Adjustment disorder

and Martina Feichter, medical editor and biologist

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of ​​enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

More about the experts

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

An adjustment disorder can occur after stressful life changes, such as a separation. Those affected suffer from anxiety and depressive moods and have difficulty fulfilling their daily obligations. In contrast to other mental disorders, the adjustment disorder is usually limited in time. Read all the important information about adjustment disorder here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. Z60F43

Adjustment disorder: 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 a partner, but also the birth of a child. If there is an adjustment disorder, the necessary adjustment will not succeed. The affected person is overwhelmed by the changes. The body and mind react to the stressful situation with symptoms. An adjustment disorder usually lasts for weeks to a few months. If the stress reaction is based on traumatic experiences and persists for a long time, there may also be a post-traumatic stress disorder.

The adjustment disorder, together with the acute stress reaction and the post-traumatic stress disorder, is assigned to the reactions to severe stress. In contrast to post-traumatic stress disorder, which occurs after severe trauma, the adjustment disorder is triggered by less serious experiences. However, the symptoms persist longer than in the case of the acute stress reaction. Doctors and therapists diagnose adjustment disorder when symptoms are more pronounced than a normal response to stress.

Adjustment Disorder: How Many Are Affected?

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

Adjustment disorder: symptoms

Grief, worry, anxiety, and loss of joy are typical signs of adjustment disorder. To some extent, such symptoms are a normal response to stressful events. However, if they are severe or persist for a long time, they affect the life of the person concerned. They then have great difficulty in going about their day-to-day tasks. They feel overwhelmed and often develop signs of depression and anxiety disorders. Adjustment disorder can also affect the body. Abdominal pain, difficulty concentrating, tension or cardiovascular problems can occur. Many of those affected 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 experienced identifiable psychosocial stress, which, however, was not of exceptional or even catastrophic proportions. Symptoms must appear within one month of the experience.
2. Those affected have symptoms and behavioral disorders, as they also occur with mood disorders (e.g. depression), neurotic disorders, stress disorders, social behavior disorders or somatoform disorders (physical complaints without an identifiable physical cause). The symptoms vary in type and severity.
3. The symptoms of adjustment disorder do not last longer than six months after the stressful event ends. The exception is a depressive adjustment disorder, which can last longer.

Depending on which symptoms are in the foreground, experts differentiate between various subforms of adjustment disorders:

• brief depressive reaction
• prolonged depressive response (can last up to two years)
• Mixed anxiety and depressive response
• with predominantly impairment of other feelings
• with predominant conduct disorder
• with mixed disorder of feelings and social behavior
• with other predominantly mentioned symptoms

Adjustment disorder in infants

Childbirth is stressful not only for the mother but also for the baby. Childbirth is stressful for both of them and does not always go without complications. The stress can trigger an adjustment disorder in both the mother and the baby. Difficulties in adjusting can be seen in infants, for example, through excessive crying, sleep and feeding disorders. These problems are also known as early childhood regulatory disorders. A regulatory disorder can also indicate a disorder in the parent-child relationship. Because infants are completely dependent on their parents' care. When parents are overwhelmed with the care of the child, both sides quickly become frustrated. The children react with increased restlessness and screaming. The desperation of the parents is thereby further increased. Parents should therefore quickly seek professional help from paediatricians or special clinics if they feel that they cannot cope with the situation.

Adjustment disorder in children and adolescents

In children, heavy thumb-sucking and bed-wetting, as well as relapse into such behaviors, can indicate an adjustment disorder.

In older children and adolescents, an adjustment disorder can manifest itself in disrupted social behavior. You react to a stressful situation with aggression, lies, truancy, stealing and other antisocial behaviors, among other things.

Adjustment disorder: causes and risk factors

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

However, not everyone who is exposed to such stress suffers from an adjustment disorder. Various factors work together to create it. Individual susceptibility plays an important role. Some people have developed strategies in life to successfully deal with difficult life situations. This makes it easier for them to cope with problems. It is also crucial how those affected rate the experience. People with a fearful tendency quickly experience situations as a threat and tend to feel overwhelmed.

The intensity and duration of the event as well as the environment also have an influence. The support of friends and family makes a significant contribution to maintaining a healthy psyche and wellbeing. However, when multiple stressful events come together, resilient people can also find themselves in crisis. It is still unclear what shares genes and biological factors play in the development of the adjustment disorder.

Adjustment disorder: examinations and diagnosis

The diagnosis “adjustment disorder” is given if the symptoms can be traced back to a specific cause and occurred within one month of the incisive experience. The adjustment disorder is only awarded for up to six months after the experience.

If you suspect an adjustment disorder, you can first contact your family doctor. The doctor will first do some tests to rule out a physical cause. Depending on the symptoms, for example, he will do an electrocardiogram (EKG) of the heart, palpate the abdomen or examine the blood. In the further course he will, for example, ask the following questions about the psychological symptoms:

1. Have you been burdened by an experience in the past few weeks?
2. Have you had little joy or interest in your work since then?
3. Do you feel sad or listless?
4. Do you feel that everything is too much for you?
5. Are you having trouble concentrating?

If the indications of an adjustment disorder are confirmed, the doctor can refer you to a therapist or psychiatrist. These make an accurate diagnosis and can rule out the possibility of 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 help measures. With a mild adjustment disorder, the support of friends and family can help. For stronger symptoms, experts recommend behavior therapy or psychoanalysis. For adjustment disorder therapy, talk therapy according to Carl Rogers and cognitive behavioral therapy have proven their worth.

In talk therapy, the relationship between the therapist and the client plays a crucial role. Rogers believed that everyone strives to grow and mature. The therapist therefore tries to create a particularly positive climate in which the client can realize himself. To solve the problems, the therapist orients himself to the client's resources.

Cognitive behavioral therapy focuses primarily on the client's handling of the situation and its misinterpretations. In the therapy sessions, the person affected learns new strategies to cope with their problems and to interpret situations more realistically. It is also important that the client re-establishes contact with his social environment. Whenever possible, the therapist involves relatives in the therapy process.

If the level of suffering is very high, the therapist may also prescribe medication for a short time in individual cases. For example, sleeping pills, sedatives from the group of benzodiazepines and antidepressants come into question (the medicinal plant St. John's wort helps if you are slightly depressed, otherwise a chemical antidepressant).

Adjustment disorder: disease course and prognosis

An adjustment disorder occurs after a stressful event and does not last longer than six months after its conclusion. In the case of long-term stress, for example due to unemployment, the course associated with depression can last for up to two years. Symptoms of depression also increase the risk of developing depression over the long term.

In many cases, symptoms of adjustment disorder go away over time, either on their own or with therapeutic treatment. In children and adolescents, an adjustment disorder lasts longer and has a poorer prognosis. Affected children and adolescents often show severe behavioral problems. However, the course of adjustment disorder also depends on the level of stress and social support.

Tags:  medicinal herbal home remedies toadstool poison plants sports fitness