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Adjustment Disorder

Work problems, getting married, going away to school, an illness — any number of life changes can cause stress. Most of the time, individuals adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an Adjustment Disorder (AD).

An AD is a type of stress-related mental illness. You may feel anxious or depressed, or even have thoughts of suicide. You may not be able to go about some of your daily routines, such as work or seeing friends. 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. Treatment of an AD may help you regain your emotional footing. Most adults get better within just a few months, although teens may struggle longer. Treatment may also help prevent an AD from becoming a more serious problem.

Symptoms—

The signs and symptoms of ADs vary from person to person. The symptoms you have may be very different from those of someone else with an AD. But for everyone, symptoms of an AD begin within three months of a stressful event in your life.

Emotional symptoms of ADs-

Signs and symptoms of AD may affect how you feel and think about yourself or life, including:

• Anxiety
• Crying spells
• Desperation
• Difficulty concentrating
• Feeling overwhelmed
• Hopelessness
• Lack of enjoyment
• Nervousness
• Sadness
• Thoughts of suicide
• Trouble sleeping
• Worry

Behavioral symptoms of ADs-

Signs and symptoms of AD may affect your actions or behavior, such as:

• Avoiding family or friends
• Fighting
• Ignoring bills
• Poor school or work performance
• Reckless driving
• Skipping school
• Vandalism

Length of symptoms-

How long you have symptoms of an AD also can vary:

• Longer than six 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.
• Six months or less (acute). In these cases, symptoms may go away on their own, especially if you actively follow self-care measures.

When to see a doctor:

Sometimes the stressful change in your life goes away, and your symptoms of AD 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 AD is less serious than other mental health problems because it involves stress, but that's not necessarily true. ADs 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.

Individuals with ADs also may abuse alcohol or drugs, engage in violence, and have thoughts of suicide. If you or a loved one has suicidal thoughts or is seriously considering hurting someone, seek help immediately.

Talk to your doctor if you're having trouble getting through each day. You can get treatment to help cope better with stressful events and feel better about life again.

Causes—

Individuals of all ages are affected by ADs. Among kids and teens, both boys and girls have about the same chance of having AD. Among adults, women are twice as likely as men to have AD. But researchers are still trying to figure out what causes ADs. 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.

Risk factors—

Although researchers don't know exactly what causes ADs, they do know some of the risk factors involved, or the things that make you more likely to have an AD.

Stressful events:

One or more stressful life events may put you at risk of developing AD. 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
• Death of a loved one
• Divorce or relationship breakup
• Financial problems
• Going away to school
• Having a baby
• Job loss
• Physical assault
• Problems in school
• Retirement
• Surviving a disaster

In some cases, individuals who face an ongoing stressful situation — such as living in a crime-ridden neighborhood — can reach a breaking point and develop an AD.

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.

Some studies also suggest that your risk of an AD is 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:

• Difficult life circumstances
• Exposure to wars or violence
• Other mental health problems

Complications—

Most individuals with AD get better within six months and don't have long-term complications. However, individuals who also have another mental health disorder, a substance abuse problem or a chronic AD are more likely to have long-term mental health problems, which may include:

• Alcohol and drug addiction
• Depression
• Suicidal thoughts and behavior

Compared with adults, teens with AD — especially chronic AD marked by behavior problems — are at significantly increased risk of long-term problems. In addition to depression, substance abuse and suicidal behavior, teens with AD are at risk of developing psychiatric illnesses such as:

• Antisocial personality disorder
• Bipolar disorder
• Schizophrenia

Preparing for an appointment—

If you or your youngster has thoughts of suicide, go to an emergency room or call 911 or your local emergency number immediately.

If you or your youngster has less urgent symptoms of an AD, make an appointment with your family doctor or your youngster's pediatrician. While ADs resolve on their own in most cases, your doctor may be able to recommend coping strategies or treatments that may help you or your youngster 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:

• 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.
• Take a trusted family member or friend along, if you are the one with symptoms of AD. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down any symptoms you've been experiencing, and for how long.
• Write down questions to ask your doctor in advance so that you can make the most of your appointment.
• 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 youngster to your family can cause AD.

For AD, some basic questions to ask your doctor include:

• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
• Are there any other possible causes?
• Do you recommend any temporary changes at home, work or school to encourage recovery?
• Do you recommend treatment? If yes, with what types of therapy?
• Does AD increase the risk of other mental health problems?
• How soon do you expect symptoms to improve?
• How will you determine the diagnosis?
• Is this condition likely temporary or chronic?
• Should a mental health specialist be consulted?
• Should school staff or work colleagues be made aware of this diagnosis?
• What do you believe is causing these symptoms?
• What will you recommend next if symptoms don't improve within a few months?

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.

You or your youngster should be prepared to answer the following questions from your doctor:

• Are you avoiding social or family events?
• Are you having trouble sleeping?
• Are you talking with friends or family about these changes?
• Do you drink alcohol or use illicit drugs? How often?
• Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you?
• Have been having any problems at school or work?
• Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most beneficial?
• Have you ever thought about harming yourself or others?
• Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you?
• How often do you feel anxious or worried?
• How often do you feel sad or depressed?
• What are your symptoms?
• What major changes have recently occurred in your life, both positive and negative?
• What other symptoms or behaviors are causing you or your loved ones distress?
• When did you or your loved ones first notice your symptoms?

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 AD.

If your youngster has symptoms of an AD, 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 youngster feel worse. But the opposite is true. Your youngster 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—

ADs are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with AD, 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 AD to be diagnosed, several criteria must be met, including:

• An improvement of symptoms within six months of the stressful event coming to an end
• Experiencing distress that is in excess of what would normally be expected in response to the stressor or that causes significant problems in your relationships, at work or at school
• Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life

Types of ADs:

Your health care provider 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 AD you have. There are six main types of ADs. Although they're all related, each type of AD has certain signs and symptoms.

The six types of AD are:

• AD unspecified. Symptoms don't fit the other types of ADs but often include physical problems, problems with family or friends, or work or school problems.
• AD with anxiety. Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Kids who have AD with anxiety may strongly fear being separated from their parents and loved ones.
• AD with depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, and a lack of pleasure in the things you used to enjoy.
• AD with disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting, reckless driving or ignoring your bills. Youngsters may skip school or vandalize property.
• AD with mixed anxiety and depressed mood. Symptoms include a mix of depression and anxiety.
• AD with mixed disturbance of emotions and conduct. Symptoms include a mix of depression and anxiety as well as behavioral problems.

Treatments and drugs—

Most individuals find treatment of AD helpful, and they're in treatment only for several months. Others may benefit from longer treatment, though. There are two main types of treatment for AD — psychotherapy and medications.

• Medications- 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 ADs. As with therapy, you may need medications only for a few months.

• Psychotherapy- The main treatment for ADs 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 weather other stressful events that may arise in your life.

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. Some examples include:

• Engaging in a hobby you enjoy
• Finding a support group geared toward your situation
• Finding support from a faith community
• Getting regular physical activity
• Sticking to a regular sleep routine
• Talking things over with caring family and friends
• Trying to keep eating a healthy diet

If it's your youngster who's having difficulty adjusting, you can help by:

• Letting your youngster make simple decisions, such as what to eat for dinner or which movie to watch
• Offering encouragement to talk about his or her feelings
• Offering support and understanding
• Reassuring your youngster that such reactions are common
• Touching base with your youngster's teacher to check on progress or problems at school

If you use these kinds of self-care steps but they don't seem to be helping, be sure to talk to your health care provider.

Prevention—

There are no guaranteed ways to prevent AD. 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
• Living a healthy lifestyle
• Seeking out humor or laughter
• 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 health care or mental health care provider to review healthy ways to manage your stress.

Q and A—

What is an adjustment disorder (AD) and how does it occur?

There are six major adjustment disorders:

• Adjustment disorder unspecified
• Adjustment disorder with anxiety
• Adjustment disorder with depressed mood
• Adjustment disorder with disturbance of conduct
• Adjustment disorder with mixed anxiety and depressed mood
• Adjustment disorder with mixed disturbance of emotions and conduct

What are the characteristics associated with an AD?

A person with AD often experiences feelings of depression or anxiety or combined depression and anxiety. As a result, that person may act out behaviorally against the "rules and regulations" of family, work, or society. In some individuals, an AD may manifest itself in such behaviors as skipping school, unexpected fighting, recklessness, or legal problems. Other individuals, however, instead of acting out, may tend to withdraw socially and isolate themselves during their adjustment problems. Still others may not experience behavioral disturbances, but will begin to suffer from physical illness. If someone is already suffering from a medical illness, that condition may worsen during the time of the AD. Individuals in the midst of ADs often do poorly in school or at work. Very commonly they begin to have more difficulty in their close, personal relationships.

Listed below are some of the characteristics associated with ADs:

1. A person with an AD with anxiety would experience anxious feelings, nervousness, and worry.
2. A person with an AD with depressed mood may have mostly a depressed mood, hopeless feelings, and crying spells.
3. A person with an AD with mixed disturbance of emotions and conduct would have a mixture of emotional and conduct problems.
4. An individual with an AD with disturbance of conduct may act out inappropriately. This person may act out against society, skip school, or begin to have trouble with the police.
5. Someone with an AD with mixed anxiety and depressed mood would, obviously, have a mixture of anxious and depressed feelings.

At what age can an AD appear?

ADs can occur at any age. Individuals are particularly vulnerable during normal transitional periods such as adolescence, mid-life, and late life.

Do ADs affect males, females, or both?

In the United States the same number of males and females experience the various ADs.

How is an AD diagnosed?

A mental health professional makes a diagnosis of an AD by taking a careful personal history from the client/patient. It is important to the therapist to learn the details that surround the stressful event or events in that person's life. No laboratory tests are required to make a diagnosis of AD nor are there any physical conditions that must be met. However, it is very important for the therapist not to overlook a physical illness that might mimic or contribute to a psychological disorder. If there is any question whether the individual might have a physical problem, the mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as a part of the physical workup.

How is an AD treated?

Therapy can be very helpful to lessen or alleviate ongoing symptoms of AD before they become disabling. Group therapy can be useful to individuals who are enduring similar stress. In some situations the use of prescription medications can be very useful to ease the depression or the anxiety associated with AD.

How often does AD appear in the community?

AD is very common in the United States. More than five percent (5%) of all persons seen in clinical, outpatient mental health settings have some type of AD.

What can individuals do if they need help?

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.

What happens to a person with an AD?

The conditions associated with AD develop within three months of the beginning of the stressful problem. An AD usually lasts no longer than three to six months. The condition may persist, however, if an individual is suffering from chronic stress such as that caused by an illness, a difficult relationship, or worsening financial problems.

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