TRAUMA AND STRESS DISORDERS

Adjustment Disorder

Credit: Kati Morton

What is an Adjustment Disorder

An inability to adjust to stressful events leading to psychological and physiological symptoms.

Everyone experiences stressors in their lives. Some major stressors could include the loss of a loved one, losing a job, or financial difficulties. However, the way in which these stressors impact us are unique and each individual experiences them differently.

In the face of these overwhelming life stressors, some individuals might experience an emotional and behavioural reaction that is lengthier and more intense than expected.

An adjustment disorder can be preceded by a single stressor or multiple stressors, and these stressors can affect more than a single individual, such as their family or an entire community. This stressor can be a major or trivial one, as regardless of its significance, the impact that it has depends on the perception of the individual.

Symptoms

For diagnosis of adjustment disorder in accordance with the Diagnostic and Statistical Manual of Mental Disorders (5th Edition), the following symptoms should be observed within the individual 

  1. Development of emotional or behavioural symptoms in response to an identifiable stressor within past 3 months of the stressor’s onset, such as:

    Ψ Violent behaviour 
    Ψ Alcohol abuse 
    Ψ Sleep problems 
    Ψ Appetite loss
    Ψ Withdrawal from loved ones
    Ψ Depression 
    Ψ Worry, nervousness, fear
    Ψ Suicidal behaviour 

  2. These symptoms significantly impair social, occupational or any other important areas of functioning and/or result in distress that is disproportionate to the intensity of the stressor.  

3. The symptoms are not representative of normal loss or grief.  

4. The symptoms do not persist for 6 months after the stressor has been removed.

5 This disturbance does not meet the criteria for another mental disorder or an intensification of a current mental disorder.   

These symptoms often lead to a reduction in functioning of the individual in various aspects of their lives. Such consequences include a decrease in performance at work or school, withdrawal from social relationships or angry outbursts during interactions, or physical consequences such as a loss in appetite or headaches. When the stressor is a medical condition, these symptoms could lead to a complication in the course of the condition.

Prevalence  

The prevalence of adjustment disorders within the general population is high, ranging from 5% to 20%. Furthermore, the risk of suicide in conjunction with adjustment disorder was found to be 4%.

Comorbidity  

The diagnosis of an adjustment disorder can be accompanied by both medical and mental disorders. For example, an individual suffering from Trichotillomania who lost their job can also have a diagnosis of adjustment disorder, if Trichotillomania does not explain symptoms in reaction to the loss of job. In the case of medical illnesses, adjustment disorders can be diagnosed when the individual experiences a disproportionate psychological response.  

Therapy

As the course of adjustment disorders is often short, an individual might not require therapy and the symptoms might be resolved over time. However, with the high risk of suicidal behavior, one should typically seek therapy options. At present, therapy options include Cognitive Behavioural Therapy, where individuals learn skills on how to cope with stressors and behavioural techniques to relax, in order to revert to previous functioning levels prior to the stressor.

What can I do to cope and feel better with Adjustment Disorder?


Ψ Take breaks in between with self-care activities such as baking your favorite cupcake or go down for a mindful walk (you may find these useful on managing stress & engaging in mindfulness) 

Ψ Be aware of your coping strategies - what are your trigger activities, how you react to them, what are the (positive/negative outcomes), and if the outcome is negative (eg. it affects  the relationships around you), what you can do differently and adopt a healthier coping strategy 

Ψ Find your social support group. This can be very helpful in times of need, and at the same time, you can help others in need. It can comprise with those closest to you like your family and friends, or a simple work/study group amongst your colleagues/schoolmates.

How can I support someone with Adjustment Disorder?


Ψ Lend them a listening ear. Support them by listening to their struggles in a non-judgmental stance.  

Ψ Offer to help them out by reducing the stressor if possible. For example, if they are experiencing occupational difficulties, offer to assist them with childcare.

Ψ Invite them out for physical activities or other activities that they enjoy.


It is important to be aware of your body; how you feel emotionally and physically, how you think, and how you act. If you find something amiss, or you haven’t “been yourself lately”, do not hesitate to contact us to not only cope better but to understand yourself. There is no shame in wanting to get better, for yourself and for those around you.