Adjustment Disorder

What Causes Adjustment Disorder?

AD follows a triggering stressful event. The event is not always negative, but it typically causes a significant change in a person’s life and is perceived as stressful by the person. AD symptoms begin within three months after the event occurs and can last for up to six months after the stressful situation is over.

Common triggering events include:

• Death of a loved one
• End of a relationship or marriage
• Getting married
• Having a baby
• Losing a job or having problems at work
• Having problems at school
• Moving to a new place
• Financial or legal problems
• Having serious health issues (yourself or a loved one)
• Being a victim of crime, or having a loved one who is a crime victim
• Stress related to sex

Is Adjustment Disorder Hereditary?

Scientists are not sure whether or not some people may have a genetic predisposition that puts them at increased risk for developing adjustment disorders. For example, AD often shares symptoms with conditions such as major depression and anxiety disorders, and the risk for these disorders seems to have a genetic component. However, some research has suggested that the risk for mild disorders such as AD may not have the same link to genetics that depression and anxiety do.

How Is Adjustment Disorder Detected?

It’s not unusual for people to react strongly to life-changing events. However, AD symptoms are usually excessive and/or prolonged, and they interfere with a person’s ability to function well in their daily life. Therefore, identifying the disorder quickly and treating it promptly can help prevent potentially serious consequences.

Some possible warning signs of adjustment disorder include:

• Problems with concentration
• Changes in appetite
• Sleeping too much or too little
• Irritability or mood swings
• Withdrawal from other people
• Being irresponsible at work, school, or home (e.g., failing to pay bills)
• Frequent crying

How Is Adjustment Disorder Diagnosed?

Diagnosis of adjustment disorder begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that AD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for AD. These criteria include:

• Symptoms begin within three months of a stressful event and don’t last longer than six months after the stress is removed.
• The symptoms exceed what would be expected in response to the stress, and they are not part of the normal grieving process.
• The symptoms cause significant distress or impairment of daily functioning.
• The symptoms aren’t caused by another mental health-related issue.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Adjustment Disorder Treated?

Psychotherapy is the most commonly prescribed treatment for adjustment disorders. Treatment programs are typically brief and may include individual cognitive-behavioral therapy (CBT, family therapy, or group therapy.

Medication

Medications are not always used to treat AD, but some doctors may prescribe them to treat symptoms of anxiety or depression associated with the disorder. The most commonly prescribed medications include:

• Benzodiazepines. These drugs are used to treat anxiety. Common benzodiazepines include alprazolam, lorazepam, diazepam, and clonazepam.
• Selective serotonin reuptake inhibitors (SSRIs). These drugs work by increasing serotonin, a neurotransmitter chemical in the brain, and higher serotonin levels seem to help elevate mood in many people. Common SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs work similarly to SSRIs in that they increase serotonin levels, but they also increase the level of norepinephrine, another neurotransmitter.

How Does Adjustment Disorder Progress?

While AD symptoms are relatively mild and usually improve with treatment, AD can lead to severe complications if left untreated. Potential consequences of AD include:

• Relationship problems
• Problems at work or school
• Risk of developing major depression
• Risk of developing anxiety disorders
• Substance abuse
• Suicidal thoughts, suicide attempts, or suicide

How Is Adjustment Disorder Prevented?

There is no way to prevent AD, but prompt diagnosis and an effective treatment plan can help to manage symptoms. Prompt treatment may help relieve symptoms more quickly and prevent more severe complications.

Adjustment Disorder Caregiver Tips

In addition to seeking support from therapy or a support group, caregivers for someone with AD disorder should consider some of the following self-care tips:

• First, learn as much as possible about the disorder.
• Make time for yourself away from the disorder.
• Take care of your own physical and mental health. Unfortunately, it is not uncommon for caregivers to experience depression or let their own healthy lifestyle suffer because of stress.

Many people with adjustment disorders also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the conditions commonly associated with AD:

• Alcoholism or substance use disorders are commonly co-morbid with AD.
• People with AD are at increased risk of suicide.

Adjustment Disorder Brain Science

Adjustment disorders share some characteristics with anxiety disorders and posttraumatic stress disorder (PTSD). However, there are significant differences between AD and the other conditions, which may call into question any assumption that all the disorders affect the brain in the same way.

A part of the brain called the amygdala has been implicated in PTSD and anxiety disorders. The amygdala is responsible for detecting potential threats and alerting the rest of the brain. However, in the case of PTSD and anxiety, the amygdala may not communicate effectively with the prefrontal cortex, a part of the brain responsible for determining whether or not a threat is real. As a result, people with PTSD or anxiety may respond inappropriately to stress.

People with AD also have reactions out of proportion to the present stressors. However, AD always happens in response to an actual stressful event, unlike anxiety, which can occur even when there is no real external stressor. And unlike PTSD symptoms, AD symptoms usually go away when the stressor is removed. These differences suggest that something different is happening in the brains of people with AD, but scientists have not yet identified the differences.

Adjustment Disorder Research

Title: PH94B in the Treatment of Adjustment Disorder With Anxiety

Stage: Recruiting

Contact: Matt Turzilli

VistaGen Clinical Site

Watertown, MA

This placebo-controlled clinical study is designed to evaluate the efficacy, safety, and tolerability of administration of PH94B nasal spray four times per day as a treatment for Adjustment Disorder with Anxiety symptoms in adults. Subject participation in the Study will last 6 to 10 weeks, depending on the duration of the screening period and whether they need a washout of concomitant anxiolytics. Upon signing an investigation review board-approved informed consent, all subjects will complete Visit 1 (Screening) and enter a screening period lasting 7 to 35 days that could include a taper of concomitant anxiolytics, if necessary. The screening visit will consist of safety assessments (medical history, physical examination, laboratory samples, electrocardiogram, urine drug screen, and urine pregnancy test [if appropriate]) and psychiatric assessments to determine eligibility. Subjects will then return to complete Visit 2 (Baseline). If the subject continues to meet inclusion and exclusion criteria, the subject will be randomized 1:1 to PH94B or placebo. Subjects will then commence four weeks of double-blind treatment with a randomized investigational product (PH94B or placebo) four times per day.

Subjects will return for weekly site visits (Visits 3, 4, 5, and 6), in which the subject will return the vial dispensed at the previous visit and receive a new vial, except at Visit 6, in which no new vial will be dispensed. Changes in AEs and concomitant medications will be collected. During these visits, psychiatric scales will be completed. When the subject returns for Visit 6, besides the assessments completed at Visits 3 through 5, the subjects will complete a brief physical examination, electrocardiogram, laboratory tests (chemistry and blood), and urinalysis. Any remaining IP vials will be collected. The subject will then come back after a one-week washout period for a Follow-up visit (Visit 7).

Title: The Trauma of Betrayal: Treating Adjustment Disorder With Reconsolidation Blockade Under Propranolol

Stage: Recruiting

Contact: Alain Brunet, PhD

Douglas Mental Health University Institute

Montreal, Quebec

Attachment injuries are events occurring within couple relationships that involve betrayal or abandonment by a significant other during times of need (e.g., infidelity). They can be understood as relationship traumas, which can lead to debilitating symptoms consistent with posttraumatic stress disorder (PTSD), depression, and generalized anxiety for the injured partner. Research has demonstrated that the presence of an attachment injury represents a barrier to empirically effective couple’s therapy. However, disrupting memory reconsolidation with the beta-blocker propranolol has been shown to alleviate PTSD symptoms by attenuating the salience of the emotional trauma memory, representing an interesting avenue for the treatment of adjustment disorders stemming from attachment injuries. Moreover, evidence suggests that a certain degree of mismatch, or an error between what is expected/predicted to occur and what actually occurs, must be present for a memory to destabilize and enter the reconsolidation phase following retrieval. Here, the investigators aim to extend the conditions under which reconsolidation therapy with propranolol can be used in a clinical setting, as well as assess whether incorporating mismatch enhances treatment effects. The investigators hypothesize that, compared to a wait-list control, 4-6 sessions of memory reactivation under propranolol will significantly reduce trauma-related and general anxio-depressive symptoms associated with an attachment injury. Moreover, the investigators hypothesize that participants randomized to the mismatch group will improve significantly more than the standard treatment group on all variables of interest.

Title: Internet-based CBT vs. TAU for Stress-related Disorders

Stage: Recruiting

Contact: Elin Lindsater, PhD

Gustavsbergs Primary Care Center

Stockholm, Sweden

Non-traumatic stress-related mental illness, in this study operationalized as adjustment disorder or exhaustion disorder, is highly prevalent in the general population and associated with high societal costs relating to productivity loss. Cognitive behavior therapy (CBT) is the most well-studied psychological treatment and has demonstrated promising effects in terms of symptom reduction. However, the overall evidence base for CBT for these disorders is fairly weak, and access to treatment is low. In a previously published randomized controlled trial, researchers found that internet-based CBT can yield significant effects on core symptoms of stress for these disorders. Delivering CBT via the internet has the significant advantage of enabling increased accessibility as each therapist can have up to 80 patients in ongoing treatment. In the previously conducted trial, researchers compared the treatment to a waitlist control, and between-group comparisons of treatment effects were only made at post-treatment as the waitlist condition was crossed over to treatment after this time point. Therefore, it is important to take the next step and investigate the effects of internet-based CBT in comparison to an active control condition. The primary aim of this study was to compare two internet-based treatments, CBT vs. structured treatment-as-usual, for adjustment disorder and exhaustion disorder.