What is Adjustment Disorder?

Change

Heraclitus, a Greek philosopher, once said that “change is the only constant in life.”  Isn’t that the truth.  The only thing that you can bet money on is that things will periodically change in life.  Babies are born, people pass on, people switch jobs, move locations, marry, or break up.  Family systems change, social circles shift, and work structures reorganize.  Whereas change is constant, a person’s reaction to change is certainly less so.  Some people welcome change with open arms, while others avoid it like the plague.  Some are accepting and open to change, while others are resistant and closed off to it.  Adjustment to change can either go smoothly, or can be a little harder for some.

Adjustment disorder is a mental health diagnosis precipitated by situations that cause stress.  A person with adjustment disorder experiences a significant amount of distress from a stressful life circumstance.  The distress is more excessive than what would be expected and causes difficulties in a person’s day to day functioning.  Most people adjust to a stressor within several months, but someone with adjustment disorder continues to experience distressing symptoms for a much longer period of time, which may lead to anxiety and depression.

The symptoms of adjustment disorder vary widely from person to person and depend on the type of stressor involved.  Some symptoms of adjustment disorder can include feeling sad and hopeless, tearfulness, and disrupted sleeping and eating patterns. Other signs can include anxiety, trouble focusing and concentrating, isolation, and withdrawal from activities that were once enjoyable.  Symptoms usually begin within a three month period of time and will conclude about 6 months after the stressful circumstance is over.  However, some adjustment disorders may last longer, especially if the stressor is ongoing.

Most individuals are able to cope with stressful situations and adjust to them accordingly.  However, someone with adjustment disorder lacks the coping mechanisms needed to effectively handle the change.  Symptoms of adjustment disorder tend to alleviate when the stressor subsides, but may linger for longer periods of time or be triggered by another event.

Adjustment disorder is always prompted by a stressful circumstance, but heredity, coping skills, personality, and temperament all have an impact on whether an adjustment disorder will develop.  A diagnosis of adjustment disorder is made when there is a precipitating stressor, when reactions to the stressor are more excessive than what is normally expected, and when the reactions negatively impact a person’s ability to function at home, work, or school. 

Diagnostic criteria in the DSM-5 includes the development of symptoms within 3 months of a stressful circumstance, disrupted daily functioning, enhanced reactions to stress, and when symptoms are not the result of another mental health disorder or the normal grieving process.  The DSM-5 outlines 6 types of adjustment disorders including adjustment disorder with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, and unspecified.  The length of time that symptoms are present will dictate whether the adjustment disorder is diagnosed as acute or chronic. 

Treatment for adjustment disorders can include psychotherapy, medication, or a combination of both.  Therapy can offer emotional support, help a person to process an event, and provides new coping skills for symptom management.  Medications such as antidepressants or anti-anxiety medications can provide extra support for those suffering from severe symptoms of anxiety and depression.

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Unfortunately, Heraclitus was right—change is constant.  Philosophers always seem to point out problems without directing us to the solutions for them.  Too bad Heraclitus had no other words of wisdom about how to gracefully handle change.  His words could have been a constant for us amidst a lifetime of changes.