Adjustment disorder (stress response syndrome) is a short-term condition that occurs when you have a considerable deal of trouble controlling or adjusting to a specific cause of stress, such as a big life change, loss, or event.
What Is Adjustment Disorder?
Adjustment Disorder (AD) 1 is a condition that is characterized by an extreme emotional response to a negative or stressful life event. It is a state of extreme distress and emotional distress experienced during the course of adapting to the stressful life event, significant life changes, a serious physical illness, or the possibility of a serious illness. An individual with this condition lacks the ability to develop coping mechanisms to face the negative or positive circumstances that life presents. The inability to cope with stressful situations poses one or more severe psychological symptoms and sometimes even physical symptoms. A 2015 study 2 laid out there are four accessory symptoms associated with this condition that includes avoidance, depression, impulsivity, and anxiety along with other core symptoms.
The International Classification of Disorders (ICD 10) classified this disorder under the category of “reaction to severe stress and adjustment disorders”. The Mental Health Diagnostic System 3 changed the name of “adjustment disorder” to “stress response syndrome”. Since people with this condition often show symptoms of clinical depression such as tearfulness, feelings of hopelessness, loss of interest in activities, it is sometimes informally referred to as “situational depression”. Diagnosis of this condition is quite common. Adult women are diagnosed twice as often as men. The presence of a casual stressor is essential for diagnosing this condition.
People who are exposed to repeated trauma are at increased risk of developing this condition. Age can be a factor due to young children having fewer coping resources than adults. Sometimes doctors prescribe medications for depression or anxiety to ease the symptoms of the condition. Treatment may not be required unless levels of risk or distress are high. It may require treatment if it lasts more or less than six months. The stress-related disturbance experienced by the individual may not be related to a pre-existing mental disorder. This condition is different from anxiety disorder since it lacks the presence of the stressor. On the other hand, post-traumatic disorder and acute stress disorder is usually associated with a more intense stressor. Research 4 has identified that stressors associated with this condition also include traumatic events such as exposure to a near-death experience, or being threatened with death as well as non-traumatic events such as interpersonal conflicts, death of a loved one, or unemployment. A 2013 study 5 found that “failure to adapt” triggers stress responses that result in significant impairment in social, interpersonal, occupational, educational, or other areas of functioning.
Adjustment disorder can sometimes develop into extreme mental disorders such as major depressive disorder, anxiety disorders, or substance abuse. A 2017 study 6 showed the prevalence rate of this condition was 11.5%.
Adjustment Disorder At A Glance
- Adjustment Disorder (stress response syndrome) is a condition that is characterized by an extreme emotional response to a negative or stressful life event.
- People who are exposed to repeated trauma are at increased risk of developing this condition.
- Symptoms of this condition start to display within three months of the stressful event and lasts no longer than six months after the end of the event.
- Stressful situations whether positive or negative may contribute to the risk of developing this disorder.
- The primary method of treatment for this disorder is therapy.
- It is important to understand that developing healthy coping mechanisms is an essential aspect of human life.
Signs And Symptoms
The signs and symptoms can depend on the severity of the circumstance or the individual concerned. They tend to experience more stress than what is normally expected from that stressful situation. The signs and symptoms of Adjustment disorder include:
1. Psychological Symptoms
The psychological symptoms include:
- Rebellious or impulsive acts
- Feeling sad or hopeless
- Not enjoying the things they usually enjoy
- Crying frequently
- Jittery or stressed out
- Lack of concentration
- Feeling overwhelmed
- Suicidal thoughts and tendencies 7
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2. Physical Symptoms
- Sleeping issues or insomnia
- Lack of appetite
- Difficulty functioning in day to day activities
- Socially withdrawn
- Avoiding important tasks such as going to work or paying bills
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Symptoms of this condition start to display within three months of the stressful event and lasts no longer than six months after the end of the event. Persistent or chronic adjustment disorders can continue for more than six months.
Types Of Adjustment Disorder
There are six types of adjustment disorders that a person may experience. Each has its own symptoms. They are as follows:
1. With Depressed Mood
People who are diagnosed with adjustment disorder with depressed mood 8 usually experience symptoms such as feelings of sadness or hopelessness. They may also cry for not being able to cope with stressful situations. They may also no longer enjoy activities that they used to enjoy.
2. With Anxiety
People with this condition experience extreme anxiety, feeling overwhelmed and worried. They may also experience a lack of concentration and memory. For children, this disorder is usually diagnosed with separation anxiety from parents.
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3. With Anxiety and Depressed Mood
Individuals suffering from this type of adjustment disorder experience both symptoms of depression and anxiety.
4. With Disturbance of Conduct
Symptoms of this kind usually include behavioral issues such as reckless driving, starting fights, or misbehaving with other people. Teens suffering from this condition may steal or vandalize property. They may also start missing school or misbehaving with teachers.
5. With Mixed Disturbance of Emotions and Conduct
Symptoms for anxiety disorder with mixed disturbance of emotions and conduct 9 include depression, anxiety, and behavioral issues.
People who are diagnosed with this type have symptoms that aren’t associated with the other types. They are often physical symptoms or problems with friends, family, or work.
Causes And Risk Factors Of Adjustment Disorder
Stressful situations whether positive or negative may contribute to the risk of developing this disorder. They include:
1. Adult Risk Factors
- Divorce or marital problems
- Genetic Factors
- Relationship or interpersonal problems
- Situational changes such as retirement, having a baby, or going away to school
- Adverse situations such as job loss, loss of a loved one, or having financial issues
- Issues at school or work
- Life-threatening experiences such as physical assault, combat, or natural disaster
- Medical illness or living in a high crime rate neighborhood
- Experiencing significant stress during childhood
- Having associated mental health problems
- Having numerous and extreme life circumstances happening at the same time
- Body pain or soreness
- Muscle twitches or trembling
2. Adolescence and Childhood Risk Factors
- Family conflict or parental separation
- School issues or changing schools
- Sexuality issues
- Death, illness, or trauma in the family
Diagnosis Of Adjustment Disorder
Diagnosis is usually based on the identification of major life events, the symptoms that the individual is experiencing associated with the event, and how it impacts the ability to function in day to day activities. The doctor can ask several questions on medical and mental history and social history. The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has laid out the diagnostic criteria for this condition. they are:
- Having emotional or behavioral symptoms within three months of the stressful event
- The presence of an extremely stressful life event
- Experiencing more stress than normally expected in response to a stressful event
- The stress causes significant problems at work or at school
- The symptoms are not a result of any other mental disorder
- Symptoms must last for more than six months
The questions that the doctor may ask are as follows:
- What are your symptoms?
- What are the major changes that have occurred in your life that are positive and negative?
- When did you first notice the symptoms?
- Have you tried any coping strategies for these changes?
- How often do you feel upset or depressed?
- Do you have suicidal thoughts?
- Do you find it difficult to finish simple tasks at home, work, or school that were easily doable before?
- Do you avoid family or social events?
- Are you having trouble sleeping?
- Did you make any impulsive decisions or engaged in any reckless behavior?
- Do you drink alcohol or recreational drugs?
After evaluation, the doctor will devise a treatment plan to ease the symptoms of this disorder.
Treatment For Adjustment Disorder
The primary method of treatment for this disorder is therapy. The doctor may recommend a mental health professional to conclude a correct diagnosis. Therapy can help to return to the normal level of functioning. Some of the treatment methods include:
1. Cognitive Behavioral Therapy
This therapy involves evaluating the negative thoughts and patterns that govern the behavior of the individual. These thoughts are then altered with positive ones to attain the desired goal. The therapist offers emotional support and can assist in understanding the situation that is triggering the symptoms. They can also help develop coping skills for any future stressful situations. A 2019 study 10 confirmed the effectiveness of CBT in treating patients with this disorder.
2. Family and Group Therapy
This therapy involves one or more therapists working with a group of individuals at the same time. Group therapy 11 can help improve mood and ease the symptoms associated with this disorder. The individuals involved in the group come together to share their experiences and discuss coping mechanisms for their stressful situations. It is targeted at a specific problem such as anxiety or depression. There are support groups specific to adjustment disorders where an individual can engage in to find comfort and balance.
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3. Interpersonal Psychotherapy
This therapy is focused on treating mood disorders. It is based on the idea that personal relationships or situations are the epicentres of psychological disorders. The therapist helps the patient to manage the stressful situation in a healthy manner so it doesn’t mentally affect them.
Medications may also be prescribed to treat patients with adjustment disorders. These are used to ease the associated symptoms of this disorder such as insomnia, depression, or anxiety. The patient may require medications only for a few months. It is recommended to not stop taking medications without consulting the doctor. This is because there can be side effects of stopping medications abruptly. Some of the medications can include
- Benzodiazepines such as lorazepam (Ativan) and alprazolam (Xanax)
- Non benzodiazepines anxiolytics such as gabapentin (Neurontin)
- Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) such as sertraline (Zoloft) or venlafaxine (Effexor XR)
Prevention Of Adjustment Disorder
There is no specified way to prevent this disorder. It is essential to learn how to cope with difficult situations. Learning to be resilient is an important trait that everyone should possess. You can do this by:
- Developing a strong network of friends or people who support you
- Looking for positivity in difficult situations
- Living healthily
- Establishing good self-esteem
- Practicing mindfulness
- Learning from past experiences
- Recognize and develop your strengths
- Working and improving on your weaknesses
- Facing your fears and accepting challenges
- Following a healthy sleep cycle
Recovery From Adjustment Disorder
Stressful events are beyond our control. However, it is important to understand that developing healthy coping mechanisms is an essential aspect of human life. Having strong family support is crucial in such circumstances because they can help you work through it. With therapy and self-determination, it is possible to recover and lead a healthy life.References:
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- Glaesmer, H., Romppel, M., Brähler, E., Hinz, A., & Maercker, A. (2015). Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation. Psychiatry research, 229(3), 940–948. https://doi.org/10.1016/j.psychres.2015.07.010
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- Baumeister, Harald & Maercker, Andreas & Casey, Patricia. (2009). Adjustment Disorder with Depressed Mood. Psychopathology. 42. 10.5167/uzh-31723.
- Jones, C. (2018). Adjustment disorder with mixed disturbance of emotion and conduct. In N. J. Pelling & L. J. Burton (Eds.), The elements of psychological case report writing in Australia (pp. 173–182). Routledge/Taylor & Francis Group.
- Quero, S., Molés, M., Campos, D., Andreu-Mateu, S., Baños, R. M., & Botella, C. (2019). An adaptive virtual reality system for the treatment of adjustment disorder and complicated grief: 1-year follow-up efficacy data. Clinical psychology & psychotherapy, 26(2), 204–217. https://doi.org/10.1002/cpp.2342
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