Adjustment Disorder: Navigating Anxiety and Emotional Discomfort

I just feel unwell all the time?

I have already seen a psychiatrist three times, and the doctor said that I have adjustment disorder.
During the third visit, he mentioned that my main issue is anticipatory anxiety and that he thinks I am fine, so he scheduled a follow-up appointment in three weeks.
The medication has been adjusted to take in the morning and evening, but I still feel uncomfortable.
The doctor also mentioned that I might talk a lot during my next visit (which I find difficult to do), but I am still able to complete my tasks! I feel like everyone—doctors, family, and friends—believes that I will get through this, and even though I say otherwise, I still have to do things and I do them, but I feel very distressed while doing so, even feeling like I might die.
Why does everyone want me to work so hard and say that this will help me mature? Every time I see the doctor, he says I am doing well and that it might just take six months or a few years to adapt.
Why does he think that is acceptable? Isn’t that a long time? He also advises me not to overthink things and that it’s okay to take it easy (it feels like he is encouraging me not to pressure myself too much).
Otherwise, it seems out of character for a doctor to say that.
I care a lot about what the doctor says, but the more he tells me I am normal, the more uncomfortable I feel.
People also suggest that I shouldn’t switch doctors or hospitals and that I should have confidence in what the doctor says, but I still feel very uneasy inside.
When I start to feel better, I begin to doubt myself, thinking that I can’t possibly be okay.
When people ask me if I want to live like this forever, I say no, but I end up feeling very distressed and keep myself in a tense state, as if everything is fine, which feels strange.
Every time someone talks to me, I feel like I am wasting their time and worry about taking up their time.
A classmate has already told me that if he really has something to do, he will let me know, so the fact that he is willing to talk to me means he still values our conversation.
However, I seem to be in a state of doubt.
In high school, I had symptoms of obsessive-compulsive disorder, constantly asking others what they just said.
In college, I felt I couldn’t continue like this, or I would lose friends, so I changed! I actually have successful experiences and should believe that I can overcome my current challenges! However, recently it seems that my issues have resurfaced.
I find myself thinking about everything the doctor and I discussed, and if I can’t recall a specific statement, I dwell on it for a long time.
I think it’s because I care too much! The doctor mentioned that I might have an anxious temperament and high expectations, being overly concerned about what others think.
During the first and second visits, I felt that the sessions were very helpful; listening to the doctor made me feel like everything would be okay.
But during the third visit, I suddenly wondered if the doctor thought I was pretending to be crazy because he kept smiling and saying, “No problem, no problem,” and he thinks I am doing well.
However, I often feel very bad when he is not around, and I told him this, but he still insists that I am normal and just have adjustment disorder and anticipatory anxiety.
Does that mean I need to show him a photo of how uncomfortable I feel for him to make a judgment? Can he really assess my symptoms just through my verbal descriptions while I am in a normal state? I am afraid that he only sees me when I am normal and doesn’t recognize my abnormal states, which is why he thinks I am fine.
When I see the doctor, I appear quite normal and not particularly anxious, so does that mean he thinks I have no issues? Also, there is very little information available about adjustment disorder.
I want to know what I can do for myself to stop suffering so much.
Thank you.

linlin, 20~29 year old female. Ask Date: 2006/10/13

Dr. Liu Guangqi reply Psychiatry

Adjustment disorders or anticipatory anxiety are complex issues that I won't delve into in detail here regarding their differences or commonalities.
When your doctor isn't seeing you, it indicates that you are truly struggling, and this is a problem that needs to be addressed.
It may take some time, and the methods used may change frequently.
You might consult various people, and their advice may differ somewhat, but fundamentally, they all share a supportive attitude and have value as references; it’s just a matter of how well they align with your situation.
Humans are complex beings, and life is complicated.
As you seek solutions to your problems, your doctor is likely also searching for ways to address your issues.
The time invested is aimed at achieving a stable therapeutic effect.
Symptoms of anxiety related to autonomic nervous system dysregulation (such as panic, tightness in the chest, or accompanying physical discomfort like cold sweats, dizziness, indigestion, etc.) are often linked to persistent stress, which arises from uncertainty about the future.
Unless there are underlying physiological factors, these symptoms are primarily caused by psychological and environmental factors.
However, humans are intricate, and it’s essential to consider all possible causes to avoid oversimplification and failing to resolve the issue.
In your process of adapting to a new environment, have you encountered many unfamiliar situations? Are you concerned about others' opinions? Are there interpersonal difficulties? Are you facing challenges related to life events? Or perhaps you don’t fully understand yourself or the world around you?
You can continue to seek advice from others, and if you experience severe discomfort, medication can be a temporary solution.
Additionally, the accumulation of time and life experiences will help.
Keep going!

Reply Date: 2006/10/13

More Info

Adjustment disorder, often characterized by emotional or behavioral symptoms in response to a significant life change or stressor, can be a challenging condition to navigate. Your experience reflects a common struggle among individuals dealing with this disorder, particularly when it comes to managing anxiety and emotional discomfort.

Firstly, it’s important to acknowledge that your feelings of discomfort and anxiety are valid. The fact that you have sought help from a psychiatrist multiple times indicates a proactive approach to your mental health, which is commendable. The diagnosis of adjustment disorder, particularly with a focus on anticipatory anxiety, suggests that your symptoms are linked to specific stressors or changes in your life. This can include anything from academic pressures to personal relationships, and it’s not uncommon for individuals in similar situations to feel overwhelmed.

Your concerns about the psychiatrist’s perception of your condition are also understandable. It’s common for patients to worry that their symptoms may not be fully recognized, especially if they feel they present as “normal” during appointments. However, it’s crucial to remember that mental health professionals often rely on a combination of verbal communication, behavioral observations, and clinical assessments to gauge a patient’s condition. If you feel that your symptoms are not being adequately addressed, it may be beneficial to express this directly to your psychiatrist. Open communication can help ensure that your concerns are taken seriously and that you receive the appropriate support.

Regarding your feelings of pressure to perform and the fear of burdening others, these are common experiences for individuals with anxiety. It’s essential to recognize that while striving for excellence is admirable, it should not come at the cost of your mental well-being. Finding a balance between personal expectations and self-care is crucial. Techniques such as mindfulness, cognitive-behavioral strategies, and relaxation exercises can be beneficial in managing anxiety and promoting emotional regulation.

You mentioned experiencing obsessive-compulsive symptoms during high school, which can often co-occur with anxiety disorders. This history may contribute to your current feelings of distress. It’s important to address these symptoms as they arise, as they can exacerbate feelings of discomfort and anxiety. Cognitive-behavioral therapy (CBT) is particularly effective for both anxiety and OCD symptoms, focusing on changing negative thought patterns and behaviors.

In terms of what you can do for yourself, consider the following strategies:
1. Journaling: Writing down your thoughts and feelings can help you process your emotions and identify triggers for your anxiety. It can also serve as a tool for reflection during your therapy sessions.

2. Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, or yoga can help reduce anxiety and promote a sense of calm.

3. Physical Activity: Regular exercise is known to improve mood and reduce anxiety. Find an activity you enjoy, whether it’s walking, dancing, or playing a sport.

4. Social Support: Engage with friends and family who understand your struggles. Sharing your feelings with trusted individuals can alleviate feelings of isolation.

5. Setting Realistic Goals: Break tasks into smaller, manageable steps. Celebrate your accomplishments, no matter how small, to build confidence.

6. Therapeutic Techniques: If your current psychiatrist’s approach isn’t resonating with you, consider seeking a therapist who specializes in anxiety disorders or adjustment disorders. Different therapeutic modalities may offer new perspectives and coping strategies.

Lastly, it’s crucial to be patient with yourself. Recovery from adjustment disorder and anxiety is often not linear, and it may take time to find the right combination of strategies and support that works for you. If you continue to feel that your symptoms are not improving, don’t hesitate to discuss this with your psychiatrist. They may consider adjusting your treatment plan or exploring additional therapeutic options.

In conclusion, navigating adjustment disorder can be complex, but with the right support and strategies, it is possible to manage your symptoms effectively. Remember, you are not alone in this journey, and seeking help is a significant step toward healing.

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