Adjustment Disorder

The overview of disorders related to traumatic and stressful events concludes with Adjustment Disorder. But what does "adjustment" mean in this context? Let's try to understand it in my own words.

Adapting to a situation means changing your behavior to be effective in a new situation. Suppose you change jobs; there will be stress due to the novelty of the situation, but once you learn the new procedures, that specific type of stress will fade. This means you have adapted. Now, suppose you experience the loss of a loved one. In this case, adapting may be more difficult, meaning it is challenging to "function well" as you did before the loss.

We understand that stressful events require effort from the individual to adapt and achieve a new healthy balance. Some events can severely test one's ability to adapt, such as the loss of a loved one, relationship breakups, financial difficulties, a potentially debilitating physical illness, and so on. If the individual does not adapt, a disorder may emerge. But what does "not adapting" mean?

According to the diagnostic manual (DSM-5), Adjustment Disorder is characterized by:

• The presence of emotional or behavioral symptoms as a result of one or more stressful events. These symptoms must emerge within three months of the stressful event.
• Marked distress disproportionate to the severity of the stressful event or significant impairment in the individual's quality of life.
• The symptoms do not persist for more than six months after the stressful event has ended.
• There is no better clinical explanation for the symptoms.

"Disproportionate to the situation" does not mean the individual has no right to feel pain, but that typically, most people studied respond differently. We might be tempted to say, "If I were in this situation, I wouldn't feel that bad!" We don't know if that is true, but we do know that "it's not me" in that situation. In my view, judging or minimizing someone else's pain in relation to your own life experience is wrong.

Try a mentalization exercise. Imagine experiencing a situation that causes you a lot of pain, and you talk about it with someone who ultimately tells you, "I think you're overreacting!" How would you feel? The person who judged your pain as an overreaction lacked empathy, particularly the cognitive part of empathy, which involves putting oneself in another person's shoes.

The diagnostic manual (DSM-5) distinguishes between traumatic episodes (such as those related to Post-Traumatic Stress Disorder and Acute Stress Disorder) and stressful episodes (like those exemplified in the previous slide). However, both trauma and stressful events deserve clinical attention.

While this disorder may be less known to non-professionals, its prevalence (i.e., the estimated percentage of its occurrence in the population) is very high. The data varies depending on the population studied (for example, it might be different in the West than in the East). However, the diagnostic manual (DSM-5) indicates that it is often the most common diagnosis in psychiatric consultations, frequently reaching up to 50%. Additionally, adjustment disorders carry an increased risk of suicide attempts and completed suicides.

Sources:

• American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

If you would like me to describe another psychology topic in my own words, feel free to write it in the comments!