Mental Health

Adjustment Disorders

FAQ's Adjustment Disorders

Adjustment disorders are extremely common. A psychological adjustment disorder is characterized by the development of emotional and/or behavioral symptoms (such as, depression, anxiety, school behavior problems, fighting, work problems, academic problems, social conflicts or withdrawal, or physical complaints), in response to a specific stressor or stressors within your environment.

To put it simply, if you are experiencing significant stress, and because of that stress you develop psychological symptoms that are greater than what might be expected, given the stress, and this causes impairment in some major life functioning, then you have an adjustment disorder. Major life functioning would include school adjustment, work adjustment, social adjustment, legal difficulties, family adjustment or physical health.

Stressors can be almost anything, such as the ending of a relationship, or a marriage, being terminated from your job, a family member developing a serious illness, being forced to relocate by your job, natural disasters such as hurricanes or floods, living in a crime-ridden area, becoming a crime victim, becoming a parent, getting married, etc. These events cause some stress in almost everyone.

However, when stress causes clinically significant symptoms to develop, or interferes with your ability to cope with ongoing life management tasks, then you may have an adjustment disorder.

There are different types of adjustment disorders, according to the symptoms that develop. These include: with depressed mood; with anxiety; with mixed emotional response; with conduct disturbance; with mixed emotional problems and conduct disturbance; and unspecified.

Some other factors distinguish psychological adjustment disorders from everyday stress and other emotional problems. First, if another psychological problem can be diagnosed that accounts for the symptoms, then it is not an adjustment problem. For example, if a person loses their job and becomes extremely depressed, then Major Depression would be the diagnosis, not an Adjustment Disorder, with depressed mood. Second, the symptoms should go away within six months, once the stressor has disappeared. If a person lost their job two years ago, and is still depressed about it, even though they have found another comparable job, then there is another problem besides an adjustment disorder. –
Adjustment Disorder

What is an adjustment disorder and how does it occur?

There are six major adjustment disorders:

* Adjustment disorder with depressed mood;
* Adjustment disorder with anxiety;
* Adjustment disorder with mixed anxiety and depressed mood;
* Adjustment disorder with disturbance of conduct;
* Adjustment disorder with mixed disturbance of emotions and conduct;
* Adjustment disorder unspecified.

What are the characteristics associated with an adjustment disorder?

A person with adjustment disorder often experiences feelings of depression or anxiety or combined depression and anxiety. As a result, that person may act out behaviorally against the “rules and regulations” of family, work, or society. In some people, an adjustment disorder may manifest itself in such behaviors as skipping school, unexpected fighting, recklessness, or legal problems. Other people, however, instead of acting out, may tend to withdraw socially and isolate themselves during their adjustment problems. Still others may not experience behavioral disturbances, but will begin to suffer from physical illness. If someone is already suffering from a medical illness, that condition may worsen during the time of the adjustment disorder. People in the midst of adjustment disorders often do poorly in school or at work. Very commonly they begin to have more difficulty in their close, personal relationships.

Listed below are some of the characteristics associated with adjustment disorders:

1. A person with an adjustment disorder with depressed mood may have mostly a depressed mood, hopeless feelings, and crying spells.
2. A person with an adjustment disorder with anxiety would experience anxious feelings, nervousness, and worry.
3. Someone with an adjustment disorder with mixed anxiety and depressed mood would, obviously, have a mixture of anxious and depressed feelings.
4. An individual with an adjustment disorder with disturbance of conduct may act out inappropriately. This person may act out against society, skip school, or begin to have trouble with the police.
5. A person with an adjustment disorder with mixed disturbance of emotions and conduct would have a mixture of emotional and conduct problems.

Do adjustment disorders affect males, females, or both?

In the United States the same number of males and females experience the various adjustment disorders.

At what age can an adjustment disorder appear?

Adjustment disorders can occur at any age. People are particularly vulnerable during normal transitional periods such as adolescence, mid-life, and late life.

How often does adjustment disorder appear in the community?

Adjustment disorder is very common in the United States. More than five percent (5%) of all persons seen in clinical, outpatient mental health settings have some type of adjustment disorder.

How is an adjustment disorder diagnosed?

A mental health professional makes a diagnosis of an adjustment disorder by taking a careful personal history from the client/patient. It is important to the therapist to learn the details that surround the stressful event or events in that person’s life. No laboratory tests are required to make a diagnosis of adjustment disorder nor are there any physical conditions that must be met. However, it is very important for the therapist not to overlook a physical illness that might mimic or contribute to a psychological disorder. If there is any question whether the individual might have a physical problem, the mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as a part of the physical workup.

What happens to a person with an adjustment disorder?

The conditions associated with adjustment disorder develop within three months of the beginning of the stressful problem. An adjustment disorder usually lasts no longer than three to six months. The condition may persist, however, if an individual is suffering from chronic stress such as that caused by an illness, a difficult relationship, or worsening financial problems.

How is an adjustment disorder treated?

Therapy can be very helpful to lessen or alleviate ongoing symptoms of adjustment disorder before they become disabling.

Group therapy can be useful to individuals who are enduring similar stress.

In some situations the use of prescription medications can be very useful to ease the depression or the anxiety associated with adjustment disorder.

What can people do if they need help?

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.

Developed by John L. Miller, MD

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