Chronic adjustment disorder

Chronic adjustment disorder

Patients with adjustment disorder experience outsized and long-lasting reactions to adverse events. Some people call it “situational depression” because the symptoms come after an identifiable trigger and the symptoms are similar to chronic depression.

Adjustment disorder can be difficult to diagnose because patients often see their reactions as typical of anyone in the same situation. Furthermore, the symptoms can mimic other mental disorders.

Types of adjustment disorders

The DSM-5 lists six types of adjustment disorder:

Adjustment disorder with depressed mood: Symptoms include feelings of sadness, hopelessness, crying and lack of joy from previous pleasurable things.

Adjustment disorder with anxiety: Symptoms include 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: Symptoms include feeling both anxious and depressed.

Adjustment disorder with disturbance of conduct: Symptoms include behavioral issues such as acting rebellious, destructive, reckless or impulsive.

Adjustment disorder with mixed disturbance or emotions and conduct: Symptoms include anxiety, depression and behavioral issues.

Adjustment disorder unspecified: Symptoms include physical symptoms such as headaches, body aches, stomach aches, heart palpitations, or insomnia.

Causes 

Any type of significant life change, including one that you may perceive as positive, can potentially lead to adjustment disorder. This disorder arises from the stress of a change resulting in an uncharacteristic and disproportionate behavioral or emotional reaction. Essentially, the change is more than we can bear using our usual coping mechanisms. The change can include events like:

• Break-up or divorce
• Relocation
• Losing a job or starting a new one
• Retirement
• Having a baby
• Illness or injuries
• Marriage
• The death of a loved one

Adjustment disorders occur within three months of a change or stressor, and generally resolve within six months. However, chronic adjustment disorders last longer, and can contribute to anxiety, depression, and substance abuse issues. Your genetics, previous life experience, and your personality can affect your likelihood of developing adjustment disorder. 

Symptoms

Signs and symptoms depend on the type of adjustment disorder and can vary from person to person. You experience more stress than would normally be expected in response to a stressful event, and the stress causes significant problems in your life.

Adjustment disorders affect how you feel and think about yourself and the world and may also affect your actions or behavior. Some examples include:

• Feeling sad, hopeless or not enjoying things you used to enjoy
• Frequent crying
• Worrying or feeling anxious, nervous, jittery or stressed out
• Trouble sleeping
• Lack of appetite
• Difficulty concentrating
• Feeling overwhelmed
• Difficulty functioning in daily activities
• Withdrawing from social supports
• Avoiding important things such as going to work or paying bills
• Suicidal thoughts or behavior

Symptoms of an adjustment disorder start within three months of a stressful event and last no longer than 6 months after the end of the stressful event. However, persistent or chronic adjustment disorders can continue for more than 6 months, especially if the stressor is ongoing, such as unemployment.

Diagnosis

Your health care provider will complete a full physical and mental health exam. They may consider the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association.

To be diagnosed with adjustment disorder, you have to meet the following five DSM-5 criteria:

• Your emotional or behavioral symptoms developed within three months of the start of the stressful event in your life.
• Your emotional or behavioral symptoms are clinically significant. This means that your distress must exceed what would normally be expected and/or the distress is causing significant problems in your work, home or social life.
• Your symptoms don’t meet the criteria for another mental disorder and are not a flare-up or worsening of an existing mental health problem.
• Your symptoms are not part of a normal grieving process.
• Your symptoms don’t last more than six months after the triggering event has ended.

Acute adjustment disorder means your symptoms last less than six months. Chronic adjustment disorder means your symptoms last six months or longer. Your healthcare provider should also take into account your cultural background in determining if your response to a stressor is in excess of what would be expected.