Major life changes or stressful life events trigger stress in most people. In addition, a feeling of distress and emotional impairment can occur, which impairs social functioning and performance and thus hinders adaptation to difficult life situations. In this case, we speak of an adjustment disorder.
Adjustment disorders are among the milder mental illnesses that have a good treatment prognosis if diagnosed early, but can also develop into more severe disorders if undiagnosed.
If you feel sadness, helplessness or other negative feelings after a stressful event, this is a completely normal reaction. However, if such feelings become so prevalent that they rob you of your freedom of action, it may be an adjustment disorder. The transition between normal reaction and illness is fluid and is defined by the level of personal suffering and the impairment of function and performance. Adjustment disorders can cause very different symptoms in those affected, with depressive and anxiety symptoms being particularly common.
Adjustment disorders are among the most common psychiatric illnesses. Up to 30% of all patients undergoing psychiatric treatment are given this diagnosis. However, there is no precise data on the frequency of adjustment disorders in the population. The reasons for this are the vague diagnostic criteria and the overlap of symptoms with other mental disorders, especially depression.
Adjustment disorders are always reactions to a specific stress. Since such situations can occur throughout the entire lifespan, adjustment disorders can be found at any age.
Critical life situations require every affected person to adapt. According to current knowledge, whether relevant psychological complaints occur during this coping process depends on various factors. Ultimately, it is about the balance between individual stress and protective factors: If the former outweigh the latter, the risk of illness increases. Among other things, the type and individual assessment of the event as well as the available resources influence the development and course of an adjustment disorder.
There are many triggers for adjustment disorders. These are not always acute, severe stressors; often less severe but long-lasting stressful situations also lead to exhaustion and suffering. In particular, the combination of several factors can cause an overload of personal coping mechanisms.
For example, the following stressful situations can result in an adjustment disorder:
Whether an event becomes a burden depends heavily on the subjective assessment. Retirement, for example, can be a burden for one person and a relief for another. Moreover, it is not always just negative events that contribute to the overall psychological burden: marriage, the birth of a child or a promotion to a position of responsibility also involve changes that tie up time and energy, which is then no longer available for coping with other stress factors.
The following criteria must be met for an adjustment disorder to be diagnosed:
If you suffer from an adjustment disorder, you are usually aware of what is bothering you. The thoughts of the triggering event will not let you go. Feelings that can have to do with fears, worries and helplessness are taking up more and more space. In any case, it is stressful feelings that take away your light-heartedness. The adjustment disorder may also mean that you are no longer able to cope with your daily life tasks as usual and that you withdraw from other people.
The symptoms that can occur with adjustment disorders are varied:
These symptoms can occur individually, in combination and in varying degrees of severity. The symptoms are not specific, i.e. they can also be found in other mental illnesses. It is therefore not always easy to make the correct diagnosis.
If you are suspected of having an adjustment disorder, we will first ask you about your medical history, in particular any stress factors, and about your symptoms. For the correct diagnosis of adjustment disorders, not only the type of symptoms is important, but also the time and duration of their occurrence.
The following questions may arise in a conversation with us:
In order to rule out other mental illnesses, we will also ask you about symptoms that you do not have. We occasionally supplement our diagnostics with standardized questionnaires. In some cases, an extended investigation to rule out a physical illness may also be necessary.
If diagnosed early, adjustment disorders generally have a good prognosis and can resolve completely. If the diagnosis is delayed and the stressful situation continues, a relatively harmless adjustment disorder can develop into a serious mental illness over the course of time, the treatment of which is more complex and also takes longer.
Important: Temporary weariness with life or suicidal thoughts are not uncommon with adjustment disorders. If you are suffering from suicidal thoughts, please do not conceal them under any circumstances. This is the only way we can work with you to find out how you can best deal with this difficult situation and what form of help makes the most sense at any given time. If you need urgent help, you can contact our duty doctors in the emergency ward of the USZ at any time.
We can only treat patients on site in the emergency ward. We are available by telephone 24 hours a day, 365 days a year.
Tel. +41 44 255 11 11
If a home visit is necessary, please contact the emergency psychiatrist in the city of Zurich via the Ärztefon (0800 33 66 55).