An adjustment disorder is an abnormal or extreme reaction to a life change, transition or stressor. Adjustment disorders can also apply to people who simply fear “moving forward,” or believe they have little control over their emotions. Adjustment disorders often manifest alongside anxiety, depression, and disturbance of conduct, and typically prevent the individual from completely functioning either at home, work or school.
When you reflect on your life and remember the times in which you struggled the most, what were the catalysts? When you describe those situations in the third person, does the severity not seem to match up to how strongly you reacted to it? In other words: does it seem like not such a big deal when you really think back? Most importantly: does this appear to be a pattern in your life? If so, you might not only be an extra sensitive person, you may have something called an adjustment disorder.
Adjustment disorder is the abnormal or excessive reaction to normal life stressors. A “normal” life stressor is considered to be something that typically happens to most people at some point in their lives, and can include the loss of a family member or loved one, a change in school or employer, financial hardship, the dissolution of a meaningful relationship. However, people with adjustment disorder have extreme reactions to these issues, leading to all kinds of symptoms including, but not limited to, bizarre behavior, social isolation, obsession, depression, anxiety, intense self-scrutiny, social anxiety, and so on.
To qualify as adjustment disorder, the stressor needs to have elicited a response that impairs one’s ability to successfully function at school, work or within their social groups. The symptoms of adjustment disorder tend to arise either preceding a life-changing event or in the months following it. Often, adjustment disorders can also be referred to as “situational depression,” but that term doesn’t quite cover the extent of what the response really means.
One of the key traits of someone with an adjustment disorder is a desire for control. They may seem to have contradicting personalities, such as being very laid-back at times but extremely particular and obsessive during others. It is common for people with adjustment disorders to fear change, to always assume the worst, be adverse to risk, and fixate if not obsess about things that seem out of their control. This is particularly true of people whose adjustment disorders are in response to breakups or other losses: they tend to blame themselves not because they have low self-esteem, but because blaming themselves helps them feel in control again, as though they can “fix” it. It is common for them to hold on for extensive periods of time, even if it’s not a person or relationship they really cared that much about in the first place. The problem is not actually the situation, it is the feeling of not being able to control the pain they are or aren’t in.
Types of adjustment disorders:
Adjustment disorder + depression
When people feel out of control of their life circumstances, they can easily adopt a sense of learned helplessness or the feeling that life is hopeless and meaningless, and so trying to fix or change anything about it would be pointless. They can feel absolutely overcome by dread or anxiety, which leads them to feeling constantly anxious, sad or even angry.
Adjustment disorder + anxiety
Another way that some people respond to feeling out of control is by having anxiety, which is more or less the body and mind’s way of “preparing” oneself for what could potentially go wrong in the future. People with anxious adjustment are often “type A,” meticulously organized and worst case scenario thinkers.
Adjustment disorder + mixed anxiety and depression
As anxiety and depression are essentially two ends of the same spectrum, it’s common for people with adjustment disorders to experience both at the same time, or to feel as though one tends to precede another.
Adjustment disorder + disturbance of conduct
Symptoms of disturbance of conduct are typically the identifying traits of someone with an adjustment disorder, as their anxiety or discomfort about a change in their lives renders them incapable of functioning. This could range from anything between impulsive behaviors, drinking, stealing or even getting into unhealthy relationships.
Adjustment disorder unspecified
Even if you are not specifically diagnosed with anxiety, depression, conduct issues or life interferences, you can still have an unspecified adjustment disorder, which umbrellas either a few of the symptoms or a bit of all of them.
Subtle symptoms of an adjustment disorder:
A “subtle symptom” refers to a habit, trait or pattern of behavior that isn’t obvious, or may pass as just being part of that person’s personality. It is subtle because it is usually not devastating, but certainly impacts one’s life to a degree at which it is at least noticeable.
1. Strong resistance to change. Even if the change is wanted, people with adjustment disorders will have a sense of irrational fear for life changes. An example could be getting into a new relationship, even if they want a relationship more than anything else: the shift into the “unknown” can be triggering for them, even if its ultimately a positive thing.
2. Consistently fearing the worst. People with adjustment disorders have an unconscious assumption that unknown = bad. Though this is at its core a natural human fear (some would even argue the only human fear) for people with adjustment disorders it controls their lives and prevents them from moving forward.
3. Desperately hanging onto the past. To create a sense of comfort and security, people with adjustment disorders will be obsessed with holding onto or re-creating relationships, situations or feelings that they once experienced. They may not want to leave the house they grew up in, or are convinced that a relationship that ended many years ago will “come back around.”
4. Self-sabotaging behaviors. People with adjustment disorders have a singular internal conflict: they want to move their lives forward and yet desperately fear that they will not be able to handle what happens when they do.
5. Irrational fears and exaggerated recollections of past situations. People with adjustment disorders literally struggle to adapt to new or different circumstances. This means that their perception of past experiences is going to be more vivid, extreme and negative than it may have actually been.
6. Coping or avoidance mechanisms. Struggling with an adjustment disorder means that an individual really struggles with managing their emotions. In order to feel more in control of them, they can use a fight/flight response to either numb themselves with food, alcohol, etc. or avoid a situation altogether.
7. Perfectionistic tendencies. Often, people with high-functioning adjustment disorders can seem as though they have their lives together more than the average person, simply because they are so adamant about making things as “perfect” as they can be.
Most common symptoms of an adjustment disorder:
- Ongoing depression or anxiety.
- Struggling with social anxiety or functioning.
- Social isolation.
- Avoiding potential triggers.
- Deep sense of shame and easily embarrassed.
- Easily irritated or prone to “snapping” at others.
- Physically sensitive, often complaining of aches or muscle stiffness.
- Often tired or low on energy.
- Stomach issues including IBS, constipation, and so on.
- Headaches and chest pain.
- Constantly calling oneself to the center of attention.
- Acting out in impulsive ways (perhaps by stealing, getting a reckless tattoo, drinking too much).
- Constant worrying.
- Deep need to be autonomous and in control of one’s life.
- Resistance to being in a relationship or merging lives together.
- Easily prone to thought or emotion “spirals.”
- Easily succumbs to A-Z thinking, assumes worst possible outcome will be the only outcome.
One of the most important things that makes an adjustment disorder distinct from simply grieving or feeling normal, natural bouts of sadness or stress is that the symptoms seem unrelated to bereavement and are directly correlated with a stressor, as in, they do not continue after the stressor is gone (as would be the case with clinical anxiety, or depression).
How to treat adjustment disorder:
One of the main characterizations of adjustment disorder is that the person suffering from it often feels as though there are no other options, or that their pain will last forever. This is often what contributes to the anxiety, depression, or even suicidal ideation. However, adjustment disorder is manageable, and in some cases, can be cured over time with regimented and consistent treatment.
Traditional treatments for the disorder include, but are not limited to: therapy, medication, cognitive behavioral therapy, group therapy or self-help study. However, for the long-term, the following techniques can be employed to help the individual respond more positively to life changes or unpredictable stresses:
1. Learn and practice relaxation techniques. This is so that you can learn how to respond more efficiently if your body is having a physiological response that you feel out of control of.
2. Work on managing what you can control in life, and identifying the difference between that and what you cannot. For example, healthy ways of managing adjustment fears can include learning to budget or exercise.
3. Try exposure therapy. By talking about or facing the feared change or stressor, you can work on mentally moving through the situation and seeing its conclusion. Typically, people with adjustment disorder panic because they think if something goes wrong, it would be the end of their lives. Exposure therapy helps to train the mind to not see challenges as finalities.
4. Work on building a fulfilling career. Something that people with adjustment disorders desperately need is a sense of control and autonomy over their lives and their futures, and applying that to their work is a productive way to accomplish that.
5. Address childhood traumas. People who struggle with adjustment disorders often have some degree of childhood trauma that has not yet been dealt with. At some point in their lives, something happened that made them feel completely out of control, and they grew to fear the feeling of being stuck.
6. Create action plans. Instead of feeling consumed by a stressor or life event, work with a professional or close and trustworthy friend to literally write out a plan of action for how you will address and respond to what’s upsetting you.
7. Validate your feelings. Yes, you’re having a strong reaction. Yes, it seems like everyone else is happy and well-adjusted. Neither of these facts mean that what you’re feeling isn’t real or shouldn’t be taken seriously.
8. Remember that it’s an overreaction. Even when you do validate how you feel, keep in mind that you are having an emotional response that is not necessarily a reflection of what’s really happening in your life.
9. Separate how you feel from what’s happening. Yes, it feels like the end of the world. That doesn’t mean it is. Work on reminding yourself that feelings aren’t facts and that your emotional response could be triggered by something entirely separate.
10. Don’t shame yourself for what you need to do to get by. If you have a coping mechanism of choice (given that it is at least relatively healthy and not self-destructive) don’t give yourself a hard time for needing to rely on it. What matters is that you’re committed to your survival.
11. Build your self-confidence. At the root of an adjustment disorder is the fear that you cannot handle what happens in your life. This is another way of saying that you are struggling with self-esteem. Work on confronting different situations in which you are forced to grow and develop your life skills.
12. Intentionally make yourself feel uncomfortable. You have to learn that what feels good isn’t always good for the long-term and that in fact, being intentionally uncomfortable is almost always necessary to growing, changing and achieving your goals. Finding ways to embrace pain rather than resisting and running from it can be very healing.
Adjustment disorders can feel scary, but they are manageable at the very least, and curable at best. What matters most is that you are at least able to identify what’s going on – that, right there, is half the battle.