An adjustment disorder or stress response syndrome is a condition that occurs when a person has difficulty coping with an extremely stressful event. Experts use the two terms interchangeably, with adjustment disorder being more common. These conditions involve a normal emotional or behavioral reaction that develops more intensely than in the average person. Doctors have recognized similar conditions for a long time, though these terms only appeared in the mental disorders classification systems around 30 years ago.
Many people view adjustment disorder as a milder form of anxiety disorder, depressive disorder, or PTSD. Adjustment disorder shares many characteristics with these conditions: nervousness, anxiety, and feelings of desperation and hopelessness. Thoughts of suicide, suicidal behavior, and self-harm are all prominent among individuals with adjustment disorders. Despite these similarities, the disorder results from an outside stressor, while anxiety and depressive disorders often stem from internal triggers. Symptoms of an adjustment disorder can be acute or chronic, persisting for less than six months, or more.
The term “stress response syndrome” applies to this condition because the symptoms arise from normal stress responses. However, in people with the disorder, these reactions are more intense than they should be. The stress response begins when a person recognizes a possible threat, which can be a physical danger, such as an oncoming car, or more intangible, like a looming deadline. When a stressful event occurs, the amygdala in the brain sends a distress signal to the hypothalamus, which triggers the adrenal glands to pump adrenaline into the bloodstream. This begins the many physical reactions that are part of the stress response.
People who experience trauma are at a greater risk of developing an adjustment disorder, even if that trauma occurred many years before. Any event of a serious and unusual nature can be a trigger, including the loss of a loved one, a medical operation, a poor evaluation, or a relocation. One study found that the most common stressors are parental and peer issues. Experts believe that recurring stressors are more likely to cause a disorder. They also believe that the objective severity of a stressor is less important than how each specific individual perceives their stressors. Adult females receive twice as many diagnoses for adjustment disorders as adult males, and research suggests up to 21% of adults have one of these disorders.
The DSM-5 lists six adjustment disorders, each with unique effects. These categories are:
Though the signs and symptoms of adjustment disorders are wide-reaching and varied, a common effect is suicidal ideation or suicidal thoughts. Ideation appears to affect the majority of individuals with the disorder, regardless of age or trigger. Up to one-fifth of adolescent suicide victims may have adjustment disorders. Various studies suggest that a similar ratio of adults with adjustment disorders attempt suicide. The exact rate appears to be less than that of major depression but is still significant enough to warrant intervention.
Because adjustment disorder and stress response syndrome appear in the DSM-5 and ICD-11, there exist official methods for diagnosis. Doctors must identify a stressor and how removing it will affect the patient. This becomes significantly more difficult with long-term stressors because the exposure results in adjustment disorders, major depressive disorder, and generalized anxiety disorder. An important part of diagnosing an adjustment disorder is ruling out these similar conditions. Additionally, the symptoms should be significantly more intense than those that are part of the normal grieving process or stress response, which are also highly variable reactions.
There is little research focusing on how best to treat people with adjustment disorders. In many cases, the disorders are self-limiting and resolve themselves within a few months to a few years. However, between 20 and 50% of people with an adjustment disorder go on to receive a diagnosis for a more serious psychiatric condition. This, in combination with the frequency of suicide ideation, makes proper treatment vital.
When treating adjustment disorders, the primary goal is to relieve symptoms and help the individual return to a healthy level of functioning. Different therapies can prove effective for each person, so it is important to find a treatment that fits the individual’s needs. Options include psychotherapy, behavior therapy, family therapy, and self-help groups. The goals of therapy include forming strong support structures and developing relaxation techniques that allow patients to manage stressors and learn to avoid those that may arise in the future.
In addition to professional help, families and friends can provide support to people with adjustment disorders. The support system can encourage the sharing of emotions and reinforce that they understand and legitimize the person's feelings. An important part of building an effective support structure is making sure that the individual has hobbies or activities that they enjoy. These interests can provide moments of relief during periods of stress, anxiety, and depression.
Throughout the years, some professionals have criticized adjustment disorders and their classification. Generally, these individuals find fault in the lack of specific symptoms, as well as few links to environmental factors. Because there is less research on these disorders, some people feel the classifications are too vague. However, supporters of the DSM-5 classification believe that it serves many useful purposes. Among them, it provides a temporary and non-stigmatizing diagnosis for people who need treatment for depressive and anxiety symptoms.
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