A qualitative contextualisation of childhood adversity, stressors and symptoms of diagnosed adjustment disorder among UK military personnel

Background: Adjustment disorder (AjD) is a maladaptive response to significant events or ‘stressors’, where an individual is unable to cope or adapt. It is frequently diagnosed among UK military personnel, yet it remains under-researched in this population. The study aimed to examine the lived experiences of UK service personnel diagnosed with AjD, including pre-enlistment childhood experiences and the events leading to diagnosis. Methods: Military personnel with a confirmed AjD diagnosis were recruited from various UK military mental health centres. Data were collected using questionnaires and interviews to explore both pre-enlistment and in-service experiences. Descriptive statistics described the sample, and thematic analysis was applied to the qualitative data. Participant interview data also informed the development of vignettes illustrating potential links between early adversities and adult stress responses. Results: Nineteen participants were recruited; most were male (78.9%), served in the Army (42.1%), and had an average service length of 15.2 years. Key stressors contributing to AjD included frequent relocations, deployments and perceived bullying/harassment. Participants described an accumulation of work and personal stressors impairing their coping abilities. Vignettes highlighted possible connections between adverse childhood experiences and adult stressors, and maladaptive coping mechanisms, including suicidality and substance misuse, to avoid or ‘escape’ the stressor. Conclusions: AjD in a UK military context often results from co-occurring occupational and personal stressors. While we should consider that individuals’ stress responses vary, the findings suggest that suicidality should be considered in all military personnel diagnosed with AjD, given the potentially serious implications of such behaviours on patients. Adjustment disorder is one of the most commonly given mental health diagnoses among UK military personnel at initial assessment.Childhood adversities and maladaptive coping mechanisms were experienced by military personnel with diagnosed adjustment disorder before enlisting, which may influence vulnerabilities to stressors in adulthood.Both work and personal life stressors were identified as the stressors linked to adjustment disorder symptoms for military personnel.Suicidality and alcohol misuse behaviours were discussed as methods to escape the stressor linked to their adjustment disorder.Recommendations are made for better awareness of adjustment disorder and to revise the adjustment disorder diagnostic criteria to include risky behaviours. Adjustment disorder is one of the most commonly given mental health diagnoses among UK military personnel at initial assessment. Childhood adversities and maladaptive coping mechanisms were experienced by military personnel with diagnosed adjustment disorder before enlisting, which may influence vulnerabilities to stressors in adulthood. Both work and personal life stressors were identified as the stressors linked to adjustment disorder symptoms for military personnel. Suicidality and alcohol misuse behaviours were discussed as methods to escape the stressor linked to their adjustment disorder. Recommendations are made for better awareness of adjustment disorder and to revise the adjustment disorder diagnostic criteria to include risky behaviours.