A Comprehensive Guide to Adjustment Disorder vs PTSD

This article will provide a clear, informative comparison between Adjustment Disorder and PTSD, highlighting their differences, similarities, and treatment options to educate and encourage those affected to seek appropriate care.

Introduction

There are several types of mental health disorders that can result from traumatic events or stress. It is important to understand the key signs and the difference between adjustment disorder and PTSD in order to get an accurate diagnosis. This article will focus on distinguishing adjustment disorder from PTSD by reviewing the symptoms and diagnostic criteria, risk factors, and treatment options for both side by side.

Understanding Adjustment Disorder:

Adjustment disorder falls under the category of trauma-and-stressor-related disorders. These include any disorders where there is an exposure to a stressful event or traumatic event that is explicitly part of the diagnostic criteria.

The most identifiable aspect of adjustment disorders is the presence of emotional or behavioral symptoms in response to a specific stressor. This stressor can be a single event like a relationship coming to an end, or it can include multiple stressors like marital problems that coexist with issues at work.

The stressors might be recurrent, like seasonal issues at work that lead to financial strain or unfulfilling relationships. The stressors can also be continuous, like living in a poor neighborhood with a lot of crime or struggling with a chronic illness that is increasing in disability.

Stressors can affect individuals, a whole family, or a larger community. Stressors might be something like interpersonal relationships in a marriage that affect a couple or low-income issues that affect the whole family, or even natural disasters that affect an entire community.

Some stressors that cause adjustment disorders are company-specific developmental stages in life such as:

• Going to school
• Leaving home for the first time
• Coming back to a parent’s home
• Getting married
• Having children
• Changing jobs
• Failing to reach work goals
• Retiring

Symptoms and diagnostic criteria.

In order to be diagnosed with an adjustment disorder an individual must display the following:

1. Adjustment disorders have emotional and behavioral symptoms which arise in response to a clearly identifiable stress or stressors. These symptoms manifest within 3 months of the identifiable stressor. 
2. Symptoms or behaviors must be significant and cause:
   1. Marked distress that is disproportionate to the intensity or severity of the stressor, even with regard to extra cultural factors or contextual factors
   2. Significant impairment in daily occupational, or social function
3. The stress-related issue can’t be an exacerbated symptom of another mental health disorder.
4. The symptoms can’t be better explained by normal bereavement or grief disorders.
5. Once the stressor is terminated, the symptoms cannot persist for more than 6 months.

Symptoms can include:

• With depressed mood, including feelings of dominant hopelessness, tearfulness, and low mood.
• With anxiety, including feelings of dominant nervousness, separation anxiety, worry, or jitteriness. 
• With anxiety and depressed mood

Adjustment disorders can accompany any other medical condition or mental health disorder. Someone with problems at work who loses their job might have a diagnosis of OCD and develop an adjustment disorder with symptoms of depression as a result of losing their job.

Causes and risk factors.

With adjustment disorder, people who come from disadvantaged life circumstances and are exposed to higher levels of stressors are at an increased risk of adjustment disorder development.

Adjustment disorders are quite common, with nearly 20% of individuals who seek mental health treatment in the United States struggling with an adjustment disorder as their primary diagnosis. adjustment disorders are higher in women than they are in men.

Treatment options and prognosis.

Treatment typically involves cognitive behavioral therapeutic approaches as well as family therapy if changes need to happen for an entire family. this type of supportive therapy can improve things like:

• Impulse control
• Stress management skills
• Anger management skills
• Communication skills
• Problem-solving skills

Cognitive behavioral therapy and family therapy can provide age-appropriate coping skills for all affected individuals. In some cases, that might include changing the relationship to the stressor, particularly for continuous stressors.

Individuals who participate in individual therapy or family and group therapy and build these skills are likely to have a positive prognosis, developing resilience that helps reduce the impact of the same or new stressors moving forward. 

Understanding PTSD (Post-Traumatic Stress Disorder):

Post-traumatic stress disorder (PTSD) falls under the category of trauma-and-stressor-related disorders. These include any disorders where there is an exposure to a stressful event or traumatic event that is explicitly part of the diagnostic criteria. 

Symptoms and diagnostic criteria.

To be diagnosed with PTSD, you might have the following:

1. Exposure to actual or threatened death, sexual violence, or serious injury in one or more of the following:
   1. Directly experiencing a traumatic event
   2. Witnessing trauma that occurs to other people
   3. Learning that a close family member or friend experienced trauma
   4. Experiencing repeated trauma or repeated exposure to aversive details about traumatic events
2. The presence of one or more intrusive symptoms associated with the trauma which begin after the event:
   1. Recurrence, intrusive, and involuntary distressing memories of the trauma
   2. Recurrent nightmares about the trauma
   3. Flashbacks where an individual feels like they are back in the traumatic event
   4. Intense psychological distress brought about by things that remind them of the trauma
   5. Marked physiological reactions to triggers
3. Persistent avoidance of stimuli which are associated with the trauma, including one or both of the following:
   1. Avoidance of distressing thoughts, memories, or feelings associated with the trauma
   2. Avoidance of external reminders like objects, places, conversations, or people that might be related to the trauma
4. Negative changes in cognition and mood which begin and get worse after the traumatic event, as manifested by two or more of the following:
   1. An inability to remember certain aspects of the trauma
   2. Persistent or exaggerated negative beliefs about one’s self or the world around them such as thinking they are a bad person or the world is completely dangerous and they can’t trust anyone
   3. Persistent and distorted thoughts that cause an individual to blame themselves for the trauma that happened to them
   4. Persistent and negative emotional states such as anger, shame, fear, or guilt
   5. Markedly diminished interest in significant activities
   6. Feelings of detachment from others
   7. A persistent inability to experience positive emotions like love, happiness, or satisfaction
5. Marked alterations in reactivity and arousal with two or more of the following symptoms:
   1. Irritable or angry outbursts without provocation that are expressed verbally or physically toward others or other things
   2. Self-destructive behavior or recklessness
   3. Hypervigilance
   4. Being startled easily
   5. Concentration issues
   6. Sleep problems
6. Disturbances for negative alterations and intrusive symptoms that last at least one month. 
7. Symptoms that cause significant distress or impairment in important areas of functioning.
8. Symptoms are not better explained by substance abuse or other medical conditions.

Symptoms of PTSD can occur at any age, but they usually develop within the first 3 months following a traumatic event. Many of the symptoms change in terms of intensity and can recur throughout life in response to ongoing stress, reminders of the original trauma, or secondary traumatic experiences.

Some people recover within 3 months, while others struggle for years or decades with their symptoms, especially if they don’t get treatment.

The national lifetime prevalence for PTSD is 6.8% of adults, with an average of 7% of adults struggling with PTSD their entire lives. Rates of PTSD are higher among certain demographics, including:

• Military personnel
• Police officers
• Firefighters
• Emergency medical personnel

Individuals who struggle with PTSD often have exaggerated and persistent negative beliefs that they apply to themselves or the world around them. For example, people who have struggled with trauma are more likely to think things like the following:

• “I can never trust anyone again.”
• “The world is completely dangerous, and I will never be safe.”
• “I am ruined, and my life is over.”
• “I will never be happy again.”
• “Bad things will continue to happen to me.”

It’s also common for people who have PTSD to have incorrect ideas about what caused the trauma, often blaming themselves or other people. 

For example, someone who was abused as a child might think that it’s their fault. 

Causes and risk factors.

PTSD can be caused by severe exposure to trauma, including:

1. Perceived threats to life
2. Personal injury
3. Interpersonal trauma
4. Military service

Other causes include socioeconomic status, lower education, childhood adversity, discrimination, family history of psychiatric conditions, and childhood emotional problems developed by the age of six.

PTSD has more than just environmental risk factors. 

There are temperamental post-traumatic factors as well, including inappropriate coping strategies or the development of acute stress disorder, both of which can increase the risk of developing PTSD. Similarly, there are environmental post-traumatic factors that can increase the risk, including:

1. Exposure to regular upsetting reminders, 
2. Trauma-related losses or financial strain, and 
3. Subsequent life challenges.

Exposure to ethnic or racial discrimination has been associated with a higher risk of PTSD development.

Exposure to regular traumatic struggles early in life and heightened daily stress can also contribute to the risk of developing PTSD.

Those who struggle with PTSD are more likely to develop symptoms for at least one other mental health disorder, including:

1. Bipolar disorder
2. Depressive disorder
3. Anxiety disorder
4. Substance abuse disorder 

People with PTSD also have an increased risk of major neurocognitive disorder.

PTSD is more prevalent in women than men, with a lifetime prevalence among women of 10% but only 5% for men. This means women are twice as likely to struggle with PTSD because of their increased risk of interpersonal violence, sexual assault, and sexual abuse, particularly in childhood. Other factors that contribute to this higher prevalence among women include gender differences in terms of cognitive and emotional processing and the effect that reproductive hormones can have. 

Treatment options and prognosis.

Trauma-Informed therapy

Trauma-informed therapy is the most common treatment for PTSD. This type of therapy can be traditional psychotherapy or cognitive behavioral therapy but from a trauma-informed approach. Professionals who lead trauma-informed therapy have a background in the techniques and approaches necessary to avoid retraumatization.

Retraumatization is when seeking help causes you to experience additional trauma because of any number of things that might trigger you or exacerbate symptoms, like certain sounds, smells, being touched, or even being treated by someone of a specific gender.

EMDR

Eye movement desensitization and reprocessing is quickly becoming the most effective form of treatment for PTSD. 

The World Health Organization and the U.S. Department of Veterans Affairs advocate for EMDR as a primary approach to PTSD treatment.

EMDR has several benefits in that it is not the same as traditional talk therapy, where you have to sit and talk about your traumatic experiences with a therapist. Instead, you can sit comfortably while you think about the traumatic memory, and you follow eye movements either directed by an individual or through a set of headphones.

This changes how your brain stores your memories. Under normal circumstances, without any trauma, memories get stored in a seamless process while you sleep. However, this process gets disrupted during traumatic events, which means the memories aren’t stored properly, and this means that new neural links are reinforced regularly, which increases your sensitivity to things like depression, anxiety, flashbacks, hypervigilance, and other PTSD symptoms.

EMDR helps to build new neural links, which removes that reinforcement and reprocesses triggers so that you don’t have the same triggers and can process the trauma successfully.

Medications

SSRIs can be prescribed to help manage some of the symptoms of PTSD. Medication is designed as a temporary solution and is most effective when used in conjunction with therapy. Therapy increases the efficacy of medication and helps individuals develop the skills they need to avoid retraumatization and reduce the need for medication long-term.

Key differences between Adjustment Disorder and PTSD:

There are a few key differences between adjustment disorders and PTSD, namely, having to do with the symptoms, causes, and treatment. 

Symptoms

One of the biggest differences between adjustment disorder vs PTSD has to do with symptoms. The symptoms themselves are different despite both of them interfering with daily function, but more importantly, when reviewing for adjustment disorder or PTSD, adjustment disorder symptoms happen on a very strict timeline, within 3 months of a new stressor, and the symptoms go away within 6 months of the conclusion of that stressor. 

By comparison, PTSD symptoms can develop several months after a traumatic event and never go away on their own without treatment. There is no set timeline for this either. 

Duration

As mentioned, the symptoms present the largest difference between adjustment disorder and PTSD. PTSD symptoms can continue until such time as proper treatment is received, whereas acute stress disorders have symptoms that manifest in a very strict timeline, and as soon as the source of the symptoms goes away, so do the symptoms. 

With PTSD and adjustment disorder, there is also a difference in how the symptoms relate to triggering events. For adjustment disorders, individuals have behavioral symptoms as a direct result of one or more stressors, but they don’t struggle with continued triggers the way someone with PTSD does. 

Causes: adjustment disorder vs PTSD

Another key difference between adjustment disorder and PTSD is the cause. Adjustment disorders are defined as reactions to stressful events, but there is no single direct cause between the two.

For example, young children and teenagers vary in terms of vulnerability, past experiences, temperament, and coping skills, so their ability developmentally to deal with stress from starting a new school or moving out of their parent’s home will differ from one person to the next.

The same is true of adults who might struggle with stressors with symptoms that vary in terms of severity, but no evidence suggests that a single factor directly causes adjustment disorders.

By comparison, PTSD has very clear causes, and they relate specifically to a traumatic event. The traumatic event causes issues in the way in which the brain stores memories and this can disrupt neural pathways, which leads to severe symptoms like hypervigilance and flashbacks.

Treatment: PTSD vs adjustment disorder

Treatment for adjustment disorder hinges on cognitive behavioral approaches. Medication is rarely used as it has limited value and adjustment disorder treatment, but things like cognitive behavioral therapy can provide age-appropriate coping skills, impulse control skills, and stress management skills, all of which help to reduce the impact of the stressors and improve resilience.

PTSD treatment centers on rewiring the way in which the traumatic memories are stored in the brain through things like EMDR therapy while also providing acute relief with medications, including SSRIs. Other therapy can include cognitive behavioral therapy from a trauma-informed approach.

Adjustment disorder vs. PTSD outcomes

Another difference has to do with the potential outcome. Adjustment disorders have the ability to be acute, lasting no more than 6 months after the stressor caused the emotional and behavioral symptoms has been terminated, or chronic which means the symptoms last longer than 6 months. 

Nonetheless, evidence suggests that acute adjustment disorder will rectify itself once the source of the distress is rectified. This means an individual can go back to their daily lives with little interference.

The same cannot be said for PTSD, which tends to be a long-term mental health condition that, if left untreated, can cause secondary and tertiary mental health and medical disorders.

That is why it’s very important to get a proper diagnosis and find the right treatment plan if you experience any of these symptoms.

Can Adjustment Disorder and PTSD be diagnosed together?

Yes, they can. PTSD and adjustment disorder can coexist. In fact, adjustment disorders have a high comorbidity with many other mental health and medical conditions. Individuals can have PTSD, developed from a previous traumatic incident, and then develop adjustment disorder as a result of a short-term stressor in life. Once that stressor goes away, so would the adjustment disorder symptoms, but the PTSD symptoms might remain if the condition is left untreated. 

For example:

Jose served in the army for 10 years. During that time, he was deployed overseas, where he directly witnessed several traumatic events. Each time he came home, he struggled a bit more with symptoms of irritability, depression, nightmares, and flashbacks. 

The high school baseball field was up the street from his house, and every Friday night, they had fireworks, which triggered him. He would tuck and roll under his bed with his firearm. 

Then Jose left the army, and he and his family moved to a new state to look after his aging parents. The process of moving caused him to develop an acute stress disorder. Symptoms appeared a month after he started clearing out the house, packing things, and making arrangements for the buying and selling of their homes. He began to struggle with low mood, feelings of hopelessness, and separation anxiety. 

Once Jose and his family relocated and settled into their new home with his aging parents, the symptoms of low mood, hopelessness, and separation anxiety dissipated. 

However, he still struggled with depression, nightmares, and flashbacks, especially when triggered. 

PTSD vs. Adjustment Disorder: Getting Help

Given the overlap in these conditions and the high rate of comorbidity, it can be difficult to get a diagnosis without professional help. A qualified mental health professional can review the complexity of your symptoms and provide a recommendation for the right line of treatment. 

No matter how minimal your symptoms might seem, if they are affecting your daily function, which is common with both PTSD and adjustment disorder, the right type of treatment can provide a sense of control in your life when things feel out of your control.

Proper treatment for adjustment disorder or PTSD can also teach you the skills you need to address symptoms, which will help reduce their severity, build your resilience, and allow you to cope with future stresses or traumas.

The right type of treatment will likely involve several forms of therapy or holistic treatment depending on your circumstances, like:

• Family therapy, 
• Individual therapy, 
• Peer support groups, 
• Meditation, 
• Yoga,
• Art therapy, 
• Music therapy
• Animal therapy or
• EMDR. 

When you get a proper diagnosis, your care team can help decide which type of plan is best for you and which overlapping treatments might offer the skills and strengths you need most. 

Summing Up

If you are struggling with signs of adjustment disorder or PTSD, it is important that you seek professional help early. Understanding the critical distinctions between PTSD and adjustment disorder can make it easier for you to discern when something might be related to a short-term stressor or when you need professional help for medication or therapy.