Adjustment disorder – When stressful events become a life crisis

Adjustment disorders are one of the types of mental illnesses that have received far too little attention for a long time. Often, those affected do not even realize themselves that their sadness, fears or anger have a pathological value and thus end up in even more serious psychological downward spirals. With the knowledge of certain signs, such a disorder can be recognized early and treated very successfully with therapeutic support.

When is an adjustment disorder present?

In the course of life, everyone experiences challenging and stressful situations. However, the way we deal with them is fundamentally different and some find it easier, others more difficult to cope with them. Grief, fear and anger are common reactions that everyone knows, no matter how pronounced. In the case of an adjustment disorder, however, the affected person does not manage to deal with these strong feelings and adequately “adapt” to the new situation. The consequences are:

  • Pronounced negative changes in the state of mind (e.g. listlessness, brooding, anxiety, inner emptiness).
  • Disturbances in social behavior (e.g. withdrawal or excessive need for closeness)
  • Decreased performance (difficulty meeting obligations)
  • Physical complaints (e.g., headaches, nausea, tension)

In severe cases, serious relationship problems arise for those affected, or they may lose their jobs. Also, not infrequently, there is increased alcohol and drug use. It is also important to mention that it is not the objective extent of an underlying situation that determines the degree of stress, but the subjective feeling as well as the existing coping strategies and resilience. In most cases, symptoms subside after about six months. In some cases, however, they develop into more serious mental disorders such as depression or anxiety disorders. Normal reaction or already an adjustment disorder? As mentioned earlier, everyone goes through challenging times – and not everyone develops an adjustment disorder. With normal reactions to stressful situations or events, a certain amount of freedom still remains and not all areas of life are affected. Likewise, symptoms do not last as long. In the case of an adjustment disorder, the symptoms usually become more pronounced within the first month. Attention in diagnosis: Differentiation from other mental disorders As has already become clear, the symptoms of an adjustment disorder are very similar to those of many other clinical pictures and require special attention in diagnosis. Physical illnesses, depression, personality disorders and autism, for example, should be excluded. Also, of course, the aforementioned time periods in which the symptoms exist are very crucial.

What are causative factors?

As with many mental illnesses, there is not THE ONE cause of adjustment disorder. However, every disorder is preceded by a stressful event, and sometimes it is the result of several such situations on top of each other. However, such an event is not a mere extreme situation, but a serious life crisis. Examples are:

  • Accidents
  • Death of a close person
  • Loss of job
  • Divorce
  • Bullying
  • Financial difficulties
  • Serious illness
  • Ongoing family or work conflicts
  • Birth of a child
  • And many more…

The social environment can also contribute to illness if there is too little or no support. As yet, it is not entirely clear how significant genetic factors are. If people have a greater degree of sensitivity by nature, this could also be the reason why some people are more likely to become ill than others.

How can psychotherapy help?

Psychotherapy is very effective in the case of an adjustment disorder – especially the earlier it is used. In many cases, the symptoms will subside on their own after a few months, but therapeutic support can accelerate this process and make it much more bearable. If it is still an early stage, even a few sessions are often enough to improve coping with negative emotions, physical discomfort and social challenges. Depending on the situation, family members may also be involved. Behavioral therapy has proven particularly effective. As part of this, individual coping strategies are developed, existing resources are strengthened and new ones are developed. These can include, for example, participating in positive activities, expanding social contacts, or promoting helpful thoughts. Relaxation techniques such as meditation, progressive muscle relaxation or yoga may also be used. In addition, work can be done on the abuse of addictive substances. At the end of therapy, it is important to define personal early warning signs, discuss how to deal with them, and point out behavioral approaches so that future stressful events do not occur in the first place.

Excursus: Little helpers in dealing with stressful situations

In order to strengthen the handling of difficult situations in general or to increase the individual ability to cope with stress, there are some helpful methods. They do not help alone if there is already a deep emotional involvement or mental illness, but they can provide for the expansion of resources:

Sufficient sleep

On average, an adult person needs between seven and nine hours of sleep. Do you regularly get that number? It is also advisable to go to bed and get up at fixed times. During sleep, vital processes take place in which the body’s defenses are strengthened, cells are renewed, and the brain processes all the newly gathered impressions.

Regular social contacts

Maintaining friendships and family contacts satisfies our very own need to belong. In addition to pleasant experiences and memories, thoughts and worries can be shared and emotional support can be received. The people around us can also inspire us as well as confirm us in our values.

Provide time out

What this means for each individual person is completely individual. Whether it is reading a good book, swimming in the lake, having a massage or going to the movies. It is important to find a balance between duties and needs to be able to act in the long term.

Sufficient exercise

For some people this may already count as time out, for others it is initially an overcoming. It is worth trying out all forms of exercise: If it’s not the classic jog or a visit to the gym, then maybe a nice walk, a few minutes of stretching or a round of badminton in the park.

Healthy diet

This point is still greatly underestimated. Hardly anything is as closely linked to our mental well-being as our gut. Regular and varied meals are the basis for this. Just like not eating dinner too late before going to bed or the recommendation to eat at least 25 different kinds of fruit and vegetables a week.

  • Bengel, Jürgen & Hubert, Sybille: Adjustment disorder and acute stress reaction. Göttingen, 2010.
  • Hoffmann, Nicolas & Hofmann, Birgit: Adjustment disorder and life crisis. Weinheim, 2017.
  • Löhmer, Cornelia & Standhardt, Rüdiger: The art of relaxing in everyday life. Stuttgart, 2013.
  • Neumeir, Christian: Coping with stress. Munich, 2010.

Categories: Therapy

Dr. med. Kjell R. Brolund-Spaether
Ärztlicher Direktor und Chefarzt Dr. med. Kjell R. Brolund-Spaether
Dr. med. Kjell R. Brolund-Spaether ist renommierter Facharzt für Psychiatrie und Psychotherapie, bei dem stets der Mensch im Mittelpunkt steht: Dank seiner individuell abgestimmten, ganzheitlichen Behandlungspläne verbessert und personalisiert er die psychiatrische Versorgung kontinuierlich. Seine umfassende Expertise in der psychotherapeutischen und medikamentengestützten Behandlung erlangte er durch sein Studium der Humanmedizin an der Christian-Albrechts-Universität in Kiel, spezialisierte Weiterbildungen sowie seine langjährige Erfahrung in führenden Positionen. Seit 2019 ist Dr. med. Brolund-Spaether als Chefarzt und seit 2023 als Ärztlicher Direktor der LIMES Schlosskliniken AG tätig. 2024 trat er unserem Vorstand bei.

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