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

Abstract

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.