What are the differences between adjustment disorder and depression? An explanation of their relationship with HSP (Highly Sensitive Person)

Table of Contents

1. Three Confusion Points Surrounding Adjustment Disorder and Depression

2. Thorough Comparison of Definitions and Diagnostic Criteria

3. Pathophysiology: Stress Response vs. Neurotransmitter Imbalance

4. Differences in Symptom Spectrum and Course

5. What is HSP?—Four Types and Characteristics

6. Risk Relationship Between HSP and Adjustment Disorder/Depression

7. Diagnosis Process: When and Where to Seek Consultation

8. Differences and Commonalities in Treatment Strategies

9. Specific Measures for Adjusting Living Environment and Workplace

10. Relapse Prevention and Self-care—From Mindfulness to Employment Support

11. Support Tips for Family and Workplace

12. Q&A: Correcting Common Misunderstandings

13. Conclusion—"Sensitivity" is Not a Weakness

14. List of Consultation Services
    
    

1. Three Confusion Points Surrounding Adjustment Disorder and Depression

• Presence of a Trigger: Adjustment disorder has a clear trigger, while depression may not.

• Duration: Adjustment disorder improves within six months if the stressor is resolved, while depression tends to become chronic.

• Treatment Approach: Adjustment disorder focuses on environmental adjustments and short-term psychotherapy. In depression, pharmacotherapy is also fundamental.kokoro.mhlw.go.jp
  
  
  
  

2. Thorough Comparison of Definitions and Diagnostic Criteria

3. Pathophysiology: Stress Response vs. Neurotransmitter Imbalance

Adjustment disorder is described as an "extension of normal stress response," with transient emphasis on HPA axis hyperactivity. Depression involves persistent imbalance in serotonin and norepinephrine systems, genetic factors, and involvement of inflammatory cytokines, among others.

4. Differences in Symptom Spectrum and Course

• Physical Symptoms: Both exhibit sleep disorders and fatigue, but depression is characterized by early morning awakening and diurnal variation.

• Emotional Aspect: Adjustment disorder often involves a mix of "irritability and anxiety."

• Course: If adjustment disorder becomes prolonged, it may be "upgraded" to a diagnosis of major depressive disorder.
  
  
  
  

5. What is HSP? — The 4 Types and Characteristics

HSP is a concept proposed by Dr. Elaine N. Aron, explained by the acronym **DOES (Depth of processing, Overstimulation, Emotional reactivity, Sensitivity to subtle stimuli)**. HSP is not a "disease" but a "temperament," yet due to sensitivity to stimuli, fatigue tends to accumulate easily.

• Introverted HSP: Avoids stimulation, recovers with alone time

• Extroverted HSE: Sociable but experiences strong fatigue later

• HSS Type HSP/HSE: Prone to excessive stress due to the paradox of seeking stimulation and sensitivityatgp.jp
  
  
  
  

6. Risk Connection Between HSP and Adjustment Disorder/Depression

People with HSP are prone to stress reactions even from subtle stimuli like "casual remarks from colleagues" or "lighting and noise." The sympathetic nervous system becomes chronically dominant, leading to a high risk of a negative chain reaction: adjustment disorder→depressive state→depression.tokyo-yokohama-tms-cl.jp

7. Diagnostic Process: When and Where to Seek Consultation?

1. Symptom Diary: Record sleep, mood, and events for two weeks

2. Primary Care Physician or Occupational Physician for initial evaluation

3. Psychiatry or Psychosomatic Medicine for DSM-5 compliant interview

4. HSP self-diagnosis is merely a reference.If necessary, take psychological tests (POMS2, PHQ-9)
   
   
   
   

8. Differences and similarities in treatment strategies

9. Specific strategies for adjusting living and workplace environments

• Adjust lighting, noise cancellation, remote work, etc., to reduce physical burden

• Task segmentation and sharing of priorities

• Use of employment transition support and rework programs
  
  
  
  

10. Relapse prevention and self-care

• Adequate sleep and low-stimulation leisure

• Mindfulness breathing techniques

• Exercise therapy: 150 minutes of aerobic exercise per week

• Digital detox: Screen-free one hour before bed
  
  
  
  

11. Tips for support that family and workplace should know

• A listening attitude without denial

• Visualizing workload together

• Encouraging medical consultation while sharing information
  
  
  
  

12. Q&A: Correcting common misconceptions

Q. Is adjustment disorder just "laziness"?
A. A condition officially recognized by the WHO. It is a state where the brain's stress response system is overloaded.

Q. Does being HSP mean you will definitely develop depression?
A. It is a temperament and does not necessarily lead to the onset of depression. By adjusting the environment and practicing self-care, the risk can be significantly reduced.

13. Conclusion - "Sensitivity" is not a weakness

Although adjustment disorder and depression differ in their mechanisms, treatments, and prognoses, they are linked in that the "sensitivity" of HSP can serve as a stress-mediating factor. By understanding the temperament and adjusting the environment, sensitivity can transform into strengths such as "deep empathy" and "insight." Establish a cycle of recovery and personal growth through early consultation and multidisciplinary collaboration.

List of Reference Articles

• Yahoo! News Expert "What are the Differences Between Adjustment Disorder and Depression? Explaining the Relationship with HSP" (2025-06-12)

• Ministry of Health, Labour and Welfare 'Kokoro no Mimi' "Stress Responses Focusing on Physical Symptoms"kokoro.mhlw.go.jp

• atGP "Differences Between HSP and Depression. Are HSPs More Prone to Depression?"atgp.jp

• Tokyo Yokohama TMS Clinic "Psychiatrist Explains: Is TMS Treatment Effective for HSP?"tokyo-yokohama-tms-cl.jp

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5)