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Adjustment disordersBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/adjustment-disorders/DS00584
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 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:
- Lack of enjoyment
- Crying spells
- Thoughts of suicide
- 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:
- 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 may go away on their own, especially if you actively follow self-care measures.
- More than 6 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.
When to see a doctor
Sometimes the stressful change in your life goes away, and your symptoms of adjustment disorder get better on their own. 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.
You may think that an adjustment disorder is less serious than other mental health problems because it involves stress, but that's not necessarily true. Adjustment disorders can affect your whole life. You may feel so overwhelmed, stressed and hopeless that you can't go about your normal daily activities. You may skip work or school, for instance, or not pay your bills. You may drive dangerously or pick fights.
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 or someone you love has suicidal thoughts, seek help immediately.
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 disorders. Among adults, women are twice as likely to have adjustment disorders. 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.
Although the cause of adjustment disorders is unknown, some things make you more likely to have an adjustment disorder.
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 illnesses such as:
- Bipolar disorder
- Antisocial personality disorder
Preparing for your appointment
If you have thoughts of suicide, go to an emergency room or call 911 or your local emergency number immediately.
If you have less urgent symptoms of an adjustment disorder, make an appointment with your family doctor. While adjustment disorders resolve on their own in most cases, your doctor may be able to recommend coping strategies or treatments that may help you feel better sooner.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms you've been experiencing, and for how long.
- Write down your key personal information, including any major stresses or recent life changes, both positive and negative. Even happy events, such as getting married or adding a new child to your family, can cause adjustment disorder.
- Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications you're taking.
- Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
- Write down questions to ask your doctor in advance so that you can make the most of your appointment.
For adjustment disorder, some basic questions to ask your doctor include:
- What do you believe is causing my symptoms?
- Are there any other possible causes?
- How will you determine my diagnosis?
- Is my condition likely temporary or chronic?
- Do you recommend treatment? If yes, with what approach?
- How soon do you expect my symptoms to improve?
- What will you recommend next if my symptoms don't improve within a few months?
- Does adjustment disorder increase the risk of other mental health problems?
- 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 take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Being ready to answer your doctor's questions may save some time to go over any points you want to talk about in-depth. 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?
- Are you talking 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 beneficial?
What you can do in the meantime
While you're waiting for your doctor appointment, try reaching out to your friends or family. Talking about your feelings and asking for help is the most important thing you can do to aid your recovery from adjustment disorder.
If your child has symptoms of an adjustment disorder, try gently encouraging him or her to talk about feelings. Many parents assume that talking about a difficult change, such as divorce, will only make a child feel worse. But the opposite is true. 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.
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 more stress than what would normally be expected in response to the stressor or having stress 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
Types of adjustment disorders
Your doctor 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.
Types of adjustment disorder are:
- 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, reckless driving or ignoring your bills. 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.
Treatments and drugs
Most people find treatment of adjustment disorder helpful, and they often require treatment only briefly. Others may benefit from longer treatment, though. 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 also learn healthy coping skills. These skills can help you deal with other stressful events that may arise in your life.
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.
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. 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, take these steps to help:
- Offer encouragement to talk about his or her feelings.
- 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, be sure to talk to your doctor.
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 doctor or mental health provider to review healthy ways to manage your stress.
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