Adjustment.

Noun. A small change, or the process of becoming familiar with a new situation.

I was diagnosed with an adjustment disorder following the birth of my daughter in April 2020.

I had been absolutely convinced I would be diagnosed with a mood disorder — my money was on bipolar disorder, or its “milder” cousin, cyclothymia — so when my psychiatrist explained she thought it was an adjustment disorder, my first response was, “What’s that?”

I’d been studying and working in psychology, mental health and related fields for almost two decades, and I had never heard of this diagnosis, nor had I known anyone with it.

When I began to research the condition, it felt like reading a description of my entire personality, mood, and mental health. What I read explained how adjustment disorder is often confused with bipolar disorder, as well as many other mental health diagnoses, because it can present in so many ways. For example, adjustment disorder with mood changes can involve mood cycling, mania, anxiety, depression, to name a few. Adjustment disorder with behavioural changes might look like risk-taking, difficulty concentrating, impulsivity, or changes to sleeping and eating. And for the lucky few — myself included — it can involve both mood and behaviour changes.

The key criterion, however, is that these changes occur “disproportionately” and always in direct response to a period of change or adjustment. For me, this was triggered by having my second baby, but I could identify similar patterns going back to age 14: mood cycling, hallucinations, behavioural changes, poor concentration, restlessness, insomnia, severe anxiety, panic attacks, and suicidal ideation — all connected to periods of adjustment.

Suddenly, a lot about my life and mental health made sense. Why I experienced acute anxiety after getting married, and why I’ve crashed my car every time I’ve moved house.

It’s always been different from the “stress” people describe when planning a wedding, moving, or starting a new job. It has felt less like stress and more like battling suicidal thoughts, mania, cognitive shutdowns, and even visual hallucinations — even when the life change was something I deeply wanted.

So yes, you could argue the response is “disproportionate” to the circumstances. But over time, I’ve realised that this description comes from someone else’s perspective. They believe it’s disproportionate; my brain clearly doesn’t. My brain interprets change and adjustment as a threat. I have theories as to why — that perhaps there was an early adjustment period that felt deeply unsafe and destabilising, and that later transitions re-trigger that original experience. It’s not just the current circumstance I’m responding to, but the echo of the first one. Much like PTSD, where people re-experience trauma despite no present threat, I believe a similar process can occur with adjustment disorder. This makes sense given the overlap between the two, and the fact that many people diagnosed with adjustment disorder simply don’t meet full criteria for PTSD.

More recently I have moved house, and not just moved, but relocated in a new area, moved the children’s schools, and because our house sale and purchase didn’t line up, have been living in short term holiday lets and Airbnb’s, resulting in moving four times, in as many months. It has been by most standards ‘a lot’, and I expected and prepared for it to be so.

Still, it has been humbling to realise that despite all my self-awareness, journaling, self-care, and therapy, I do struggle with adjustment, and I do still have an adjustment disorder. This period has been the closest I’ve come to the distress I experienced in 2020 — (though perhaps only 10% of it) — yet still both unsettling and wildly frustrating.

Mental health diagnoses are a polarising topic, and I’m not entirely sure where I sit. There is no objective test or ultimate truth, and we don’t (and likely will never) fully understand the complexities of the mind. People have the right to interpret both science and lived experience in their own way. But we cannot dismiss someone’s lived reality by saying “it doesn’t exist.”

If I were to summarise my own beliefs (and it feels impossible to do this in a single paragraph): mental health and wellbeing are complex systems influenced by countless factors. I don’t see human experience as “disordered.” If I had my way, I’d replace the word “disorder” with “distress.” I believe diagnosis is useful only when it brings clarity, understanding, and access to support. Labels can help identify patterns of distress across populations and guide people to resources, but they don’t define someone. I don’t think we’re born with these difficulties — though we may be born with the potential for them. I see anxiety, depression, psychosis and more, as expressions of distress in response to changes in physiology, trauma, grief, loss and… adjustment. Like physical pain, psychological distress is feedback that something feels wrong or unsafe — whether the threat is real or perceived.

Good support helps us understand our mind’s processes and turn the dial down on the distress, without numbing or “fixing” who we are. I believe medication, therapy and other supports all have a place when informed and desired. I deeply value autonomy in navigating one’s mental health, while also recognising the nuance of times when capacity for informed consent is impaired.

One of the greatest forms of self-care is taking time to understand your own processes, how you experience distress, and what you personally need to stay well, maintain self-esteem, and navigate life’s inevitable ups and downs.

If you’re having a hard time, you’re not broken. Perhaps challenge yourself to consider what you are responding to, and what your distress might be telling you or trying to protect you from. What happened to you? - Not, what is wrong with me?

If you want support as you prioritise this, consider booking therapy to continue your own journey of self-discovery. And if you’d like that support to be with me, please head to the booking form in my bio.

Sarah x