Adjustment disorders are related to stressful life events. While disorders like PTSD are related to extreme traumatic or stressful events, adjustment disorders are related to much less stressful events. The difference between disorders like PTSD, acute stress disorder, and an adjustment disorder is in the nature of the stressful event and the duration of symptoms.
With adjustment disorders, the events that are related to the adjustment issues can be nearly anything that results in stress, whereas with PTSD and acute stress disorder, the events triggering the behavior are much more extreme. This designation has resulted in some controversy and claims regarding the American Psychiatric Association (APA) pathologizing and medicalizing what many consider to be normal reactions to everyday stressors. Nonetheless, according to APA, an adjustment disorder represents an overreaction to commonly experienced types of stress and a resulting level of impairment that would not be expected in normal circumstances given the nature of the event.
Adjustment disorders are reactions to stressful events that are time-limited. A stressful event can be any event that results in a person developing significant tension, worry, pressure, or physical strain. Nearly any event perceived as stressful and trying to an individual can be involved in an adjustment disorder. These may include:
- Losing one’s job
- The death of someone close
- Buying a new home
- The dissolution of an important relationships
- Financial issues
- Getting married, planning a wedding
- Getting a new job or going away to school
- Coming into a lot of money
In addition, children may experience adjustment problems as a result of stress at home (e.g., parents arguing or separating), issues at school (e.g., poor academic performance), or expectations placed on them by peers, parents, and teacher
The interesting thing about the way that “stressful events” are defined by APA is that they can include both negative and positive events, although it is far more common to experience adjustment issues as a result of negative stressors. Nonetheless, individuals experiencing what many would consider positive changes may also develop adjustment issues and an adjustment disorder. Unlike disorders like PTSD, where the types of events that precede the onset of the disorder are relatively well-defined, adjustment disorders can occur in response to nearly any type of event or situation. Of course, as mentioned above, this has led to some controversy regarding the diagnoses of these disorders.
Adjustment disorders are heterogeneous disorders, meaning that they can present in a number of different ways. APA specifies different types of adjustment disorders that are based on the major type of stressful reaction the individual displays. These include:
- Adjustment disorder with depressed mood
- Adjustment disorder with anxiety
- Adjustment disorder with mixed presentation (significant displays of anxiety and depression)
- Adjustment disorder with disturbance of conduct (primarily behavioral symptoms, such as becoming angry or aggressive)
- Adjustment disorder with a mixed disturbance of emotions and conduct (displays both emotional and conduct problems)
- Unspecified adjustment disorder (displays very transient and undefined symptoms)
Diagnoses that are related to stress and trauma that are considered to be far more serious than adjustment disorder, such as PTSD, are typically associated with more severe events. Both the severity of the stressor and the timing of the events distinguish adjustment disorders from acute stress disorder and PTSD.
Acute stress disorder is typically associated with a more severe stressful event and can only occur three days to one month after being exposed to the stressful event, whereas PTSD cannot be diagnosed until at least one month after the stressful event has occurred. Adjustment disorders can be diagnosed immediately and can only persist for six months after the stressor or its consequences have passed.
Adjustment Disorders and Comorbidity
Comorbidity refers to the presence of more than one illness or disorder in an individual. Adjustment disorders can be diagnosed with other mental health disorders and nearly any medical disorder; however, the symptoms of the adjustment disorder cannot be better explained by the expected symptoms of the comorbid disorder in question. For example, a person with bipolar disorder would only be diagnosed with an adjustment disorder if they experience a stressful event and the event was responsible for their emotional/behavioral presentation as long as the criteria for both disorders can be met separately. This is a bit of a tricky situation, and only licensed mental health professionals with experience in these disorders can tease apart these types of issues.
Adjustment disorders are relatively common. Reports of the prevalence of adjustment disorder ranges from 5 percent to 20 percent in individuals being treated for mental health issues. In inpatient psychiatric situations, the prevalence is often reported to be as high as 50 percent.
Adjustment disorders are associated with increased risks for suicide attempts. Individuals who have adjustment disorders and pre-existing medical conditions may often experience increased difficulty as a result of their emotional and behavioral issues as well as increased severity of their medical condition or other mental health disorder. Adjustment disorders are often associated with substance abuse issues for individuals who attempt to cope with stress with the use of alcohol or other drugs. Because individuals with adjustment disorders may choose maladaptive approaches to dealing with stress, they may also find themselves developing other psychological disorders, including substance use disorders or major depressive disorder.
Some signs that may indicate an individual is experiencing issues with adjustment include:
- Tearfulness, depressed mood, problems with motivation, and inability to experience pleasure
- Irritability, jitteriness, nervousness, feeling on the edge, and anxiety attacks
- Isolating oneself, withdrawing from activities once enjoyed, impulsivity, aggressiveness, or acting out
- Increased absences from work or school, or performance issues at work or school
- Headaches, muscle aches, tension, insomnia, loss of appetite, increased blood pressure, and general feelings of fatigue and malaise
- Conflicts with family and friends, supervisors, and/or coworkers
Signs that an individual is engaging in substance abuse in addition to having issues with adjustment include:
- The person suddenly spends a significant amount of time using drugs or alcohol, or spends a great deal of time recovering from their use.
- The person begins having issues with controlling their substance use, such as using more than they had originally intended to use or using drugs/alcohol more often than they originally intended.
- The person continues to use drugs or alcohol in spite of experiencing negative consequences, such as issues at work, in relationships, or legal or financial issues.
- The person becomes very defensive regarding their use of drugs or alcohol.
- The person mixes drugs or alcohol, engages in “doctor shopping” for prescription medications, or uses drugs or alcohol in situations where it is physically dangerous to do so.
Individuals with adjustment disorders can engage in any type of substance abuse, but the most common substances that these individuals abuse include alcohol, prescription medications (often due to being prescribed medications for anxiety or a medical condition), and marijuana.