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What is adjustment disorder?

Adjustment disorder is a very present difficulty in today’s society. Unlike our ancestors, in the XXI century it is common for us to change employment, partner, home or place of residence. However, we do not always know how to adapt to these new circumstances.

Precisely, this disorder occurs when we are unable to adequately manage such changes, to the point that we are affected by clinical stress that decreases the quality of life. What does it consist of? What are the diagnostic criteria? We will detail it below.

Do all the changes generate an adjustment disorder?

The answer is a definit no. Keep in mind that almost any type of major change  causes a number of inconveniences and inconveniences. However, we are usually able to adapt to them in a relatively short period of time.

Thus, being more irritable, nervous, showing symptoms of anxiety or sadness is usually normal in a context of life change, even if it is towards a better situation. We need a mental space to adapt. The problem appears when this symptomatology does not stop, but persists, and even increases over time.

¿Todos los cambios generan un trastorno adaptativo?
Not all changes lead to an adjustment disorder. In general, it is normal to experience anxiety or nervousness in any context of change.

Read also: How to manage stress properly

Diagnostic criteria for adjustment disorders

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , the adjustment disorder is included within the disorders related to trauma and stressors. Thus, the diagnosis is positive if the following criteria are met:

  1. Emotional or behavioral symptoms occur within the first three months after the stressful process begins.
  2. The clinical symptoms are relevant and can manifest as greater discomfort in response to the stressor or a significant deterioration in the social, work or academic environment.
  3. The symptoms do not meet criteria for another specific disorder and are not an exacerbation of a pre-existing mental disorder.
  4. Discomfort does not respond to a grieving reaction .
  5. After the stressor or its consequences are over, the symptoms do not persist beyond 6 months.

What types of adjustment disorders are there?

Faced with a traumatic or stressful event, people express discomfort in different ways. It will depend, above all, on the triggering factor , our personality and the mix of experiences previously lived. The DSM-V distinguishes the following subtypes according to symptoms:

  • With depressed mood. Low spirits, the urge to cry and a feeling of hopelessness predominate.
  • Anxiously. The most common symptoms are nervousness, worry, feeling overwhelmed, and difficulty concentrating or remembering things.
  • With a mixture of anxiety and depressed mood. Symptoms include a mixture of depression and anxiety.
  • With behavioral disturbance. Behavior changes abruptly and leads to a wide variety of behavioral problems such as truancy or work, fighting, reckless driving, or vandalism.
  • With a mixture of altered emotions and behavior. Emotional symptoms such as anxiety or depression predominate and are manifested together with behavioral problems.
  • Unspecified. This group would include all behaviors that cannot be classified in the other subtypes.

Other common symptoms of adjustment disorder

In addition to the symptoms described in the previous section, it is also common for people with adjustment disorder to have the following manifestations:

  • Concern.
  • Irritability.
  • Difficulty maintaining a daily routine.
  • Hostility.
  • Feeling of deep loneliness.
  • Low self-esteem.
  • Somatic complaints.
  • Excessive substance use.

For children and adolescents, the symptoms may be different. Thus, these tend to be irritable, anxious and with a lower school performance. Also, they often have difficulty sleeping, such as nightmares and night terrors. 

Read also: Histrionic personality disorder

Causes of adjustment disorders

There are factors that increase the possibility that a person will respond to a major change in a more pathological way. Among some of the most important are the following:

  • Low socio-cultural and economic level.
  • History of having suffered violence against children.
  • Previous anxiety disorder.
  • Having some type of personality disorder, such as dependent and borderline.
  • Severity of stressors.
  • Low level of resilience .
  • Poor family and social support system.

Is there any treatment for adjustment disorder?

The goal of treatment for adjustment disorder is to contribute to better management of emotions. Therefore, it is based mainly on two options: psychotherapy and medication.

Psychotherapy

The Psychotherapy is the primary treatment for these disorders. Depending on the symptoms to be treated, it can be individual, family or group. In particular, this therapy contributes to the following:

  • Have emotional support.
  • Understand why the stressor triggered such an intense reaction.
  • Strategies to better manage stress on a day-to-day basis.
  • Gradually recover normality.
Mujer en terapia
A combination of psychotherapy and medications can help you overcome adjustment disorder. In any case, it must be individualized.

Medicines

In some cases, the prescription of medications to treat anxiety and depression resulting from adjustment disorder can be a very good option, especially if they are combined with psychotherapy. Options include the following: 

  • Benzodiazepines , such as lorazepam Ativan ) and alprazolam (Xanax) .
  • Non-benzodiazepine anxiolytics, such as gabapentin (Neurontin) .
  • SSRIs or SNRIs, such as sertraline (Zoloft) or venlafaxine (Effexor XR ).

How to proceed with an adjustment disorder?

When suspecting an adjustment disorder, it is essential to consult a mental health professional such as a psychologist. Timely attention to this problem is essential to overcome it and prevent it from causing complications.

Similarly, it is helpful to consult your GP first for the first examination of symptoms. In any case, symptoms do not usually last long and recovery with treatment is quick.

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