Adjustment disorder: When the tough get going

Stress and sleep

Owen Wiseman

05 April 2020

What is adjustment disorder?

This condition is exactly what it may sound like intuitively. A stressful life event occurs and there is difficulty adjusting to the change, so in response, the individual may develop behavioural or emotional problems that can be linked back to the event at least within the past three months.

How common is it?

The statistics in Canada are unclear, but the disorder itself falls under the category of mood and anxiety disorders, which affect approximately 11.6% of those living across the nation. Supporting this, it is also estimated based on data amalgamated from the Canadian Chronic Disease Surveillance System that 1 in 10 Canadians use health services for mood and anxiety disorders annually.

What are the symptoms of an adjustment disorder?

Adjustment disorder is clinically diagnosed through criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), currently on its 5th edition.

The difficulty adjusting that the individual feels must be in excess of the response that an average individual would have. Considering the example in the intro where a child finds out they're moving, they would most likely be upset and rightfully so. However, if the child continued to weep for weeks on end, or become highly aggressive, then these may be beyond a 'normal' reaction.

The problems that they start exhibiting must also impair day-to-day function, whether socially or in the academic or occupational spheres.

  • The individual may slowly become withdrawn from their usual activities, or become less involved in their work or social circles.
  • One may start to demonstrate rebellious or impulsive behaviours that are out of character.
  • Sudden and random episodes of crying may occur
  • The child or adult may have difficulty focusing at school or work
  • Insomnia is not uncommon as thoughts of the stressor prevent the individual from falling asleep or may suddenly wake them. This could lead into a pattern of daytime sleepiness and further contribute to issues with concentration.
  • There may be a loss of self-esteem
  • A decreased mood is also common as the individual may feel a sense of loss over the situation at hand. In some cases, this change of mood may progress into clinical depression and it is critical to be mindful of suicidal ideation or thoughts.

What can trigger an adjustment disorder?

There are a variety of triggers, but the Holmes-Rahe Stress Inventory includes the Social Readjustment Rating Scale which was developed to score the intensity of stress associated with certain life events:

  • Minor violations of the law such as traffic tickets are scored at an 11,
  • Pregnancy comes in at a 40,
  • While topping the list at 100 is the death of a spouse.

These events are tallied based on those that have occurred in the past year with the final score predicting the chance of experiencing a major stress-induced breakdown in your health within the next two years. Many of the events here may contribute to an individual developing an adjustment disorder.

Is adjustment disorder a mental illness?

Yes, as per the DSM-V, although temporary and without long-term impacts given the benefit of a good support system.

Does the condition require medication? What can I do to manage?

Sometimes, watchful waiting is all it takes as some of the stressors may alleviate on their own given time. For example, if you lose your job and begin to experience symptoms of adjustment disorder, these will typically disappear when you find stability with new employment.

However, if the stressor is of a more chronic nature and you find yourself unable to cope, then participating in a mindfulness-based stress reduction program (MBSR) which runs over the course of 8 weeks may be just what the doctor ordered. MBSR offers a variety of evidence-based interventions including body scans, meditation, yoga and homework such as journaling. These activities help us become aware of triggers and identify and reflect on why we have these habitual reactions to stressors.

If the stressors are too much to handle, taking something to bolster your ability to cope with stress may be suggested. Researchers refer to this aspect as resilience, the ability or capacity to recover following adversity or trauma – general sources of stress.

One study published in 2017 demonstrated that individuals taking an extract of a plant known as Passion flower (Passioflora incarnata) experienced a significant increase in their overall levels of resilience. This included improvements in quality of life and accompanying symptoms of general stress such as sleep disturbances, lack of concentration, and inner restlessness. These effects were seen over the course of 12 weeks of treatment with the extract.

In other clinical trials, this plant has been shown to be as effective as oxazepam, a commonly prescribed benzodiazepine used for treating generalized anxiety disorder, but without the daytime impairment that may come accompany the pharmaceutical. Products such as Passion Flower contain an extract equivalent to about 279-308mg of the fresh herb. An easy to take tincture that can be added to water and dosed throughout the day.



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