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Adjustment Disorder

Adjustment Disorder

Life is stressful. Many of these stressors are obvious and easy to identify - death (of spouse, loved one or friend), divorce, marital separation, jail term, personal injury or illness, being fired or other problems in career/occupation, legal or financial trouble, family conflict, etc. But there are many less obvious stressors we encounter every day that have smoothly and surreptitiously integrated themselves into our regular daily routine. Some of these feel so normal that they are practically invisible.
  • Commitments (towards job/profession, to our children, spouses, our home, community, and more…)
  • Procrastination – postponing stuffs to pile up stresses us out
  • Disorganization – visual clutter making it difficult to find stuff we need stresses us out
  • Being late – then having to rush to get ready, rush to get there - always stresses us out
  • Exerting control over our environment - is a sure way to get stressed out
  • Multitasking – actuality slows us down from actually focusing on a task and completing it, stressing us out in the meantime
  • Difficult people – bosses, co-workers, customers, friends, family, etc.
  • Over-scheduling and multiple to-do lists
  • Fast paced lifestyle
  • 9-5 Schedule Work – your absolute biggest stressor
  • Unhealthy lifestyle – not enough exercise and unhealthy diet
  • Negative thinking
These everyday behaviors and situations (which we often accept as by-products of an otherwise normal lifestyle) are notorious for accumulating stress, the effects of which can often be greater than we can handle. These effects have names like anxiety, depression, and panic attack. But while stressful events and stress (the body’s response to stressors) may break down our mental resiliency, shaping, even distorting our ability to handle to our environment, these events themselves are not necessarily synonymous with the onset of mental disease. Rather it is the kind and manner of one’s coping response to stressful events that reveal the diagnosis of adjustment disorder.

What is Adjustment Disorder and What are the Symptoms

In basic terms, Adjustment Disorder represents a breakdown of our psychological immune system to the effects of environmental stressors (e.g., medical illness, marital problems, loss of a job, financial problems, self-related conflicts). The result is a combination of emotional and behavioral symptoms that cause greater than expected distress, including -
  1. Depressive symptoms (e.g., feeling sad, crying, feeling of hopelessness)
  2. Anxiety symptoms (e.g., nervousness, worry, jitteriness)
  3. Significant impairment in social and/or occupational functioning
In adjustment disorder, emotional and behavioral symptoms develop within three months, and must be significantly beyond what would be generally expected. While there are no specific symptoms for this disorder, any combination of behavioral or emotional symptoms that occur in association with a stressor may qualify.

The nature of the symptoms is described by a variety of adjustment disorder subtypes, including ‘with depressed mood’, ‘with anxiety’, and ‘with mixed anxiety and depressed mood’. Although this diagnosis lacks rigid specifics, its treatment is no less challenging or less important.

The type of adjustment disorder with depressed mood is characterized by symptoms of depression, such as sad mood, loss of interest in activities, change in appetite, sleep disturbances, and fatigue. People with this type of adjustment disorder may also have difficulty concentrating and making decisions.
 
The type of adjustment disorder with anxiety is characterized by symptoms of anxiety, such as restlessness, irritability, muscle tension, and difficulty sleeping. People with this type of adjustment disorder may also have difficulty concentrating and may feel on edge.

Although adjustment disorder with anxiety is not classified as a true anxiety disorder, it is a frequently diagnosed form of anxiety. The term adjustment disorder with anxiety is used when excessive and harmful anxiety occurs in response to a recent, identifiable stressor. This type of reactive anxiety improves or resolves when the stressor ends, or when the patient reaches a new level of adaptation or adjustment. By definition, this type of anxiety must begin within three months of the causal stressor and must last no longer than six months after the stressor is resolved.
 
The type of adjustment disorder with mixed anxiety and depressed mood is characterized by symptoms of both anxiety and depression. This includes symptoms such as sad mood, loss of interest in activities, change in appetite, sleep disturbances, fatigue, restlessness, irritability, muscle tension, and difficulty sleeping. People with this type of adjustment disorder may also have difficulty concentrating and making decisions.

Adjustment Disorder Treatment

There are two approaches to treatment of adjustment disorders. In one, the stressor has to be identified, described, and shared with the individual. Plans must be made to mitigate the situation, if possible. The abnormal response may be lessened if the stressor can be eliminated or reduced. Studies have shown that in the medically ill the most common stressor is the medical illness itself, and the adjustment disorder may abate when the medical illness improves or a new level of dealing with the situation is reached. 

The other approach to treatment is to provide intervention for the symptoms themselves, despite the fact that it is not a specific anxiety disorder, the associated impact on life and wellbeing requires that symptoms be treated with similar treatments. This may include therapy, prescription anti-depressants or anxiety deterrents, or a combination of the two.

Therapy for adjustment disorders is intended to reduce the effects of the stressor, enhance the coping of the stressor that cannot be reduced or removed, and establish a mental state and support system to maximize adapting to the situation overall. Therapy can involve any one of several approaches, including behavioral treatment, interpersonal therapy, or counselling.

While adjustment disorder with anxiety may be an imprecise and general diagnosis, the effect of the anxiety on the patient is no less difficult. With proper support and treatment, as well as resolution of the stressor when at all possible, most incidences of adjustment disorder will resolve within six months of the stress that caused it.

Coping Skills for Adjustment Disorder

Therapeutic intervention is almost always the most often and the preferred treatment for Adjustment Disorder. Alternatively, other choices include cool, self-help, programs and techniques that can have good results in dealing with adjustment stress-related disorders like anxiety, depression, and panic.

BUT YOU WANT HELP NOW... So here is a list of interventions and strategies that combat the debilitating effects of stressful events that can lead to Adjustment Disorder. This list represents a clinically-effective, easy-to-follow, time-honored recipe that you can use right now to help alleviate symptoms of anxiety, depression, and negative self-feelings. The key to the success of these powerful strategies in treating symptoms is that they are “action oriented” and, thus, change your symptom-related behavior right away. Emphasizing “doing” rather than “thinking” is one of, if not the most important aspects to any successful psychological treatment plan. Follow the suggestions below and feel better soon:
  1. Recognize /adjust negative expectations: Make a list of all the expectations you have about yourself that make life difficult. Change each of these into one that makes your life more bearable. Example: change “I am always afraid of the future” into “The future is what I make it.” Rehearse this list, out loud, daily.
  2. Widen self-definition: Sense of self should not come primarily from your career or how much money you make. Expand your behavioral scope/repertoire to include activities that speak to other parts of you: Sign up for dance class, a book group, a painting class, theater, cooking class, volunteer for an organization you admire, do some community service, do more exercise... essentially put more eggs in more baskets. The value here is that if one basket breaks, you’ve got a bunch more.
  3. All things are possible: An important mantra to rehearse out loud... often (a few times a day) which can ward off behavioral inhibition, low frustration, tolerance and disappointment. Post this as a sign... in colorful large letters... on your refrigerator, your bathroom mirror, your bulletin board.
  4. If you persevere you will succeed: Similar to #3: say out loud often and rehearse again and again, post in prominent locations.
  5. Stay out of the future/past; be in the present: A common pitfall that people slip into is failure to stay at present. If you worry about an uncertain future (which, by definition is always uncertain) or concern yourself about a regretful past, you achieve two negative results: (1) you perpetuate an anxious process, and (2) you destroy your ability to enjoy the present.
  6. Think less; do more: Self-explanatory; this is the critical basis of all action oriented interventions. Another version of this little instruction: 'Don’t think, just do'. Remember, this is an 'action oriented' intervention. Keep active.
  7. Stay out of your head: Your head is a dangerous place to be, particularly if you’re depressed, anxious, self-recriminatory. Keep busy with activities that expand and extend your self-definition, as in #2 above.
  8. The joy comes from the doing: No recipe or formula for happiness can possibly work unless you are doing something you enjoy. Think about it...!
  9. Make a plan; work from the plan: Based on #7 above, this idea minimizes random, unstructured thinking (the dangerous, anxiety-provoking kind) - focusing instead on thinking dedicated to organizational activity (the kind which reduces anxiety).
  10. Take a step back when you are frustrated, overwhelmed, stymied by a situation; come back when cooled off: Self-explanatory, anxiety-reducing tactic.
  11. People make mistakes - it’s what you do about it that counts: Action oriented idea that allows and facilitates behavioral recovery following behavioral inhibition/withdrawal related to error.
  12. Proper sleep, healthy diet and regular exercise: Three critically important components that figure prominently into any plan for overall mental and physical well-being.

Adjustment Disorder: Don’t Just Sit There, Do Something.


Adjustment disorder (AD) is a crippling, maladaptive behavioral inhibition response to stressful life events. One of the most proven effective ways to combat AD is to adopt an active approach to treatment; that is, training oneself to replace undesirable behaviors with healthier behavioral patterns. Forget trying to find out why you behave the way you do, just change your behavior. Sound like a simple concept? It is... but, often quite difficult to execute, and requires dedication and commitment, even in the face of repeated disappointment and frustration. Remember, perceptions, thoughts, beliefs about oneself produced within the context of the AD condition are themselves the product of anxious and depressive thinking, and, thus, by definition, cannot be relied upon for accuracy or measure of reality.

In the spirit of this framework, try the following powerful strategic interventions for changing maladaptive behavior:
  1. Test drive new responses to existing situations that have become difficult to navigate or problematic. That is, imagine the difficult situation and then imagine a step-by-step process of facing and successfully dealing with it. Practice and rehearse the steps mentally. Ideally, when the situation arises in real life, you will draw on the rehearsed behavior to address and overcome it.
  2. Keep a diary and jot down, in detail, your thoughts, feelings, and actions when specific situations arise. The journal helps to make you aware of maladaptive thoughts and to show their consequences on behavior. Later, it can serve to demonstrate and reinforce positive behaviors.
  3. Engage a friend in role-playing exercises in which appropriate behaviors or responses to challenging situations are acted out.
  4. Pre-learn a relaxation response; you can find lots of approaches to doing this: e.g. Use meditation to alter your state of consciousness, or try a guided meditation, or learn ways (and there are more than one), of changing brainwave patterns. Then, with this learning firmly in place, imagine a situation you fear, while performing the well-learned relaxation response in order to cope with or counter-condition (i.e. teach a different task or behavior than the one that usually occurs in response to a situation) your fear reaction and eventually eliminate it altogether.
Employing the above strategies can make the all-important difference in the debilitating impact of AD and how long AD will hang around.

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