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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:
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 teachers.
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.
According to APA, the symptoms used to diagnose an adjustment disorder consist of behavioral responses, emotional reactions, or a combination of both emotional and behavioral responses to the particular stressor. Adjustment disorders can only be diagnosed if the symptoms occur within three months of the stressful event and can only last for six months following the termination or conclusion of the event.
A general description provided by the APA diagnostic criteria indicate that:
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:
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.
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:
Signs that an individual is engaging in substance abuse in addition to having issues with adjustment include:
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.
The approaches used to address adjustment disorders include either one or a combination of the following:
Often, combinations of the three major interventions can be used. Individuals with co-occurring adjustment disorders and substance use disorders need to be involved in an integrated treatment program that treats both disorders simultaneously and uses a multidisciplinary approach that addresses both conditions. These individuals may need to go through withdrawal management, inpatient treatment, outpatient treatment and therapy, and long-term aftercare programs in order to protect against relapse in the future.