Change and Adjustment Disorders

Humans move through life in different stages and reach different attainment levels. We can see this in Maslow’s Hierarchy of Needs, Erik Erickson’s Eight Stages of Psychosocial Development, as well as the therapeutic change process. Change can be positive or negative depending on the individual and what life circumstances end up being affected

While change is one of the big life lessons, in a therapeutic focus, change is not always effective or needed. It may force us out of ineffective habits and give us more positive habits but it can also be stressful, costly, and even destructive. What’s important about change is how we anticipate it and react to it. 

Change can teach us to adapt and help us develop resilience, but only if we understand our own capacity for growth and learning. When change makes us better, it’s because we have learned how to turn a challenging situation to our own advantage, not merely because change happens.

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Progress is impossible without change. And those who cannot change their minds, cannot change anything. - George Bernard Shaw

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Adjustment Disorders

When it comes to change in the therapeutic lens, adjustment difficulties can be brought about in the face of sudden, unexpected changes. There are several adjustment disorder subtypes identified in the Diagnostic and Statistical Manual (DSM-V) under trauma and stressor-related disorders. 

An adjustment disorder is a reaction to a stressful event or change in a person’s life. The reaction is considered an excessive response to the event or change. Adjustment disorders are more commonly diagnosed in children rather than adults. 

Stressful events or changes in the life of a child may be a family move, the parents’ divorce, the loss of a pet, or the birth of a sibling. A sudden illness or restriction due to chronic illness may also result in an adjustment response.

In all adjustment disorders, the reaction to the stressor is excessive than what would be deemed expected. Additionally, the reaction significantly interferes with social or educational functioning. Age can also have an effect based on coping skills as well as differences in the symptoms. 

Differences in symptoms also include how long they last and how strong they are and what effect they have on the individual. Adolescent symptoms of adjustment disorders can be more behavioural while adults who experience adjustment disorders exhibit more depressed symptoms.

Adjustment disorder subtypes listed in the DSM-5 include:

• Adjustment disorder with depressed mood

• Adjustment disorder with anxiety

• Adjustment disorder with depressed mood and anxiety

• Adjustment disorder with disturbance of conduct

• Adjustment disorder with mixed disturbance of emotions and conduct

• Adjustment disorder unspecified

Treatment Options for Adjustment Disorders

Individual therapy

Individual therapeutic interventions can include cognitive behavioural approaches. Cognitive behavioural approaches are used to improve problem-solving skills, communication skills, impulse control, anger management skills and stress management skills. Cognitive restructuring can also help disrupt negative views of the individual and the world around them. Restructuring negative thought patterns and developing skills that can build resilience is helpful.

Family therapy

Family therapy that focuses on making changes within the family system is beneficial for the individual and the family alike. Viewing the individual in a systems approach creates alliances and supports where they may not have been present focusing on individual skills.  Family therapy can improve things such as communication skills and family interactions. Family therapy also allows therapists to assess adjustment difficulties in other family members.

Group therapy

Group therapy is another supportive therapeutic approach that can offer an environment for sharing experiences. Group therapy is often focused on developing and using social skills and interpersonal skills. The social isolation brought on by adjustment disorders can be mitigated by providing similar-aged peers to provide support and accountability of treatment goals.

Acculturation

A key aspect in the diagnosis of adjustment disorders in children revolves around the topic of acculturation. While more and more families are migrating and emigrating to different places around the world for better opportunities, adjustments to new cultures can be significantly difficult for children. Acculturation is a process through which a person or family from one culture comes to adopt the practices and values of another culture, while still retaining their own distinct culture. 

Acculturation on children can be a difficult transition hence the difficulties leading to adjustment disorder diagnoses. The process of acculturation can take different forms and have different outcomes. When a family believes that it is important to maintain their original culture and maintain relationships with the greater community at the same time there are different stressors that present unique to children. 

Often, a family will encourage establishment of getting used to immersing in the new culture but will also require traditional, original cultural ways to dominate the home environment. The struggle lies in children being able to quickly adapt to the dominant culture while not seeing a need to remain dedicated to keeping traditional cultural ways or languages which in turn can disconnect them from other family members like parents and grandparents.

Outcomes of Acculturation

Assimilation

Assimilation occurs when there is little interest in maintaining the original culture, fitting in and developing relationships with the new culture is more important. The outcome is that the original culture is essentially discarded, and the individual become fully immersed in the new culture. This type of acculturation is considered a melting pot.

Separation

Separation is when little to no importance is placed on embracing the new culture and importance is placed on maintaining the original culture. The outcome is that the original culture is maintained while the new culture is rejected. Separation can occur when there is segregation and when individuals give up on being able to immerse themselves in the new culture in fear of losing their original culture.

Integration

Integration is when both maintaining the original culture and adapting to the new one are considered important. Integration is a common strategy of acculturation. Individuals who use this strategy might be thought of as bicultural and may code-switch when moving between different cultural groups. Code-switching is changing behaviours or languages around others depending on which culture they associate with that will minimise obvious differences.

Marginalisation

Marginalisation is what occurs when individuals place no importance on either maintaining their original culture or adopting the new one. The result is that the person is pushed aside, overlooked, and forgotten by the rest of society. When certain cultural backgrounds are vilified, marginalisation often occurs. Marginalisation makes it difficult for individuals to integrate.

Transmutation

Transmutation is used by individuals who place importance on both maintaining their original culture and on adopting the new culture — but rather than integrating two different cultures, individuals create an offshoot culture, blending both cultures together. Transmutation can be another outcome of acculturation that leads to adjustment disorders with children.