Diagnosis with a chronic illness, divorce, or moving to a new city are all major life changes that can lead to feelings of stress. Usually, these feelings of stress are transient and people adjust within a few months. However, some people find that they’re having trouble adapting to their changing lives. Adjustment disorder (AD) is a group of stress-related symptoms, including sadness, hopelessness, and feelings of being overwhelmed, that occur when a person is unable to properly cope or adjust to a major life stressor or event. These feelings of stress and other symptoms are disproportionate to the precipitating event.
Sometimes referred to as “situational depression,” adjustment disorder often has many of the symptoms of depressive disorders, such as crying spells, loss of interest in once-enjoyable activities, and feelings of sadness. However, unlike a depressive disorder, adjustment disorder is the result of the influence of an outside stressor and tends to resolve when the person begins to adjust to the situation. The changes in a person’s life become so overwhelming that they lead to serious consequences if left untreated.
There are six sub-types of adjustment disorder that feature a different focus of clinical symptoms. Subtypes of adjustment disorder include:
Adjustment disorder with depressed mood: The symptoms of depression, including loss of self-esteem, low mood, lack of motivation, are the primary complaint.
Adjustment disorder with anxious mood: The predominant symptomatology includes anxiety-related concerns such as excessive worry, feeling overwhelmed, and overarching negative view of possibilities.
Adjustment disorder with mixed anxiety and depressed mood: The symptomatology reflects a combination of depression and anxiety.
Adjustment disorder with disturbance of conduction: Dominating the symptoms are behaviors that break the norms of society or the rights of others such as substance abuse, outbursts of anger, and efforts to seek revenge on others.
Adjustment disorder mixed disturbance of conduct and emotions: The symptoms prevalent in this type of adjustment disorder include emotional symptoms and disturbances of conduct.
Adjustment disorder unspecified: This type of adjustment disorder features maladaptive responses to major life events that do not meet the criteria for other subtypes of adjustment disorder.
The length of time a person who has adjustment disorder experiences the symptoms may vary from person to person. Acute adjustment disorder occurs when a person experiences symptoms for six months or less, before resolution. Chronic adjustment disorder features symptoms longer than six months that cause major disruption in a person’s life. Many people erroneously think that adjustment disorder is less serious than other types of mental health disorders since it involves stress. Adjustment disorders impact a person’s whole life, leading them to suffer in every area of their functioning. Without prompt diagnosis and treatment, adjustment disorder can become a long-term, chronic condition.
The frequency with which adjustment disorder is diagnosed varies tremendously depending upon the population studied and assessment methods that are used. A number of studies have reported rates of adjustment disorder to be about 12% across a variety of populations; this number may be as high as 23% in clinical situations.
Causes and Risk Factors for Adjustment Disorder
Adjustment disorder impacts people differently at different ages and can occur at any age. The causes and risk factors for adjustment disorder likely include a complex interplay of genetic, environmental, and physical risk factors working together.
Common types of stressors that can trigger adjustment disorder include:
- Ending a relationship or marriage
- Losing or changing jobs
- Death of a loved one
- Developing a serious, chronic illness
- Being the victim of a crime
- Major life changes – getting married, having a baby
- Living through a natural disaster
- Other mental health disorders
- Lack of support system
- Difficult life circumstances
- Chronic stressors
- Traumatic events during childhood
- Physical or sexual abuse or assault
- Overprotective or abusive parenting as a child
- Family disruptions as a child
- Frequent moves in early life
Signs and Symptoms of Adjustment Disorder
The symptoms of adjustment disorder do change from person to person, often wildly enough that a diagnosis of adjustment disorder is challenging. The one constant characteristic of adjustment disorder is the symptoms appearing within a certain time period after a major, stressful life event.
- Frequent crying jags
- Fighting with other people
- Being unusually argumentative
- Ignoring bills and other financial obligations
- Avoiding friends, family, and loved ones
- Poor work or school performance
- Being late to work or school frequently
- Excessive absenteeism
- Vandalizing and destroying property
- Trouble eating
- Changes in sleeping patterns
- Difficulties making decisions
- Trouble concentrating
- Loss of self-esteem
- Feeling isolated, apart from others
- Inability to feel joy or pleasure
- Anxiety and nervousness
- Feeling “on-edge”
- Feelings of being overwhelmed
- Thoughts of suicide
Effects of Adjustment Disorder
Left untreated, the effects of adjustment disorder can severely impact a person’s life. Children and teens most especially face long-term complications of adjustment disorder. Some of the most common effects of untreated, chronic adjustment disorder include:
- Depressive disorder
- Anxiety disorders
- Drug or alcohol addiction
- Suicidal thoughts and behaviors
People who develop adjustment disorder may have another co-occurring mental health disorder. Common co-occurring disorders include:
- Bipolar disorder
- Antisocial personality disorder