Adjustment Disorders

Adjustment disorders are a group of conditions that can occur when someone has difficulty coping with a significant life change, such as a job loss, divorce, or the death of a loved one. These disorders are characterized by emotional or behavioral symptoms that are out of proportion to the stressor and can impair daily functioning.

Causes of Adjustment Disorders

Adjustment disorders can be triggered by a variety of life events. These events can be single or multiple, such as:

• Relationship issues (e.g., breakup or divorce)
• Loss of a job or significant change in employment
• Death of a loved one
• Major life changes (e.g., moving to a new city, retirement)
• Financial difficulties
• Health problems or a serious illness
• Natural disasters or traumatic events

While the specific cause of adjustment disorders can vary widely from person to person, these conditions generally arise when an individual is unable to adapt to a new situation or change in their life. Factors such as individual temperament, coping skills, and social support can influence how one responds to stress and the likelihood of developing an adjustment disorder.

Types of adjustment disorders

This is the American Psychiatric Association’s guide to mental health conditions. Types of adjustment disorders and associated symptoms include:

• Adjustment disorder with depressed mood: Feelings of sadness, hopelessness, crying and lack of joy from things that used to bring you pleasure.
• Adjustment disorder with anxiety: Feeling worried, anxious and overwhelmed. You also have trouble concentrating. Separation anxiety is a dominant symptom in children.
• Adjustment disorder with mixed anxiety and depressed mood: Feeling both anxious and depressed.
• Adjustment disorder with disturbance of conduct: Behavioral symptoms such as acting rebellious, destructive, reckless or impulsive.
• Adjustment disorder with mixed disturbance or emotions and conduct: Anxiety, depression and behavioral issues.
• Adjustment disorder unspecified: Physical symptoms such as headaches, body aches, stomach aches, heart palpitations or insomnia.

Symptoms of Adjustment Disorders

The symptoms of adjustment disorders can differ depending on the person and the stressor involved. However, they typically fall into two categories: emotional and behavioral.

Emotional Symptoms

Individuals with adjustment disorders may experience a range of emotional symptoms, including:

• Sadness or hopelessness
• Anxiety or excessive worry
• Feelings of being overwhelmed
• Difficulty concentrating
• Tearfulness or frequent crying
• Loss of interest in activities
• Feelings of isolation or withdrawal from social interactions

Behavioral Symptoms

Behavioral symptoms are also common and may include:

• Changes in sleeping or eating habits
• Increased use of alcohol or drugs
• Irritability or anger
• Reckless or impulsive behavior
• Decline in performance at work or school
• Neglect of responsibilities

These symptoms typically appear within three months of the stressful event and can last for up to six months. If the symptoms persist beyond this period, it may indicate the presence of another mental health disorder, such as major depression or anxiety disorder.

Risk factors

Stressful life events and experiences ― positive and negative ― may put you at risk of having an adjustment disorder. Examples include:

• Major stress as a child, such as bullying or difficulties with school.
• Divorce or marriage problems.
• Relationship problems or trouble getting along with others.
• Major changes in life, such as retirement, having a baby or moving away.
• Bad experiences, such as losing a job, loss of a loved one or having money problems.
• Problems in school or at work.
• Life-threatening experiences, such as physical assault, combat or natural disaster.
• Ongoing stressors, such as having a medical illness or living in a neighborhood that has a lot of crime.
• More than one major change or bad experience happening at the same time.
• Other mental health conditions, such as major depression, intense anxiety or post-traumatic stress disorder.

Diagnosis of Adjustment Disorders

Diagnosing adjustment disorders requires a thorough evaluation by a mental health professional. The diagnosis is typically based on the individual’s history, symptoms, and the presence of a recent stressor. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for diagnosing adjustment disorders, including:

• The development of emotional or behavioral symptoms in response to an identifiable stressor within three months of its occurrence
• Symptoms that are out of proportion to the severity of the stressor and cause significant impairment in social, occupational, or other areas of functioning
• Symptoms that do not meet the criteria for another mental disorder and are not simply an exacerbation of a pre-existing condition
• Symptoms that do not represent normal bereavement

Treatment of Adjustment Disorders

Treatment for adjustment disorders typically involves a combination of therapy, medication, and lifestyle changes. The goal of treatment is to help the individual develop coping skills, reduce symptoms, and improve functioning.

Psychotherapy

Psychotherapy, or talk therapy, is often the first line of treatment for adjustment disorders. Different types of therapy can be effective, including:

• Cognitive-behavioral therapy (CBT): This type of therapy helps individuals identify and change negative thought patterns and behaviors, develop problem-solving skills, and improve stress management.
• Interpersonal therapy (IPT): IPT focuses on improving communication skills and addressing interpersonal issues that may be contributing to the adjustment disorder.
• Supportive therapy: This approach provides emotional support and helps individuals build resilience and coping strategies.

Medication

In some cases, medication may be prescribed to help manage symptoms, particularly if they are severe or not improving with therapy alone. Medications that may be used include:

• Antidepressants: These can help alleviate symptoms of depression and anxiety.
• Anti-anxiety medications: These can help reduce anxiety and improve sleep.

It’s important to note that medication should be used in conjunction with therapy and under the supervision of a healthcare professional.

Lifestyle Changes

Incorporating healthy lifestyle changes can also play a crucial role in managing adjustment disorders. Some strategies include:

• Maintaining a regular exercise routine
• Practicing relaxation techniques (e.g., meditation, deep breathing)
• Ensuring adequate sleep
• Eating a balanced diet
• Building a strong support network
• Engaging in enjoyable activities and hobbies

Prognosis and Prevention

With appropriate treatment, individuals with adjustment disorders can recover and return to their normal level of functioning. The prognosis is generally good, especially when the person has access to support and effective coping strategies.

While it may not be possible to prevent adjustment disorders entirely, certain steps can help reduce the risk, such as:

• Developing strong social connections
• Improving stress management skills
• Seeking help early when facing difficult life changes
• Maintaining a healthy lifestyle

Nursing Care of Patients with Adjustment Disorders

These disorders can result in emotional and behavioral symptoms that hinder daily functioning. Nurses play a crucial role in providing care and support to patients diagnosed with adjustment disorders, making their involvement essential for successful outcomes.

Nursing Assessment

Initial Evaluation

The first step in nursing care is conducting a thorough assessment, which includes:

• Collecting a comprehensive medical history
• Identifying recent stressors
• Assessing symptoms and their impact on daily life
• Evaluating coping mechanisms and support systems

Psychosocial Assessment

Understanding the patient’s psychosocial context is vital. Nurses should explore:

• Family dynamics
• Social support networks
• Employment or academic pressures
• Cultural and spiritual beliefs

Nursing Interventions

Creating a Supportive Environment

It is essential to create a safe and supportive environment for patients, which includes:

• Building a trusting relationship
• Providing a calm and non-judgmental space
• Encouraging open communication

Developing Coping Strategies

Helping patients develop effective coping strategies is a key nursing intervention. This may involve:

• Teaching stress management techniques, such as deep breathing exercises and mindfulness
• Encouraging the use of positive self-talk
• Assisting in the development of problem-solving skills

Facilitating Social Support

Strengthening the patient’s social support network can significantly improve outcomes. Nurses can:

• Encourage participation in support groups
• Facilitate family involvement in the patient’s care
• Provide resources for community support services

Collaboration with Mental Health Professionals

Nurses should work closely with mental health professionals to ensure comprehensive care. This collaboration can include:

• Referring patients for psychotherapy or counseling
• Coordinating with psychiatrists for medication management
• Participating in multidisciplinary team meetings

Education and Health Promotion

Patient and Family Education

Educating patients and their families about adjustment disorders is crucial. Nurses should provide information on:

• The nature of adjustment disorders
• Symptoms and treatment options
• Strategies for managing stress and preventing relapse

Promoting a Healthy Lifestyle

Encouraging patients to maintain a healthy lifestyle can aid in recovery and prevent future episodes. Key points include:

• Regular physical activity
• A balanced diet
• Adequate sleep
• Avoiding alcohol and drug use

REFERENCES

1. Adjustment Disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
2. American Psychiatric Association. What is Posttraumatic Stress Disorder (PTSD)?. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd) Last reviewed 11/2022.
3. Geer K. Adjustment disorder: Diagnosis and treatment in primary care. In: Primary Care: Clinics in Office Practice. Volume 50, issue 1. Elsevier; 2023. https://www.clinicalkey.com/. 
4. Personality disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022; https://dsm.psychiatryonline.org.
5. Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. https://pubmed.ncbi.nlm.nih.gov/29107817/. J Affect Disord. 2018 Feb; 227:243-253..
6. Casey P. Adjustment disorder: new developments. https://pubmed.ncbi.nlm.nih.gov/24748555/. Curr Psychiatry Rep. 2014 Jun; 16(6):451.
7. Merck Manual, Consumer Version. Adjustment Disorders. https://www.merckmanuals.com/home/mental-health-disorders/anxiety-and-stress-related-disorders/adjustment-disorders. Last reviewed 8/2023.
8. National Library of Medicine (U.S.). Adjustment disorder. https://medlineplus.gov/ency/article/000932.htm. Last reviewed 4/30/2022.
9. O’Donnell ML, Agathos JA, Metcalf O, et al. Adjustment Disorder: Current Developments and Future Directions. https://pubmed.ncbi.nlm.nih.gov/31315203/. Int J Environ Res Public Health. 2019 Jul;16(14):2537.

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