Adjustment Disorders

Adjustment disorders

An adjustment disorder is a type of stress-related mental illness. You may feel anxious or depressed, or even have thoughts of suicide. You may not be able to go about some of your daily routines, such as work or seeing friends. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences.

You don’t have to tough it out on your own, though. Treatment of an adjustment disorder may help you regain your emotional footing. Most adults get better within just a few months, although teenagers may struggle longer. Treatment may also help prevent an adjustment disorder from becoming a more serious problem.

 

Symptoms

The signs and symptoms of adjustment disorders vary from person to person. The symptoms you have may be very different from those of someone else with an adjustment disorder. But for everyone, symptoms of an adjustment disorder begin within three months of a stressful event in your life.

 

Emotional symptoms of adjustment disorders
Signs and symptoms of adjustment disorder may affect how you feel and think about yourself or life, including:

  • · Sadness
  • · Hopelessness
  • · Lack of enjoyment
  • · Crying spells
  • · Nervousness
  • · Thoughts of suicide
  • · Anxiety
  • · Worry
  • · Desperation
  • · Trouble sleeping
  • · Difficulty concentrating
  • · Feeling overwhelmed

 

Behavioral symptoms of adjustment disorders
Signs and symptoms of adjustment disorder may affect your actions or behavior, such as:

  • · Fighting
  • · Reckless driving
  • · Ignoring bills
  • · Avoiding family or friends
  • · Poor school or work performance
  • · Skipping school
  • · Vandalism

 

Length of symptoms
How long you have symptoms of an adjustment disorder also can vary:

  • · Six months or less (acute). In these cases, symptoms may go away on their own, especially if you actively follow self-care measures.
  • Longer than six months (chronic). In these cases, symptoms continue to bother you and disrupt your life. Professional treatment can help symptoms improve and prevent the condition from continuing to get worse

Causes

People of all ages are affected by adjustment disorders. Among children and teenagers, both boys and girls have about the same chance of having adjustment disorder. Among adults, women are twice as likely as men to have adjustment disorder. But researchers are still trying to figure out what causes adjustment disorders. As with other mental disorders, the cause is likely complex and may involve genetics, your life experiences, your temperament and even changes in the natural chemicals in the brain.

 

Risk factors

Although researchers don’t know exactly what causes adjustment disorders, they do know some of the risk factors involved, or the things that make you more likely to have an adjustment disorder.

 

Stressful events
One or more stressful life events may put you at risk of developing adjustment disorder. It may involve almost any type of stressful event in your life. Both positive and negative events can cause extreme stress. Some common examples include:

  • · Being diagnosed with a serious illness
  • · Problems in school
  • · Divorce or relationship breakup
  • · Job loss
  • · Having a baby
  • · Financial problems
  • · Physical assault
  • · Surviving a disaster
  • · Retirement
  • · Death of a loved one
  • · Going away to school

In some cases, people who face an ongoing stressful situation — such as living in a crime-ridden neighborhood — can reach a breaking point and develop an adjustment disorder.

 

Your life experiences
If you generally don’t cope well with change or you don’t have a strong support system, you may be more likely to have an extreme reaction to a stressful event.

Some studies also suggest that your risk of an adjustment disorder is higher if you experienced stress in early childhood. Overprotective or abusive parenting, family disruptions and frequent moves early in life may make you feel like you’re unable to control events in your life. When difficulties then arise, you may have trouble coping.

Other risk factors may include:

  • · Other mental health problems
  • · Exposure to wars or violence
  • · Difficult life circumstances

 

Lifestyle and home remedies

When you face a stressful event or major life change, you can take some steps to care for your emotional well-being. Do what works for you. Some examples include:

  • · Talking things over with caring family and friends
  • · Trying to keep eating a healthy diet
  • · Sticking to a regular sleep routine
  • · Getting regular physical activity
  • · Engaging in a hobby you enjoy
  • · Finding a support group geared toward your situation
  • · Finding support from a faith community

If it’s your child who’s having difficulty adjusting, you can help by:

  • · Offering encouragement to talk about his or her feelings
  • · Offering support and understanding
  • · Reassuring your child that such reactions are common
  • · Touching base with your child’s teacher to check on progress or problems at school
  • · Letting your child make simple decisions, such as what to eat for dinner or which movie to watch

If you use these kinds of self-care steps but they don’t seem to be helping, be sure to talk to your health care provider.

 

Prevention

There are no guaranteed ways to prevent adjustment disorder. But developing healthy coping skills and learning to be resilient may help you during times of high stress. Resilience is the ability to adapt well to stress, adversity, trauma or tragedy. Some of the ways you can improve your resilience are:

  • · Having a good support network
  • · Seeking out humor or laughter
  • · Living a healthy lifestyle
  • · Thinking positively about yourself

If you know that a stressful situation is coming up — such as a move or retirement — call on your inner strength in advance. Remind yourself that you can get through it. Use stress management and coping skills, such as exercise, yoga, meditation or even a night at the movies with friends. In addition, consider checking in with your health care or mental health care provider to review healthy ways to manage your stress.

Symptoms

Complications

Most people with adjustment disorder get better within six months and don’t have long-term complications. However, people who also have another mental health disorder, a substance abuse problem or a chronic adjustment disorder are more likely to have long-term mental health problems, which may include:

  • · Depression
  • · Alcohol and drug addiction
  • · Suicidal thoughts and behavior

Compared with adults, teenagers with adjustment disorder — especially chronic adjustment disorder marked by behavior problems — are at significantly increased risk of long-term problems. In addition to depression, substance abuse and suicidal behavior, teenagers with adjustment disorder are at risk of developing psychiatric illnesses such as:

  • · Schizophrenia
  • · Bipolar disorder
  • · Antisocial personality disorder

 

Tests and diagnosis

Adjustment disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with adjustment disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

For an adjustment disorder to be diagnosed, several criteria must be met, including:

  • · Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life
  • · Experiencing distress that is in excess of what would normally be expected in response to the stressor or that causes significant problems in your relationships, at work or at school
  • · An improvement of symptoms within six months of the stressful event coming to an end

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There are six major adjustment disorders:

 

Your health care provider may ask detailed questions about how you feel and how you spend your time. This will help him or her pinpoint which specific type of adjustment disorder you have. There are six main types of adjustment disorders. Although they’re all related, each type of adjustment disorder has certain signs and symptoms.

 

The six types of adjustment disorder are:

  • · Adjustment disorder with depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, and a lack of pleasure in the things you used to enjoy.
  • · Adjustment disorder with anxiety. Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones.
  • · Adjustment disorder with mixed anxiety and depressed mood. Symptoms include a mix of depression and anxiety.
  • · Adjustment disorder with disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting, reckless driving or ignoring your bills. Youngsters may skip school or vandalize property.
  • · Adjustment disorder with mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety as well as behavioral problems.
  • · Adjustment disorder unspecified. Symptoms don’t fit the other types of adjustment disorders but often include physical problems, problems with family or friends, or work or school problems.

 

 

 

 

References

  • ·Adjustment disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Feb. 17, 2009.
  • ·Strain JJ, et al. Adjustment disorders. In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed Feb. 17, 2009.
  • ·Adjustment disorders. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/supportivecare/adjustment/Patient/page4. Accessed Feb. 17, 2009.
  • ·Adjustment disorders. In: Sadock BJ, et al. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 8th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2005. http://www.psychiatryonline.com. Accessed Feb. 17, 2009.
  • ·Ahmed SM, et al. Psychosocial influences on health. In: Rakel RE. Rakel: Textbook of Family Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/1209963843/0/1481/1.html?tocnode=53391787&fromURL=1.html. Accessed Feb. 17, 2009.
  • ·Clarkin JF, et al. The role of psychiatric measures in assessment and treatment. In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed Feb. 17, 2009.
  • ·Bray JH, et al. The family’s influence on health. In: Rakel RE. Rakel: Textbook of Family Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/120920914-7/0/1481/25.html?tocnode=53391850&fromURL=25.html#4-u1.0-B978-1-4160-2467-5..50005-1–cesec2_64. Accessed Feb. 17, 2009.

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