Work problems, going away to school, an illness — any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an adjustment disorder.
An adjustment disorder is a type of stress-related mental illness. You may feel anxious or depressed, or even have thoughts of suicide. Your normal daily routines may feel overwhelming. 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. Adjustment disorder treatment — usually brief — is likely to help you regain your emotional footing.
Adjustment disorders symptoms vary from person to person. The symptoms you have may be 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:
- Lack of enjoyment
- Crying spells
- Anxiety, which may include separation anxiety
- Trouble sleeping
- Difficulty concentrating
- Feeling overwhelmed
- Thoughts of suicide
Behavioral symptoms of adjustment disorders
Signs and symptoms of adjustment disorder may affect your actions or behavior, such as:
- Reckless driving
- Ignoring bills
- Avoiding family or friends
- Performing poorly in school or at work
- Skipping school
- Vandalizing property
Length of symptoms
How long you have symptoms of an adjustment disorder also can vary:
- 6 months or less (acute). In these cases, symptoms should ease once the stressor is removed. Brief professional treatment may help symptoms disappear.
- More than 6 months (chronic). In these cases, symptoms continue to bother you and disrupt your life. Professional treatment may help symptoms improve and prevent the condition from continuing to get worse.
When to see a doctor
Sometimes the stressful change in your life goes away, and your symptoms of adjustment disorder get better because the stress has eased. But often, the stressful event remains a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again.
Talk to your doctor if you're having trouble getting through each day. You can get treatment to help you cope better with stressful events and feel better about life again.
If you have suicidal thoughts
If you or someone you know has thoughts of suicide, get help right away. Consider talking to your doctor, nurse, a mental health professional, a trusted family member or friend, or your faith leader.
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. Or call a suicide hot line number. In the United States, you can call the 24-hour National Suicide Prevention Lifeline at 800-273-8255 (toll-free) to talk with a trained counselor.
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.
Although the cause of adjustment disorders is unknown, some things make you more likely to have an adjustment disorder. Among children and teenagers, both boys and girls have about the same chance of having adjustment disorders. Among adults, women are twice as likely to be diagnosed with adjustment disorders.
One or more stressful life events may put you at risk of developing an 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
- 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.
Your risk of an adjustment disorder may be 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
Most adults 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:
- Alcohol and drug addiction
- Suicidal thoughts and behavior
Compared with adults, teenagers with adjustment disorder — especially chronic adjustment disorder marked by behavioral 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 disorders such as:
- Bipolar disorder
- Antisocial personality disorder
If you have symptoms of an adjustment disorder, make an appointment with your primary care doctor. While adjustment disorders resolve on their own in most cases, your doctor may be able to recommend coping strategies or treatments that help you feel better sooner.
What you can do
To prepare for your appointment, make a list of:
- Any symptoms you've been experiencing, and for how long
- Key personal information, including any major stresses or recent life changes, both positive and negative
- Medical information, including other physical or mental health conditions, and names and dosages of any medications or supplements you're taking
- Questions to ask your doctor so that you can make the most of your appointment
Ask a family member or friend to go with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
For adjustment disorder, some basic questions to ask your doctor include:
- What do you think is causing my symptoms?
- Are there any other possible causes?
- How will you determine my diagnosis?
- Is my condition likely temporary or long term (chronic)?
- Do you recommend treatment? If yes, with what approach?
- How soon do you expect my symptoms to improve?
- Should I see a mental health specialist?
- Do you recommend any temporary changes at home, work or school to help me recover?
- Should people at my work or school be made aware of my diagnosis?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
Don't hesitate to ask questions during your appointment anytime you don't understand something.
What to expect from your doctor
Be ready to answer your doctor's questions so you have time to focus on your priorities. Your doctor may ask:
- What are your symptoms?
- When did you or your loved ones first notice your symptoms?
- What major changes have recently occurred in your life, both positive and negative?
- Have you talked with friends or family about these changes?
- How often do you feel sad or depressed?
- Do you have thoughts of suicide?
- How often do you feel anxious or worried?
- Are you having trouble sleeping?
- Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you?
- Are you avoiding social or family events?
- Have you been having any problems at school or work?
- Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you?
- What other symptoms or behaviors are causing you or your loved ones distress?
- Do you drink alcohol or use illegal drugs? How often?
- Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?
Adjustment disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with adjustment disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, 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 more stress than would normally be expected in response to the stressor, or having stress that causes significant problems in your relationships, at work or at school — or having both of these criteria
- An improvement of symptoms within six months after the stressful event ends
- The symptoms are not the result of another diagnosis
Types of adjustment disorders
Your doctor may ask detailed questions about how you feel and how you spend your time. This will help pinpoint which type of adjustment disorder you have. There are six main types. Although they're all related, each type has certain signs and symptoms:
- Adjustment disorder with depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, and experiencing 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 or reckless driving. Youths 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.
Most people find treatment of adjustment disorder helpful, and they often need only brief treatment. Others may benefit from longer treatment. There are two main types of treatment for adjustment disorder — psychotherapy and medications.
The main treatment for adjustment disorders is psychotherapy, also called counseling or talk therapy. You may attend individual therapy, group therapy or family therapy. Therapy can provide emotional support and help you get back to your normal routine. It can also help you learn why the stressful event affected you so much. As you understand more about this connection, you can learn healthy coping skills to help you deal with other stressful events that may arise.
In some cases, medications may help, too. Medications can help with such symptoms as depression, anxiety and suicidal thoughts. Antidepressants and anti-anxiety medications are the medications most often used to treat adjustment disorders. As with therapy, you may need medications only for a few months, but don't stop taking any medication without talking with your doctor first. If stopped suddenly, some medications, such as certain antidepressants, may cause withdrawal symptoms.
When you face a stressful event or major life change, take steps to care for your emotional well-being. Talking about your feelings and asking for help is important to aid your recovery from adjustment disorder.
Do what works for you. For example:
- Talk things over with caring family and friends
- Try to keep eating a healthy diet
- Stick to a regular sleep routine
- Get regular physical activity
- Engage in a hobby you enjoy
- Find a support group geared toward your situation
- Find support from a faith community
If it's your child who's having difficulty adjusting, try gently encouraging him or her to talk about feelings. Many parents assume that talking about a difficult change, such as divorce, will make a child feel worse. But your child needs the opportunity to express feelings of grief and to hear your reassurance that you'll remain a constant source of love and support. Take these steps to help:
- Offer support and understanding
- Reassure your child that such reactions are common
- Ask your child's teacher to check on progress or problems at school
- Let 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, talk with your doctor for advice.
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
- Learning how to think 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. In addition, consider checking in with your doctor or mental health provider to review healthy ways to manage your stress.
April 02, 2014
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