What is Adjustment Disorder?

Often in stressful or traumatic situations, we find it difficult to cope with the stressors and display an emotionally or behaviorally strong response. When this response to psychosocial stressors is excessive or more intense that would be typically expected, and there is an inability to cope with it to an extent that causes significant levels of distress affecting functionality in daily tasks, work or school, relationships, presenting over a period of time, a mental health condition called Adjustment disorder occurs.

Adjustment disorder is a stress related mental disorder that is triggered by stressful life events or major changes including but not limited to death of a loved one, divorce, family or interpersonal conflict, relocation, moving to a new school or job, bullying, being fired, accidents and illnesses. These risk factors can predispose someone at risk for developing Adjustment disorder.

While major life changes are a part of life that everyone goes through, some people find it harder to adjust to them. This inability to adjust can cause one or more severe symptoms which can present in different ways such as excessive crying, feeling disinterest and low moods, behaving impulsively or recklessly, which are divided into six types of adjustment disorders as discussed below.

Adjustment disorder can occur in any age group, however it is found to be higher among children with a prevalence rate of 2.94%, affecting 34.4% of adolescents with the most common subtype as Adjustment disorder with depressed mood, as compared to adults having a estimated prevalence rate to be 1%-2%.

Adjustment disorder symptoms

Recognizing the symptoms of Adjustment disorder is important, which present differently in everyone and vary according to the type or form of Adjustment disorder. Symptoms usually occur during or after one has experienced a stressful event and generally include:

• Sadness, hopelessness, feeling trapped and/or a loss of interest
• Crying spells
• Anxiety, worrying, feeling nervous or stressed out
• Feeling irritable and experience mood fluctuation or mood swings
• Inability to concentrate or focus
• Social withdrawal or isolation
• Difficulty in sleeping, insomnia, changes in appetite
• Suicidal thoughts
• Rebellious or impulsive, risky behavior such as substance abuse
• Body pain, fatigue, muscle twitches or experiencing irregular heartbeats

Adjustment disorder in children

Adjustment disorders occur at all ages but it is quite common in children as compared to adults. Children with an Adjustment disorder find difficulty in coping with the feelings about the event and exhibit symptoms of anxiety, depression and behavioural problems. The symptoms often comprise of difficulty in sleeping, excessive crying, excessive clinginess, avoiding school, difficulty in maintaining interpersonal relationships with family, friends, acting out through temper tantrums, violent behaviour and anger outbursts.

Adjustment disorder comes in many forms, to understand the categorization of the variety of symptoms, we will look at types of Adjustment disorder.

Adjustment Disorder ICD-10 and DSM-5

ICD-10 (International Classification of Diseases, 10^th Revision) code for Adjustment disorder is F43.2 within the category of Reaction to severe stress and adjustment disorders. It is characterised by emotional or behavioural symptoms in response to a stressful event, with aninefficiency to deal with the triggering effect.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition) categorizes Adjustment disorder under Trauma- and Stressor- Related Disorders, defined as an emotional or behavior response to an identifiable stressor within three months of onset.

Both DSM-V and ICD-10 require the disorder to arise within a few months of the stressor, but the DSM-V specifies three months, additionally, both recognize the same subtypes of categorization.

Adjustment disorder is divided into these subtypes based on the symptoms in ICD-10 and DSM-5:

Adjustment disorder with depressed mood

• Mood fluctuations
• Feelings of hopelessness and helplessness

Adjustment disorder with anxiety

• Nervousness
• Worry
• Irritability and fear of separation

Adjustment disorder with mixed anxiety and depressed mood

• Combination of symptoms from both of the conditions are present

Adjustment disorder with disturbance of conduct

• Violation of the rights of others
• Violation of the society’s rules and regulations

Adjustment disorder with mixed disturbance of emotions and conduct

• Combination of symptoms from the above-mentioned subtypes are present

Adjustment disorder unspecified

• Reactions to stressful events may include behaviours like social withdrawal or inhibitions to normally expected activities (personal, social, emotional)

Treatment for Adjustment Disorder

There are a few treatment approaches when it comes to Adjustment disorder, mostly used in combination.

Adjustment disorder medications are sometimes used in its treatment, generally including antidepressants which are Selective Serotonin Reuptake Inhibitors (SSRIs) and Norepinephrine Reuptake Inhibitors (SNRIs). Anti-anxiety medications are also found to be effective in the treatment process which includes Benzodiazepines or alprazolam for anxiety and insomnia. An important note is that the medicines should not be stopped abruptly without the consultation of the health care professional because it might cause disturbing physical reactions.

The adjustment disorder treatment often includes a therapeutic intervention which is equally important for better prognosis. The common therapeutic approaches used in Adjustment disorders are-

1. Cognitive Behaviour Therapy (CBT) mainly focuses on identifying the negative thought patterns and behaviours contributing to anxiety and depressive mood.
2. Interpersonal Therapy or IPT (short-term psychotherapy treatment) focuses on improving the communication patterns required for interpersonal relationships and adaptability to social and personal changes in the relationships.
3. The third approach is Solution Focused Brief Therapy (SFBT) which aims at identifying solutions or immediate strategies to deal with the current situations.
4. Mindfulness based techniques are helpful to cope with Adjustment disorder because the mindfulness meditation, breathing techniques and other grounding techniques helps in reducing symptoms of depression, anxiety and other stressors.

If you or someone you know is struggling with Adjustment disorder symptoms, search for mental health professional services near me with North America Behavioral Health Servicesto seek professional help as early assessment and intervention for effective and proper treatment is essential that includes medication and therapy which leads to successful results and restores physical, psychological well-being.