Adjustment Disorder

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Adjustment Disorder stemmed from a moment that changed by life. On January 8th, 2020 an incident occurring working on a Mental Health Intensive Care unit lead to a diagnosis of Adjustment disorder.

Two thoughts are likely popping up: 1. “Wow, what awful thing happened?” and 2. “What the heck is Adjustment Disorder?”

Well, you are not alone, so how about I start with what Adjustment Disorder is…

Posted: April 23th, 2021

Disclaimer: Although I am a mental health professional, all information and reflections are meant for educational purposes only. If you plan to make changes in your life, it may be worth consulting with loved ones and/or your wellness team. Also, this post may contain affiliate links that will connect you with some pretty cool products and when making a purchase through those links, I receive a small commission at no extra cost to you.

Intro

What is Adjustment Disorder?

According to the Diagnostic and Statistical Manual 5th Edition (DSM-5) diagnostic criteria for Adjustment Disorder is:

– Under the umbrella of traumatic disorders.

– Development of emotional or behavioural symptoms related to an identifiable stressor (one where your life is not threatened).

– The distress is more intense than an expected reaction.

– Impairment occurs in social, occupational or other areas of functioning.

– Does not meet criteria for other mental illnesses

– Symptoms do not last longer than 6 months after the consequences of the incident.

– Usually has additional anxiety, depression, emotional dysregulation or dysfunctional behaviour.

Now if I were to phrase Adjustment Disorder in my own terms, I would say that something upsetting happens and instead of your mind readjusting, your ability to cope seems to have disappeared. A little simpler, but still not the best explanation.

My experience may shed some more light on the topic…

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    The Incident

    Now back to the question, “What awful thing happened?”

    Due to confidentiality reasons, there is little detail I can get into, but basically I was verbally and emotionally abused by a patient for hours.

    Now, in my line of work, this is NOT unusual, which speaks to how much abuse we endure…

    Something was different that night though. I was tolerating it well, as I usually would, but there was one moment when my fight-or-flight kicked in and then wouldn’t shut back off. That feeling lasted for weeks.

    Next Steps

    I made it through the remainder of my nightshift with many tearful moments outside of patient view. My coworkers were amazingly supportive, and we were all confused by my intense reaction to yelling.

    Because something just didn’t feel right, I called WorkSafeBC (a supportive service for workplace injuries) and made a claim.

    My next shift wasn’t for another four days, so I figured I would be back to my normal self by that time. I was wrong. My anxiety spiked to levels I had never experienced, so I called in sick… I did not return to being a full-time nurse until October 26th, 2020.

    The Process

    Now, if a fellow nurse experiences a mental health injury at work, your experience may be different than mine. This was my process with WorkSafeBC. Some details are hazy as that time still seems like a blur, but I’ll do my best to remember.

     

    1. Contacted WorkSafe BC Help Line & filled in incident report for health authority.
    2. Unit manager contacted me within 24 hours.
    3. WorkSafeBC representative contacted me regarding details of the incident and my symptoms.
    4. WorkSafeBC set me up with a telephone appointment with a Psychologist for assessment.
    5. Diagnosis of Adjustment Disorder approved as a valid for WorkSafeBC claim.
    6. Disability management from my Health Authority contacted me regarding time off.
    7. WorkSafe sent a letter regarding pay coverage (they have a maximum)
    8. Health Authority topped up the pay coverage to 90% of earnings the previous year.
    9. Later, I was offered the option of a referral to an Occupational Therapist, which I accepted.
    10. WorkSafe agreed to pay for counselling, but only a percentage to the one I was already seeing.

     

     

    On my own, I met with my doctor, who provided a sick note for 6 months, which at the time I assumed was excessive.

    My Symptoms

    Psychological testing showed that I was not experiencing depression, but my anxiety was quite high. Even talking about the incident sent me into a crying fit and panic attack.

    A General List:

    – Horrible nightmares.

    – Frequent Panic attacks.

    – Unprovoked crying spells.

    – Inability to concentrate.

    – Angry outbursts.

    – Trouble with decision making.

    – Obsessive cleaning.

    – Generalized anxiety.

    Treatment

    As I mentioned before, I was seeing a counsellor and occupational therapist. But what do they do?

    Counsellor

    The treatment we did was called EMDR (Eye Movement Desensitization and Reprocessing), which is a specialized method for healing trauma. A future post will have info on EMDR.

    Talk-therapy was also part of this, but the majority was focusing on triggering images of the event and processing each one.

    Occupational Therapist (OT)

    Although I am a mental health professional, I had no idea OTs assisted people with returning to healthcare worksites!

    She and I started the process of Exposure Therapy. In a nutshell, exposure therapy involves doing progressively more anxiety provoking activities to help reduce my fight-or-flight response over time. A future post will have more detailed information on this too.

    It was truly awful. Forcing myself to cause anxiety multiple times a week was not fun for me, but I had a wonderfully supportive care team to help me through. The process started in March 2020 and did not end until the end of August 2020.

    At the beginning, I couldn’t even watch a documentary about mental health without bringing on severe panic and the first time I stepped foot into the hospital, my heartrate spiked to 190 (it usually sits around 80).

    By the end of it, though, I was sitting on the unit the incident happened and was anxiety free.

    Return to Work

    During this time, I was no longer doing shifts. I have been working since the age of 12 (I was 32 when the incident happened), so this was strange for me.

    The treatment was HARD WORK though, so I wasn’t sitting around having a good time.

    In September 2020, I was able to start returning to work for smaller chunks of hours and gradually built up my time. This process took 6 weeks. I did not have a patient load, but was able to help out my coworkers with whatever they needed.

    What Was I Like?

    Initially, I was embarrassed and scared. I had been a nurse for over 10 years and literally felt like my superpower of handling anything that came my way was taken from me.

    Over time and with lots of talk-therapy, I was able to process these emotions and embrace my humanness. We ALL have our Kryptonite; I just hope we don’t all have to experience that moment.

    I decided right from the beginning that I would be super open about my condition even though I was so bothered. As a mental health advocate, I did not want to stifle my shame and chose to be vulnerable.

    I am so lucky to have such an amazing team at work who welcomed me back respectfully and lovingly. (Tearing up as I wrote that) I cannot thank them enough for their support and understanding, although I’m sure some thought my experience was unusual.

    Welp, it was unusual, and I know not everyone will understand.

    What I Learned?

    I am pretty darn resilient and proud of the progress I’ve made. I was diagnosed with Adjustment Disorder and a Pandemic was announced, all while completing courses for my Master of Arts in Counselling Psychology and business preparation.

    It is vital to put your mental health as a priority, especially when it takes a turn for the worst.

    I cannot express the relief I feel knowing that I can still be a compassionate and competent nurse after a long period of wondering if I could ever work in a hospital again.

    Although I already had a desire to help healthcare workers once finished my counselling education, I now have a passion to step into that role. I want to change the high expectations of nurses to more realistic and compassionate ones because MANY never would have taken a step back due to fear of stigma.

    Insight

    If you have made it this far, I commend you. Either you were just super intrigued, or something resonated with you. Either way, thank you for reading!

    Mental illness is no joke. It can truly affect anyone. I never could have imagined being in the position I was, but can say that the work paid off.

    My mental health is better now than I believe it ever was. Finally, it had become the priority.

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