adjustment disorder

Adjustment error: Description

Life changing events, both positive and negative, create stress. They challenge people to adapt to the new situation. Stressful events can be for example an accident, the loss of the partner, but also the birth of a child. In an adjustment disorder, the required adjustment does not succeed. The person affected is overwhelmed by the changes. Body and psyche respond with symptoms to the stress situation. An adjustment disorder usually lasts for weeks to a few months. If the stress response is due to traumatic experiences and persists for a long time, post-traumatic stress disorder may also be present.

The adjustment disorder, along with the acute stress response and post-traumatic stress disorder, is attributed to severe stress responses. In contrast to the post-traumatic stress disorder, which occurs after severe trauma, the adjustment disorder is already triggered by less serious experiences. However, the symptoms persist longer than in the case of an acute stress reaction. The diagnosis of adaptive disorder is given to physicians and therapists when symptoms are more pronounced than a normal response to stress.

Adjustment disorder: how many are affected?

The diagnosis of adjustment disorder is given very often. This is also because it is difficult to differentiate this disorder from others. There are currently no clear figures on how many affected people actually have an adjustment disorder. It is estimated that about 0.6 percent of women and 0.3 percent of men suffer from it. An adjustment disorder can occur at any age. Singles are more at risk of suffering an accommodation disorder.

Adjustment disorder: symptoms

Grief, worry, fears and loss of pleasure are typical signs of an adjustment disorder. To a certain extent, such symptoms are a normal response to stressful events. However, if they are pronounced or last longer, they affect the life of the person affected. They then have great difficulty pursuing their day-to-day tasks. They feel overwhelmed and often develop signs of depression and anxiety disorders. An adjustment disorder can also affect the body. Abdominal pain, difficulty concentrating, tension or cardiovascular problems can occur. Many sufferers also withdraw from social life.

According to the ICD-10 classification of mental disorders, the following symptoms must be present for the diagnosis of adjustment disorder:

1. Those affected have experienced identifiable psychosocial distress but this has not been exceptional or even catastrophic. Symptoms must occur within one month of the experience.
2. Those affected have symptoms and behavioral problems, such as those associated with affective disorders (for example, depression), neurotic disorders, stress disorders, social behavior disorders, or somatoform disorders (physical complaints with no apparent physical cause). The symptoms vary in type and severity.
3. The symptoms of adjustment disorder do not last longer than six months after the onset of the stressful event. The exception is a depressive adjustment disorder that can last longer.

Depending on which symptoms are in the foreground, specialists distinguish different sub-forms of adjustment disorders:

• short depressive reaction
• prolonged depressive reaction (may last up to two years)
• Mixed anxiety and depressive reaction
• with predominant impairment of other emotions
• with prominent disturbance of social behavior
• with mixed disorder of feelings and social behavior
• with other predominantly mentioned symptoms

Adjustment disorder in infants

A birth is stressful not only for the mother, but also for the baby. The birth is associated with both stress and not always without complications. The stress can cause an adjustment disorder in both the mother and the baby. Adaptation difficulties in infants, for example, by excessive crying, sleep and feeding disorders. These problems are also referred to as early childhood regulatory disorders. A regulatory disorder may also indicate a disorder in the parent-child relationship. Because infants are completely dependent on the care of their parents. If parents are overwhelmed with caring for the child, both sides are quickly frustrated. The children react with increased agitation and screaming. The despair of the parents is thereby further strengthened. Parents should quickly seek professional help from paediatricians or specialist clinics if they feel they can not cope with the situation.

Adjustment disorder in children and adolescents

In children, heavy sucking of the thumb and bedwetting as well as a relapse into such behaviors may be indicative of an adjustment disorder.

In older children and adolescents, an adjustment disorder can manifest itself in a disturbed social behavior. They respond to a stressful situation, including aggression, lies, tails, stealing and other dissocial behaviors.

Adjustment disorder: causes and risk factors

Compared to other disorders, there is a clear cause of adjustment disorders. Without the stressful situation, the symptoms of adjustment disorder would not occur. Triggers of the adjustment disorder are not difficult traumatic experiences, but crises and stressful life changes. These include, for example, difficulties in work, separation from the partner, the transition to retirement, but also physical illnesses. In children and adolescents, the disorder often occurs in connection with school problems.

However, not everyone who is exposed to such stress suffers an adjustment disorder. Various factors interact to form the origin. Individual susceptibility plays an important role. Some people have developed strategies in life to deal successfully with difficult life situations. It is therefore easier for them to overcome problems. It is also crucial how those affected rate the experience. People with an anxious tendency quickly experience situations as a threat and feel overwhelmed.

The intensity and duration of the event as well as the environment have an influence. The support of friends and family makes a significant contribution to maintaining a healthy psyche and well-being. However, when several stress-causing events come together, resilient people can also run into crisis. The share of genes and biological factors in the development of the adaptation disorder is still unclear.

Adjustment disorder: examinations and diagnosis

The diagnosis “adjustment disorder” is awarded when the symptoms are due to a specific cause and have occurred within one month of the significant event. The adjustment disorder will only be given up to six months after the event.

If you suspect an adjustment disorder, you can first contact your family doctor. The doctor will first do some examinations to rule out a physical cause. For example, depending on the symptoms, he will do an electrocardiogram (ECG) of the heart, scan the abdomen, or examine the blood. Later, for example, he will ask the following questions about the mental symptoms:

1. Has you had an experience in recent weeks?
2. Have you had little pleasure or interest in your activities since then?
3. Do you feel sad or impotent?
4. Do you feel that everything is too much for you?
5. Do you have difficulty concentrating?

If the evidence of an adjustment disorder is confirmed, the doctor can refer you to a therapist or psychiatrist. These make a precise diagnosis and can rule out that it is another mental disorder. A correct diagnosis is important for further treatment.

Adjustment disorder: treatment

Depending on the severity of the adjustment disorder, the therapist will suggest various remedies. With a slight adjustment disorder, support from friends and family can already help. For stronger symptoms, experts recommend behavioral therapy or psychoanalysis. For the adjustment disorder therapy especially the talk therapy according to Carl Rogers as well as the cognitive behavior therapy proved itself.

In talk therapy, the relationship between the therapist and the client plays a crucial role. Rogers took the view that every person strives for growth and maturation. The therapist therefore tries to create a particularly positive climate in which the client can realize himself. To solve the problems, the therapist orientates himself to the resources of the client.

Cognitive behavioral therapy focuses above all on how the client deals with the situation and on its misinterpretations. The patient learns new strategies in the therapy sessions in order to cope with his problems and interpret situations more realistically. It is also important that the client re-establishes contact with his social environment. If possible, the therapist involves relatives in the therapy process.

If the level of suffering is very high, the therapist sometimes prescribes medication for a short time. For example, sleeping pills, tranquillizers from the group of benzodiazepines as well as antidepressants (in mild depressive moods, the medicinal plant St. John’s wort helps, otherwise a chemical antidepressant).

Adjustment disorder: disease course and prognosis

An adjustment disorder occurs after a stressful event and lasts no more than half a year after it has been completed. For long-term stress, such as unemployment, the course of depression can last up to two years. Depressive symptoms also increase the risk of developing depression over the long term.

In many cases, the symptoms of a disorder of adaptation disappear after some time either alone or by a therapeutic treatment. In adolescence, an adjustment disorder lasts longer and has a worse prognosis. Affected children and adolescents often show strong behavioral problems. The course of the adjustment disorder It also depends on the extent of burden and social support.