Have you recently experienced a stressful event or serious life change? Has this caused you to react in ways that are significantly affecting your life? Do you feel “crazy,” or “not normal” for how it is affecting you? If this sounds like you, you may be suffering from an adjustment disorder.
What is Adjustment Disorder?
An adjustment disorder is a severe reaction to a stressful event or life experience and is a common diagnosis.
Many people don’t realize this is a mental health disorder which can lead to serious and unhealthy emotions and behaviors that can affect your life. According to the Diagnostic and Statistical Manual of Mental Disorders- 5th Edition (DSM- 5), adjustment disorders are also associated with an increase of suicide attempts and completions.
Knowing how to spot an adjustment disorder and how to treat it is essential in preventing more serious complications down the line.
What Causes Adjustment Disorders?
Adjustment disorders are triggered by stress. Stress can be anything that affects you directly or it can be something that happened to your family, your community or a group of people you are associated with in some way.
Stressors can fall into any of the following categories:
- Single events: Break up, job loss, death of a loved one, unexpected natural disaster, or moving to a new home or place.
- Recurring stressors: Financial problems every winter when work is slow, seeing family during the holidays, or school exams.
- Ongoing stressors: Having an illness that progressively worsens, divorce, or being a caretaker for a family member or living in a high crime area.
- Developmental changes: Child going to away to college, becoming a parent or retiring.
- Multiple stressors at the same time: A family member becomes ill the week you have a deadline for work and you are having relationship issues.
Adjustment Disorder Symptoms
Symptoms vary depending on the type of adjustment disorder you are experiencing and can sometimes resemble other mental health disorders or health issues.
Some common symptoms of adjustment disorders are:
- Sadness
- Insomnia
- Exhaustion
- Excessive worry
- Thoughts of suicide
- Increased irritability
- Decreased self-esteem
- Avoiding social interactions
- Lack of or increased appetite
- Decreased performance in work or school
Adjustment Disorder DSM 5/ ICD 10: What Does it Mean for Everyday Life?
An adjustment disorder can affect your relationships, your performance at work or school and/or your health.
Is there an Adjustment Disorder Test: How is it Diagnosed?
There is currently no reliable test designated to help licensed mental health providers (LMHP) accurately diagnose adjustment disorders.
To diagnose, your LMHP will complete a thorough evaluation by gathering information about your symptoms, life experiences and mental health history.
Mental health providers use the Diagnostic and Statistical Manual of Mental Disorders- 5th Edition (DSM- 5) and the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) as tools to help them assess and diagnose mental health disorders.
- The DSM-5 is published by the American Psychiatric Association, has detailed descriptions of mental health disorders and provides clinicians the ability to have a common language about diagnoses.
- The ICD-10 is produced by the World Health Organization and includes conditions and diseases not pertaining to mental health. It serves as the official coding system used for billing purposes in clinical and medical settings.
Adjustment Disorder Diagnostic Criteria
Adjustment disorders are part of the Trauma-and stressor-related disorders found in the DSM-5 and part of the Reaction to severe stress, adjustment disorders in the ICD-10.
There are slight differences between the DSM-5 and the ICD-10 criteria for adjustment disorder, but overall, your therapist will look for the following:
- Symptoms occurred in response to a specific stressor(s) within 1 month (ICD-10) to 3 months (DSM-5) of it happening.
- Symptoms are affecting performance of daily, social or occupational functioning.
- Symptoms are “out of proportion” to what is typically expected in response to stressor(s), given your culture, background or other factors that might influence the severity of a reaction.
- Symptoms do not meet criteria for a different mental disorder and are not a symptom of a pre-existing mental disorder.
- Symptoms are not due to normal bereavement.
- Symptoms do not last more than 6 months after the stressor or its consequences have ended.
- ICD-10 makes an exception for prolonged depressive reaction.
Types of DSM-5 and ICD-10 Adjustment Disorders
Adjustment disorders are diagnosed under specific categories called specifiers(DSM-5) or subtypes(ICD-10). These are based on the symptoms that are most prevalent and help guide treatment.
Below are some of the most common adjustment disorder categories with possible symptoms:
DSM-5 Adjustment disorders specifiers:
DSM-5 Adjustment Disorder with Depressed Mood
- Sadness
- Hopelessness
- Decreased motivation
DSM-5 Adjustment Disorder with Anxiety
- Nervousness
- Excessive worry
- Restlessness
- Children: Increased difficulty when separating from caregiver.
DSM-5 Adjustment Disorder with Mixed Anxiety and Depressed Mood
- Combination of anxiety and depressed mood symptoms.
DSM-5 Adjustment Disorder with Mixed Disturbance of Emotions and Conduct
- Combination of emotional and behavioral symptoms.
DSM-5 Adjustment Disorder with Disturbance of Conduct
- Disrespectful toward others
- Disregard for rules
- Reckless driving
- Children and adolescents: Fighting, truancy, and vandalism.
ICD-10 Adjustment Disorders Subtypes:
- ICD-10 Adjustment Disorder Brief Depressive Reaction
- ICD-10 Adjustment Disorder Prolonged Depressive Reaction
- ICD-10 Adjustment Disorder Mixed Anxiety and Depressive Reaction
- Combination of anxiety and depressive symptoms.
- ICD-10 Adjustment Disorder with Predominant Disturbance of Other Emotions
- Anxiety
- Depression
- Worry
- Anger
- Children: Regressive behaviors such as bed-wetting, thumb-sucking or baby talk may be present.
- ICD-10 Adjustment Disorder with Predominant Disturbance of Conduct
- Increased aggression
- Disregard for rules
- Selfish behavior
- ICD-10 Adjustment Disorder with Mixed Disturbance of Emotions and Conduct
- Combination of emotional and behavioral symptoms.
Who is at Risk for This Disorder?
Adjustment disorders can affect anyone!
At this time, there is no significant research indicating that a certain race, class or gender is at greater risk for an adjustment disorder. However, it is believed that people who are exposed to high levels of stress could be at increased risk. This could include people of lower socioeconomic status, or those living in areas with high community violence. Adolescents, middle-aged and late-aged adults may also be at greater risk as they are experiencing major life changes.
DSM-5/ICD-10 Adjustment Disorder Case Example
Nancy’s mother had a stroke and needed her as her full-time caretaker. Nancy had to move across country to help her mother and initially had difficulties sleeping, would randomly burst into tears and experienced heart palpitations when she thought of all that had changed.
Additionally, she was constantly worried about her mother’s health and felt angry and resentful most of the time. Nancy felt embarrassed to admit that she was having such a hard time, but followed her doctor’s advice and found a therapist. Her therapist provided her with information to a caretakers support group, helped her create a plan to meet new people and take more breaks for self-care.
With time, Nancy was able to adapt to her new situation and make new friends. She was able to understand that being a caretaker is hard and that it is okay to feel overwhelmed at times.
Nancy’s case is an example of adjustment disorder with mixed anxiety and depressed mood.
DSM-5/ICD-10 Adjustment Disorder in Adults and Children: How does it differ between age groups?
Adults tend to “internalize.” Their symptoms may be more emotional and harder to spot.
- Constant sadness
- Isolating
- Anxiety
- Thoughts of suicide
Children and adolescents tend to “externalize.” Their symptoms may be more behavioral and obvious to others.
- Fighting
- Skipping school
- Disregard for rules
- Yelling
- Regressing to childlike behaviors
According to Child Mind Institute, “Teenagers with untreated adjustment disorder are at a heightened risk for developing depression, chronic anxiety, and substance abuse problems.”
Adjustment Disorder Treatment
Therapy is effective for adjustment disorders and various approaches can be considered:
- Individual Therapy: Talk therapy, specifically, cognitive-behavioral therapy (CBT) has been known to be effective for addressing adjustment disorders. CBT will address unhelpful thoughts and behaviors regarding the stressor, help you increase coping skills, identify areas of vulnerability and prepare for future stressors.
- Family Therapy: Family therapy may be helpful in dealing with stressors that involve the entire family. Your therapist may help you improve communication, address unhelpful family dynamics and/or increase familial support.
- Group Therapy: Group therapy may be helpful in normalizing your experience and sharing coping skills. Groups are made up of people who have similar experiences which can help you build a stronger support system and improve your ability to socialize.
A person is usually able to recover completely from an adjustment disorder once they are able to either adapt to the new situation or the stressor has ended.
Possible Medications for Adjustment Disorder
Your medical provider may be able to prescribe antidepressants or anti-anxiety medication to help alleviate symptoms such as insomnia, anxiety, and/or suicidal thoughts. Medicine alone has not been proven effective for adjustment disorders, therefore therapy will still be important. Cost of medication may vary depending on the insurance provider.
Insurance Coverage for Adjustment Disorder
Adjustment disorders are a billable diagnosis and are usually covered by most insurance providers. Call your insurance provider to get information on preferred providers, number of sessions allowed and other coverage information. Some therapists do not take insurance so you may have to pay out of pocket and request a reimbursement from your insurance.
How to Find a Therapist
- Ask your medical provider for referrals.
- Ask friends or people you trust (teachers or pastors) for recommendations.
- Call your employer’s Human Resources. Some employers provide access to therapists as part of your benefits, especially if the stressor is work-related.
- Call your insurance provider for a list of preferred (covered) therapists in your area.
- Call 2-1-1 or visit www.211.org and ask for mental health providers in your area.
- Call one of the helplines identified in this article and request a referral for local therapists.
- Search online for “therapists near me,” “mental health providers” or “community mental health centers.”
What should I be looking for in an LMHP?
Titles for licensed mental health professionals (LMHP) may vary depending on their field of study or where they practice. Some examples are:
- Psychiatrist
- Psychologist
- Licensed Clinical Social Worker
- Marriage and Family Therapist
- Licensed Professional Counselor
- Psychiatric Nurse Practitioners
When looking for an LMHP it is important to consider several factors:
- Cost of treatment will vary depending on the provider’s title, usually, psychiatrists and psychologists tend to be more expensive.
- The provider’s therapeutic approach will vary depending on their training and education. For adjustment disorders, you want someone knowledgeable in treating stress-related disorders.
- Find someone who offers sessions at a time that works well for you in order to decrease the possibility of missing sessions.
- Not all therapists are a good fit. Feel free to “shop around” to find a person you feel comfortable with based on personality and approach. Give yourself a few sessions to make a decision and be honest if something isn’t working. You are the customer and it is okay to speak up.
- Therapy is hard work and part of the therapist’s job is to help you find more effective ways to look at a situation, so don’t give up on therapy at the first sign of feeling challenged. It is all part of the process leading to a healthier life!
Questions to Ask a Potential Therapist
- What kind of license do you have?
- What kind of therapy will you provide?
- How long will the treatment be?
- How often will I see you for sessions?
- How will I know if I’m getting better?
- What method of payment do you accept?
Coping With Adjustment Disorder
Here are some coping skills for some of the most common forms of adjustment disorders:
- DSM-5/ ICD-10 adjustment disorder with anxiety
- Avoid foods or substances that may worsen your symptoms such as caffeine, sugar, drugs or alcohol.
- Distract from worry by engaging in positive activities such as yard work, reading, watching a funny movie or show.
- Engage in relaxation activities such as yoga, stretching, or deep breathing.
- DSM-5/ ICD-10 adjustment disorder with depressed mood
- Get active: Go on a walk, go to the gym, or spend time doing positive activities that keep you busy.
- Socialize: If you have a dog, go to the park and meet other dog owners, call a friend, or hang out with loved ones.
- Challenge your negative thoughts with positive ones! Remind yourself of the positive stuff in your life.
- DSM-5/ ICD-10 adjustment disorder with mixed anxiety and depressed mood
- Practice a combination of the coping skills mentioned above!
Look out for These Complications
Talk to your mental health provider right away if you notice:
- Your symptoms have worsened or have lasted longer than 6 months.
- You develop new symptoms.
- You are having thoughts of suicide.
4 Tips for Improving Your Stress Tolerance
Here are some tips to help strengthen your ability tolerate stressful situations. These will help reduce your vulnerability to future episodes of adjustment disorder and other mental health conditions.
- Take care of your body! Don’t skip meals, try to sleep enough so that you at least feel functional, and try to exercise, even if it is a short walk around the block,
- Avoid drugs or alcohol since they can affect your perception of reality and cause you to feel worse.
- Do small things that make you feel good throughout the day, everyday! Sneak a piece of chocolate in the car before picking up your kids, take an extra-long shower, watch highlights of the game during your break, or start a new hobby.
- Strengthen your support system. Surround yourself with people who help you stay positive and encourage you to be your best self. Spend time with family or friends, volunteer at a shelter or join a workout class.
Adjustment Disorder Leave Policies
According to the Americans with Disabilities Act (ADA), “a reasonable accommodation may be obtained for any condition that would, if left untreated, “substantially limit” one or more major life activities.”
Adjustment disorders typically do not last more than six months, however, depending on the severity of your symptoms and your treatment needs, you may be eligible to request reasonable accommodations from your employer. Accommodations can vary depending on the employer and the type of work you do.
Your therapist may need to provide documentation verifying that your symptoms are limiting your job performance and provide an explanation of how an accommodation could help you.
Adjustment Disorder Support Helplines
National Alliance on Mental Illness (NAMI) Helpline: Provides information on mental health disorders and referrals to local providers. Live person available M-F from 10am-6pm EST.
1-800-950-NAMI
1-800-950-6264
www.nami.org
National Suicide Prevention Lifeline: 24 hour toll-free crisis hotline to help connect you to a local crisis center that can help you seek help in your area.
1-800-273-TALK
1-800-273-8255
SAMHSA Treatment Referral Helpline: Provides general information on mental health and helps you locate treatment services in your area. Speak to a live person M-F 8am-8pm EST
1‑877‑SAMHSA7
1‑877‑726‑4727
www.samhsa.gov
Teen Line: Provides teen-to-teen counseling services from 9pm to 10pm.
1-310-855-HOPE
1-310-855-4673
1-800-TLC-TEEN
Texting available: TEEN to 839863
Remember that you are human and stressful things are tough! Remind yourself to take a break and don’t be afraid to ask for help if life feels overwhelming. Reach out to your family, friends, or therapist for support. Be kind to yourself! Don’t let mental disorders prevent you from living your best life!
About the Author:
Celia Viveros is a Licensed Clinical Social Worker in Washington State. The majority of her work has been with adolescents and families dealing with traumatic stress due to immigration, sexual abuse, and community violence. A great deal of her work has also been focused on helping adolescents with sexual behavior problems. Celia was inspired to write in order to provide an accessible way for people to get information on mental health issues. She hopes to provide helpful coping skills and most of all, normalize, the many issues people face but are too ashamed to talk about. Her goal is to provide people with tools that will help them find a healthy and joyful life.