typically be solution-focussed, short course of psychotherapy. The treatment goal is to equip an affected person to understand how to overcome adjustment disorder by teaching those techniques for dealing more effectively with their particular problem and its effects on their life.

Family therapy

Family therapy will generally be recommended in cases of childhood or adolescent adjustment disorder. It is designed to overcome conflicts in family life and improve communication skills among family members. It may also be useful in teaching family members how to support the child/adolescent who is experiencing adjustment disorder.

Group therapy

In some cases, sharing challenge and coping techniques with a group of people also experiencing the condition can equip a person to understand how to overcome adjustment disorder in a practical sense and to apply this to their own life. Group therapy can also help the person improve their communication skills and can be a useful source of support and encouragement.

Medication

Although supportive, solution-oriented psychotherapy is the first-line treatment for adjustment disorder, medications are sometimes additionally prescribed.

When medications are prescribed, they are used in order to treat specific symptoms of adjustment disorder ‒ for example, if a person is sleeping badly, is experiencing nerves or anxiety most of the time or is excessively depressed. It is for this reason that medications are usually only prescribed in severe cases, are carefully evaluated by a person’s medical care team and are most likely an adjunct to rather than a replacement for talk therapy, which targets the condition’s root cause.

How to prevent adjustment disorders

There’s no guaranteed way to prevent an adjustment disorder. However, learning to cope and be resilient can help you deal with stressors. Being resilient equates to being able to overcome stressors.  You can increase your resilience by:

  • developing a strong network of people to support you
  • looking for the positive or humor in hard situations
  • living healthfully
  • establishing good self-esteem

It can be helpful to prepare for a stressful situation if you know you will need to confront it in advance. Thinking positively can help. You can also call your doctor or therapist to discuss how you can best manage especially stressful situations.

‘The greatest weapon against stress is our ability to choose one thought over the other’- William Jones

Adjustment Disorder: The Mental Illness we don’t talk about!

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