Wednesday, Atlanta, Georgia

Yesterday I confessed that for many years I have been an anxious flyer. This in spite of the fact that dialogue nearly 150,000 miles a year in the air. Most flights on pretty calm. But my anxiety becomes heightened anytime I experience a particularly turbulent or otherwise scary flight. And of course, there was that story I related about the disgruntled 19-year-old flight attendant who actually set fire to his plane while it was still IN FLIGHT in order to force its landing! But you kidding me!? As far as I’m concerned, this bonehead should be forced to take his next flight while strapped to the wing of a plane. Let’s see how he likes that route!

In any event, after being involved in any harrowing, traumatic experience that causes you to fear for your life, it is not uncommon to experience what therapists diagnose as an “adjustment disorder.” Adjustment disorders are probably the most common diagnosis… although in fact it is frequently not formally diagnosed at all because most people don’t seek treatment when they are suffering. But the term describes the condition very accurately.

When something happens to you that derails your normal routine, it is not uncommon to have a reaction that only further disorients you. In such cases you have what is known as a “maladaptive response” to whatever it is that has happened to you. When a therapist assigns this diagnosis, it indicates that although your response to the stressful event is “maladaptive” it does not mean that you are suffering from any other mental illness. In addition, the diagnosis is not usually given in the aftermath of a loss that causes grief.

Adjustment disorders don’t usually last very long, but they can be very uncomfortable. As far as what causes a person to have an adjustment disorder, naturally it varies depending on the meaning of the event to the individual. As a result the diagnosis is essentially a subjective judgment by a therapist that your reaction to an event is outside the bounds of what would be considered a normal reaction. Obviously the more the therapist knows about you and your temperament, the better judgment I can make about what would constitute an extreme reaction, a reaction that is abnormal for you in particular.

The reason adjustment disorders are so common, is because the root cause is usually the struggle to adjust to a major change. And in modern life, disruptive change has become the norm. There are very few people who are not coping with a life characterized by significant change, sometimes very turbulent change. This can involve alterations in relationships, the status of your company or your job in particular, a change in behavior of your child or the status of your health. You can even come about in the aftermath of what was considered to be a positive change. For instance a relocation that you’re excited about initially in turn out to be an adjustment that is more profound than you were ready to negotiate. The same could be said about a desired job promotion, where the edit responsibilities become difficult to manage.

The treatment for an adjustment disorder is openly communicating about the stressful event in the struggle you’re having adapting to it. And while it is certainly helpful to have this ongoing conversation with the professional therapist, a lot of the same results can be experienced with a strong social support system, family and friends who are available and caring and ready to listen and offer encouragement.
In the DSM-IV six recognized types of adjustment disorders are recognized, and each has unique features.

There are Adjustment Disorders with:

1. Depressed mood can include tearfulness and feelings of hopelessness
2. Anxiety can includes excessive worry and nervous jitters
3. Anxiety & depressed mood (a combination of the above two).
4. Disturbance of conduct (reckless behavior, fighting, property destruction.
5. Mixed disturbance of emotions & conduct (depression, anxiety & conduct).
6. Unspecified in which the reaction to stressful events does not fit any of the other subtypes.

In addition to the above 6 descriptions consider some additional types of adjustment disorders:

Adjustment Disorder…

- with incessant marathon running causing a precipitous loss of body mass

- with projectile vomiting which erupts without warning at dinner parties

- with inappropriate nail clipping resulting in very tiny finger and toe nails

- with verbal outbursts where fits of foul language are shouted in public

- with binge eating to a point where body mass is doubled within three months

- with the Heebee Jeebees featuring inappropriate jumping in place

- with formal dress where daily attire always includes a tuxedo

- with nudity combining refusal to dress with an insistence on travel

- with chain saw fetish characterized by indiscriminate cutting down of neighborhood trees

- with reckless gunplay featuring flagrant waving of a pistol at slight provocation