What is adjustment disorder?

Adjustment disorder is a mental health condition that arises during a period of adaptation to a difficult life situation, as a result of a stressful event or cultural shock.

When does adjustment disorder occur?

When a person changes their job, home, or school, leaves their parents, or returns to their homeland after a long stay abroad, they are exposed to greater stress, psychological strain, and a risk of interpersonal conflicts. At such times, the likelihood of finding oneself in the "land of Adjustment Disorder" is high. This is a different place from the land of Depression, Stress, or Low Mood, even though many people fall into precisely this trap of confusion.

What are the symptoms of adjustment disorder?

Physical symptoms

The anxieties arising from uncertainty about the future and the difficulties a person faces in orienting themselves in a new, unfamiliar situation can manifest physically — for example through headaches, stomach pain, nausea, chest tightness, or skin reactions — as a way for the body to "store" and "displace" psychological pain, while the psyche still lacks the means to think symbolically (Klein, 1946).

Ogden emphasizes that these physical symptoms are particularly visible in people experiencing cultural shock or a drastic change in their social environment, and adds that the body sometimes becomes the primary carrier of psychological pain when thinking and verbal processing are insufficient (Ogden, 1989, 2009). Stress and anxiety have their own physical manifestations: "Emotions that the individual cannot contain and make sense of are 'placed' onto the body, and sometimes onto the objects and people around them" (Bronstein, 2010), and adaptation is blocked or delayed.

Emotional symptoms

In addition to signals from the body, a person who has found themselves in the land of Adjustment Disorder may experience:

• sadness and low mood;

• feelings of hopelessness or failure;

• increased anxiety and tension;

• irritability;

• a sense of insecurity about the future;

• a feeling of being unable to cope with the situation.

These experiences are usually linked to a specific life change and exceed the expected reaction to it.

Behavioural symptoms

In addition to emotional and physical manifestations, changes in behaviour may also occur:

• difficulty concentrating;

• absences from school or work;

• avoidance of responsibilities;

• social withdrawal;

• conflicts with loved ones and colleagues;

• aggressive reactions;

• abuse of alcohol or psychoactive substances.

These changes are often an attempt to cope with tension, but can further hinder adaptation to the new situation.

Adjustment disorder or depression?

Although the two conditions share similar manifestations, adjustment disorder arises following a specific stressful event and is usually associated with the process of adapting to change. In depression, symptoms are often more prolonged and cannot always be linked to a specific life situation.

How long does adjustment disorder last?

In many people, symptoms gradually diminish as they adapt to the new situation. However, when stress continues or sufficient support is lacking, difficulties may deepen and develop into more persistent emotional problems. Seeking help early supports recovery and reduces the risk of complications.

How does psychotherapy help?

The therapist plays the role of an emotional guide, helping the individual to:

• understand and name their emotions;

• connect their bodily reactions to their inner world;

• express feelings in a safe and healthy way;

• restore a sense of control and the capacity for adaptation.

In this way, the person gradually frees themselves from anxiety, restores contact with their inner life, and learns to function effectively in the new environment.

The hidden meaning of symptoms is revealed when we find the appropriate mental space for them. Then the body stops "speaking on our behalf" and begins to serve our ability to live fully (The Global Psychotherapist).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington

Василев, С. [VASILEV, S.] (2021). Съвременна клайнианска психоанализа [Contemporary Kleinian Psychoanalysis]. София: Колибри. [in Bulgarian]

Catalina Bronstein. (2010). On psychosomatics: The body as a target of primitive attacks. International Journal of Psychoanalysis, 91(5), 1077–1095. https://doi.org/10.1111/j.1745-8315.2010.00276.x

Melanie Klein. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-Analysis, 27, 99–110.

Thomas Ogden. (1989). The primitive edge of experience. Northvale, NJ: Jason Aronson.

Thomas Ogden. (2009). Rediscovering psychoanalysis: Thinking and dreaming, learning and forgetting. London, UK: Routledge.

Песешкиян, Н. [PESESCHKIAN, N.] (2003). Психосоматика и позитивна психотерапия - Том 2 [Psychosomatics and Positive Psychotherapy – Volume 2]. Варна: Славена. [in Bulgarian]

World Association for Positive and Transcultural Psychotherapy. (2020). Articles on psychosomatics and positive psychotherapy. Retrieved from https://www.positum.org