PTSD and Adjustment Disorder Explained

By Jessika Endsley

Post-Traumatic Stress Disorder (PTSD) has been defined as a mental health illness triggered by a traumatic event. It is no longer classified in the DSM as a simple anxiety condition because of the very specific diagnostic criteria and the fact that PTSD indeed involves a life-long alteration in the brain that doesn't entirely revolve around the anxiety of the situation and alters the cognitive process long after the adjustment to the specific trauma or traumas has occurred. While the criteria for a diagnosis of PTSD include symptoms such as "reliving the trauma," and "flashbacks," many people with PTSD are left undiagnosed because their specific trauma may not seem to be monumental to mental health practitioners. The sensitivity of the individual is rarely taken into account when all criteria for PTSD are met other than one specific trauma - but what if the professionals paid mind to the sensitivity an individual may have to repeated small traumas and the longevity of a harshly anxiety-inducing situation?

For some time, Post-Traumatic Stress Disorder was seen as a form of "Adjustment Disorder" by those in the psychiatric realm, and was generally only diagnosed in those who had experienced trauma during military battle. Post-Traumatic Stress Disorder is as old as humanity but the term was not added to the DSM until 1980 due to the rise of behavioral and anxiety problems in war veterans. The symptoms include nightmares, flashbacks, intrusive thoughts, emotional numbness, physical reactions to sensory stimulation that reminds the individual of the traumatic event, dissociation, and exaggerated startle response, among many others. But for individuals who meet all of the criteria and lack a specific "super trauma," the diagnosis is likely to be "Adjustment Disorder." Adjustment Disorder is a very vague and often useless diagnosis that is often used to diagnose anxious people who have depressive traits or, as previously stated, those who display all signs of PTSD but don't have sufficient enough evidence of a trauma. It differs from Anxiety Disorder because it does not completely lack a stressor, but differs from PTSD in that the trauma is "less significant." The diagnosis acts as a placeholder diagnosis and is, more often than not, given as a temporary label in patients who need to be diagnosed with something for insurance coverage. With a vague diagnosis, patients who display the features of PTSD but lack one traumatic event to blame it on go without proper treatment and are not taken seriously by therapists and psychiatrists. Nearly half of patients diagnosed with Adjustment Disorder attempt suicide; it isn't too shocking considering the people with this diagnosis aren't being treated for the very probable PTSD (or other mental health problem) they are suffering from.

Post Traumatic Stress Disorder

In the case of Highly Sensitive People - ranging from completely neurotypical individuals to those on the Autistic Spectrum to those with pre-existing mental conditions - the word "trauma" can take on a new meaning. Imagine being in a social situation and saying something incredibly stupid; a person who is inclined to care what others think may relive the situation in their head over and over, whether for an hour, a day, or in a more neurotic individual, weeks. While very unlikely to produce an actual disorder, if something that simple can cause flashbacks in some individuals as well as depression and avoidance, imagine what a Highly Sensitive Person will experience when a scary life event hits. To be diagnosed with Adjustment Disorder, the events considered are often in the realm of marital issues, family conflict (which can often include long-term abuse,) sexuality issues, and familial death. This is all fine and well except for the fact that these life events can trigger every single symptom of Post-Traumatic Stress Disorder but the treatment for Adjustment Disorder is not only different from the treatment for PTSD, but extremely dismissive if not nearly non-existent. Even if you lose someone close to you in a sudden trauma, such as in battle, an epidemic, a wreck, or even in a layoff at work, you can be diagnosed with "Survivor Guilt" which is a type of Post-Traumatic Stress Disorder. Although a person with Survivor Guilt may not have even been anywhere near the trauma, the empathy and the fear surrounding the event leads to symptoms of PTSD and the survivor receives the same treatment as a trauma victim. For someone with Adjustment Disorder, there is no such luck.

How Is Adjustment Disorder Treated?

To put it simply, Adjustment Disorder is not treated. If the diagnosis itself is a place holder in the realm of trauma and anxiety-related depression, it is much like a "NOS" diagnosis such as Personality Disorder Not Otherwise Specified - also known as "we don't know what's wrong with you" disorder. This means that many professionals will be winging it when treating the individual, and either masking the specific symptoms of trauma, such as anxiety and depression, with medication, or treating the symptoms in psychotherapy without paying much attention to their causation, even after the disordered behavior has been present chronically. There are no specific medications for Adjustment Disorder, and professionals instead opt to give anti-depressants for depressive symptoms, anti-anxiety drugs for the usually present anxiety symptoms, and sometimes throw in an anti-psychotic for some speculative reason. If nightmares are persistent and bothersome, a blood pressure pill may be prescribed to relieve the symptom by reducing "fight-or-flight" during sleep, as is done with many traumatized war veterans. The psychotherapy can include family therapy, couples counseling, and Cognitive Behavioral Therapy to build support and understanding within the patient's social circle and to adapt new behaviors for coping with the stress and general upset that living with Adjustment Disorder. Professionals will often put an emphasis on "self-help" programs for the patient, meaning that the person diagnosed with Adjustment Disorder is to join a group of others who have gone through rough patches in their lives so they can exchange advice on how best to complain about it and to gain social support.

How is PTSD Treated?

Post-Traumatic Stress Disorder is treated a variety of ways depending on the individual trauma and on the possible dysfunctional coping mechanisms developed by the sufferer, such as drug abuse. It seems that Cognitive Behavioral Therapy with an emphasis on "exposure therapy" is a preferred method for many; this includes imagery, writing, reenacting the trauma (if non-violent) or visiting the site of a traumatic event so that the patient can experience the trauma in safety. While very uncomfortable, exposure therapy can greatly reduce the symptoms of PTSD in many sufferers and can be the most monumental piece to their recovery. Along with this method are the usual components of psychotherapy, allowing the individual with PTSD to discuss the trauma so as to better understand it. Many traumatic memories are stored incorrectly. Eye Movement Desensitization and Reprocessing (EMDR) is a newer psychotherapeutic treatment for those with PTSD. This treatment uses the individual's own eye movement to lessen the emotional response to a traumatic event by having the patient move their eyes as indicated while recalling the traumatic event verbally and gradually shifting to pleasant thoughts. Although fairly new and debatable, it is a big step for the progress of neuropsychological treatments for Post-Traumatic Stress Disorder. And while some symptoms of PTSD can resurface even after recovery, the disorder is taken seriously in psychiatric circles and strides are being made for furthering progress. Along with therapy, a patient may be given medication to treat nightmares or to temporarily relieve anxiety to increase functionality.

"Adjustment Disorder" often misdiagnosis

The dismissive treatment of those who are often diagnosed with Adjustment Disorder is lazy psychology. Much like Personality Disorder NOS, Adjustment Disorder is the product of scooping fragments of a shattered mind away to be ignored like so many shards of glass under a carpet. Levels of sensitivity in individuals can indeed be measured not only through casual observance, but through studies of empathy quotients, type of empathy, and the study of highly-sensitive personalities. The tools exist for breakthroughs to be made not only in the treatment of PTSD, but in other disorders and in the study of social conduct. The fact is that a person could be subjected to years of psychological abuse and their blatant PTSD will be laughingly dismissed and the person will be diagnosed with Adjustment Disorder, where they will be medicated into behavioral changes, spoken to as if their psychological reactions to stress are indeed their fault, and their risk for suicide will increase exponentially. If strides like EMDR have been made in the treatment of Post-Traumatic Stress Disorder, treatment programs for highly-sensitive patients should be altered and further research is needed for those who are neurologically damaged by chronic and uncontrollable life circumstances.

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1.  Lord Hampton    Saturday, May 31, 2014

Some years ago I had a therapist who suggested EMDR, but for various reasons I ceased therapy soon after. It wasn't until recently while reading about PTSD that I discovered what EMDR was most commonly used to treat. I have never received a PTSD diagnosis and I was rather shocked when I finally made this connection. I wish I knew what his thoughts were about my situation at that time.

2.  EMDR is very powerful    Sunday, June 29, 2014

Hi LH. I used EMDR several years ago to cure my PTSD and I recommend it to anyone.

And yes, as this article says, the sensitivity of an individual is important to take into account. All my PTSD occurred through personally jarring, yet very common civilian life experiences, such as being told by a manager I had lost my job. It's actually embarrassing to me. I don't look fragile on the outside, or behave in ways that would suggest it.

Because I realised that I must be pretty sensitive, I use EMDR to treat any jarring experiences (for me) soon after they occur. High maintenance mind, lol (but a high performance one too, in a creativity sense).

Good luck & best wishes

3.  Lord Hampton    Tuesday, July 8, 2014

Thank you, EMDR. I too am a deeply sensitive person who presents a stoic front to the world. Many things affect me very deeply, so maybe I will look further into this.

4.  Mikke Musen    Friday, March 13, 2015

"EMDR is very powerful"

Or was it what you call "trauma" that is very weak.

This isn't world cup of suffering, but c'mon..... It is offensive

5.  richard    Tuesday, September 22, 2015

Will the va award compensation for PTSD if it say probable PTSD/adjustment with axis IV 55?

6.  tony greene    Monday, May 22, 2017

It's very difficult to get to the point of sanity.

7.  Susan    Tuesday, May 1, 2018

I am a therapist and I often use the diagnosis of Adjustment Disorder, when it is the most accurate diagnosis. If a person has a trauma history and they have an Adjustment Disorder with features of Anxiety and symptoms of PTSD, I treat the symptoms of PTSD just as I would a person who meets the full criteria for PTSD. I don't understand saying that an Adjustment Disorder is not treated. I certainly do treat it.

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