Adjustment Disorder

Major life changes, such as the death of a loved one, relationship changes or moving to a new city can cause stress. Most people adjust to changes within a few months. For some people however, coping with the sadness, hopelessness and stress that come with change become overwhelming.

Adjustment disorder or situational depression is a type of short term, stress-related mental illness that can occur in some people after experiencing a major life event.

Causes

The type of stress that can trigger adjustment disorder varies depending on the person, but can include:

• Divorce
• Losing or changing jobs
• Difficult life circumstances
• Developing a serious illness–yourself or a loved one
• Being a victim of a crime
• Having an accident
• Undergoing a major life change–getting married, having a baby or retiring from a job
• Living through a disaster, such as a fire, flood or tornado
• Worries about money

Triggers of stress in teenagers and young adults may include:

• Family problems or conflict
• School problems
• Sexuality issues

Because no two people are alike in how they react to stress, there is no way to predict who may develop adjustment disorder. Those who do not cope with change or do not have a good support system may be at greater risk of developing adjustment disorder. 

Signs and Symptoms

Symptoms of adjustment disorder are similar to depression.  They may be severe enough to affect work, school or social life.

• Frequent crying
• Anxiety and worry
• Body aches of unknown explanation
• Palpitations (an unpleasant sensation of irregular or forceful beating of the heart)
• Problems sleeping
• Fatigue

Signs include:

• Acting defiant or showing impulsive  or destructive behavior  
• Absence from work or school
• Withdrawal or isolation from people and social activities
• Changes in appetite, either loss of appetite or overeating
• Increase in the use of alcohol or other drugs
• Trembling or twitching

To be diagnosed with adjustment disorder, the symptoms:

• Are the result of a life change, usually occur within 3 months
• Are more severe than would be expected
• Are only related to adjustment disorder and there are no other mental health disorders involved
• Are not part of normal grieving for the death of a loved one

Some people who have severe cases of adjustment disorder may have thoughts of suicide or make a suicide attempt.

Diagnosis

After ruling out a physical ailment, your healthcare provider may refer you to a mental health assessment to find out about your behavior 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.
• Unspecified adjustment disorder. 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.

Treatment

In cognitive-behavioral therapy, individuals learn how to break out of the vicious cycle of negative thoughts. The therapist first assists the client in recognizing negative thoughts and feelings, and their effects. Then the therapist teaches the client how use negative thoughts as cue to change them into helpful thoughts and healthy actions. 

Medications may be recommended. With the right help and support, clients with adjustment disorder improve quickly.

CHI Health Psychiatric Associates, with offices in Omaha and surrounding areas, has highly-trained mental health providers who can address the needs of those who suffer from an adjustment disorder.  If you think you or a loved one may be suffering from an adjustment disorder, call (402) 717-HOPE.