5 Signs You Are Experiencing a Lockdown Adjustment Disorder

How the COVID-19 pandemic and lockdown can cause adjustment disorder.

Posted Jul 02, 2020

The COVID-19 pandemic and associated lockdown measures have resulted in significant and often sudden changes to most people’s lives. The term “new normal” is being increasingly used but in reality, the situation remains turbulent and it’s impossible to know what the new normal will look like. For many people, there remain huge questions over job security, when they will be able to travel abroad, when they will see a particular friend or loved one, whether their finances will hold out, and perhaps also whether their patience will hold out.

The far-reaching impact of the COVID-19 pandemic is a good reminder that things change. Some people excel in times of change and embrace the challenges and possibilities that it holds. However, while change and uncertainty are not necessarily a bad thing, in general we tend to form strong attachments to situations, people, places and routines. These “living reference points” can serve to reassure and orientate us, helping us to function in an effective manner. Such reference points might take the form of being a regular spectator at a sporting event, going to the gym after work, taking an annual trip abroad, not bringing work into the home environment, or walking down a high street bustling with people.

When we abruptly find that our living reference points are no longer available, it can disrupt our emotional and psychological well-being as well as leave us feeling disoriented and insecure. In general, people know that things have to change but this doesn’t mean that everyone is good at coping with change. Letting go of our attachment to what used to constitute “normal” is often easier said than done.

Adjustment Disorder and the COVID-19 Pandemic

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), adjustment disorder is a type of trauma- and stress-related disorder. A key feature of adjustment disorder is the development of emotional and behavioral symptoms that are linked to a stressful event or set of stressful circumstances. Adjustment disorder can arise when an individual perceives they are facing a significant life change or challenge that they have difficulty adjusting to.

The increased risk of developing adjustment disorder during the COVID-19 pandemic has been acknowledged in the academic literature, and is supported by emerging research evidence. For example, a study conducted online administered the International Adjustment Disorder Questionnaire (and other measures of mental health) to over 18,000 people living in Italy three to four weeks into the lockdown. The study found that 22.9% of respondents had adjustment disorder symptoms which were associated with quarantine measures or other stressful events related to the COVID-19 pandemic.

Knowing the Signs of Lockdown Adjustment Disorder

Adjustment disorder is sometimes referred to as an intermediate condition between healthy and pathological categories of psychological functioning. Therefore, awareness of how the lockdown and other impacts of the COVID-19 pandemic can trigger adjustment disorder symptoms can help people determine whether their mental health is deteriorating and whether it is time to seek help from a medical professional. Accordingly, based on the DSM-5 diagnostic criteria as well as emerging research evidence specific to the COVID-19 pandemic, the following outlines five signs that could be indicative of a person developing adjustment disorder as a result of the lockdown or other challenges relating to the COVID-19 pandemic:

  1. Lockdown worry: Excessive worry including recurrent and distressing thoughts related to the lockdown or impact of the COVID-19 pandemic is likely to indicate problems with adjusting. This might involve a high level of rumination or co-brooding (i.e., rumination with a relationship partner) about how the lockdown or pandemic situation will negatively affect one’s future.
  2. Social difficulties: Reduced appetite for social interaction and conflict with family members could be signs that a person is not adapting well, as are other inter-personal problems such as being less caring of others.
  3. Work problems: Adjustment disorder is associated with decreased performance at work (or school), which may involve a loss of appetite for work during the COVID-19 pandemic, including a desire to be absent from work.
  4. Cause is specific: The distress and other emotional or behavioral symptoms should not be due to the worsening of a pre-existing mental health problem or the normal experience of grief following the loss of a loved one.
  5. Symptoms are recent: In order to meet the DSM-5 diagnostic criteria for adjustment disorder, the condition must begin within three months of whatever is serving as the cause of stress, such as lockdown measures or other stressful impacts of the COVID-19 pandemic.

If you are concerned about adjustment disorder or other mental health problems, speak to your general practitioner/family doctor or a mental health professional.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395: 912–20.

Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., et al. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res., 112934. doi:10.1016/j.psychres.2020.112934.

Dong, L., and Bouey, J. (2020). Public Mental Health Crisis during COVID-19 Pandemic, China. Emerg. Infect. Dis. 26. doi:10.3201/eid2607.202407.

Durcan, G., O’Shea, N., & Allwood, L. (2020). Covid-19 and the nation’s mental health Forecasting needs and risks in the UK: May 2020. Centre for Mental Health. Available Online at: https://www.centreformentalhealth.org.uk/sites/default/files/2020-05/CentreforMentalHealth_COVID_MH_Forecasting_May20.pdf

Jia, R., Ayling, K., Chalder, T., Massey, A., Broadbent, E., Coupland, C., & Vedhara K. (2020). Mental health in the UK during the COVID-19 pandemic: Early observations. MedRxiv, Advance online publication. DOI: 10.1101/2020.05.14.20102012

Rossi, R., Socci, V., Talevi, D., Mensi, S., Niolu, C., Pacitti, F., … Di Lorenzo, G. (2020). COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N=18147 web-based survey. MedRxiv Pre-print. DOI: 10.1101/2020.04.09.20057802.

Van Gordon, W., Shonin, E., Diouri, S., Garcia-Campayo, J., Kotera, Y., & Griffiths, M. D. (2018c). Ontological addiction theory: Attachment to me, mine, and I. Journal of Behavioral Addictions, 7, 892-896.