Adjustment Disorders

This article provides an overview of adjustment disorders, including the specific types, common symptoms, causes, and available treatments.

Key Takeaways:

• Adjustment disorders are typically short-term conditions involving significant difficulty coping with stress, often leading to disproportionate behavioral or emotional responses to the stressors.

• Common triggers of adjustment disorders include changes with relationships, finance, or health. However, any major life event can cause it, and everyone reacts differently.

• With proper treatment, adjustment disorders can resolve within several months, sometimes sooner. Therapy is typically the first option, while medication may help for more severe cases.

Adjustment Disorders

Adjustment disorders are characterized by significant difficulty adjusting to life changes or stressors. These difficulties often involve intense emotional or behavioral responses and are disproportional to the severity of the stressor. People with adjustment disorders may behave recklessly or impulsively, experience depression or anxiety, or feel hopeless or helpless, among other symptoms.^[1][2]

Symptoms of adjustment disorders typically begin soon after the stressful event and resolve within 6 months of it ending. Therefore, an adjustment disorder is not a chronic condition, but rather a distinct symptomatic period in direct relation to the stressor(s).

How Common are Adjustment Disorders?

Adjustment disorder affects approximately 1 to 2% of the population, but rates are significantly higher in certain groups or circumstances. For example, research has found that adjustment disorder affects:^[1]

• 27% of recently unemployed individuals

• 18% of individuals experiencing bereavement

• Up to 30% of psychiatric patients (making it one of the most commonly diagnosed mental health disorders)

• 32% of individuals in the emergency department for self-harm

• 14% of acutely ill medical inpatients

Who do They Affect?

Adjustment disorders can affect anyone, regardless of age, gender, or other factors. However, they are more likely to occur in individuals with higher stress levels or disadvantaged life circumstances. Adjustment disorders are also more common in women than men, although the exact rates are unclear.

Types of Adjustment Disorders

TheDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) lists several specific types of adjustment disorders, including:^[1][2][3]

• With depressed mood: Involves low mood, lack of joy, sadness, frequent tearfulness, and/or hopelessness.

• With anxiety: Characterized by nervousness, jitters, worry, or feeling on edge. May also involve separation anxiety.

• With mixed anxiety and depressed mood: Involves symptoms of both anxiety and depression. They may occur together or alternate over time.

• With disturbance of conduct: Characterized by behavioral disturbances, such as recklessness, impulsivity, or destructive behavior.

• With mixed disturbance of emotions and conduct: Involves emotional symptoms (depression and/or anxiety) and conduct disturbances.

Some research suggests that these symptoms often overlap and may not be completely distinct, but identifying them can help guide treatment options and understanding.^[1]

Symptoms

Adjustment disorders are characterized by behavioral and emotional reactions that are disproportionate to the specific stressor or trigger. Common symptoms of adjustment disorders include:^[2][3][4][5]

• Sadness

• Tearfulness

• Low energy

• Lack of pleasure

• Hopelessness

• Helplessness

• Anxiety or worry

• Restlessness/ trouble sleeping

• Irritability/easily agitated

• Body aches, such as headache or stomach issues

• Irregular heartbeat

• Trembling or twitching

The specific symptoms can vary widely among individuals and can range from mild to severe.

It’s also important to note that these symptoms can occur in many other mental health disorders, and can also occur in anyone from time to time. However, they’re more likely indicative of an adjustment disorder if:

• You experience multiple symptoms

• You experience symptoms in direct response to a stressor, which subside over time if the situation is resolved or you’ve adapted to it.

Causes of Adjustment Disorders

To be diagnosed with an adjustment disorder, there has to be an identifiable stressor that triggers it. In general, the causes of adjustment disorders are specific life events or circumstances that result in a difficult emotional or behavioral response. Common causes of adjustment disorders include:^[2][3][4]

• Retirement

• Getting married

• Having a baby

• Death of a loved one

• Moving to a new home, city, school, etc.

• Changing jobs

• Getting fired

• Break-ups, divorce, relationship conflicts

• Financial hardship

• Receiving a medical diagnosis, whether injury or illness

• School or work problems

• Sexuality issues

• Family problems

• Environmental disaster

Not everyone who experiences these stressors will develop an adjustment disorder. Each individual will be affected by these causes to varying degrees, which depends on factors such as genetics, past trauma/life experiences, personality, coping skills, and mental health history.^[2][5]

Can it be Prevented?

There’s no way to fully prevent an adjustment disorder, in part because it is influenced by many factors. However, there are certain protective strategies that may lower your risk, such as:^[2][3]

• Getting a regular check-up

• Addressing identified concerns with early treatment

• Practicing stress management and healthy coping skills

• Identifying your stress triggers

• Building or maintaining a strong social support system

• Planning ahead if you anticipate stressful events/changes

Risks and Complications

Adjustment disorders can cause significant stress and make it difficult to feel like your true self. Individuals with adjustment disorders may struggle at work or in school, isolate themselves from others, lose motivation, and find it difficult to function in daily life.

Adjustment disorder also increases the risk of more severe complications, such as:^[2][4]

• Suicidality

• Self-harm behaviors

• Alcohol and substance use disorders

• Anxiety disorders

• Depressive disorders

Diagnosing Adjustment Disorder

Diagnosing adjustment disorder is typically performed by a psychiatrist, psychologist, or other qualified mental health professional. Initially, you may meet with your primary care doctor, who will complete a comprehensive physical exam, assessing your overall health to rule out other possible causes.

The most important part of the diagnostic process is a comprehensive mental health evaluation. Your mental health provider will conduct an interview to go over your personal and developmental history, life events, and current symptoms, including specific emotional responses and behaviors. If the diagnosis is for a child or adolescent, parents or caregivers are typically interviewed as well.^[2][3][4]

Diagnosis is based on the specific diagnostic criteria found in theDSM-5, which are:^[1]

• Development of emotional and/or behavioral symptoms in response to an identifiable stressor(s) that happens within 3 months after the start of the stressor(s)

• Symptoms or behaviors are clinically significant, with one or more of the following:

• Significant distress that’s disproportionate to the stressor

• Significant impairment in social, occupational, or other important areas of life functioning

• Stress-related disturbance doesn’t meet the criteria for another mental disorder and is not solely an exacerbation of a preexisting mental disorder

• Symptoms don’t represent normal bereavement and are not better explained by prolonged grief

• Once the stressor or its consequences have ended, symptoms don’t last longer than an additional 6 months

Treatment Options

Common treatments for adjustment disorder are therapy, medication, or both. The goal of these treatments is to reduce distress, help the individual adjust to their situation, and return to normal daily functioning.

Therapy

Psychotherapy (or talk therapy) is often the first-line treatment for adjustment disorders. Therapy can help you analyze and reframe your stressors, while providing specific, actionable steps to reduce stress and improve functioning.^[6]

Several forms of psychotherapy may be helpful, including:^[3][4][5][6]

• Cognitive-behavioral therapy (CBT): Helps you recognize specific thoughts, feelings, and behaviors that are contributing to stress and dysfunction. The goal is to change how you respond to stress and to implement more adaptive thoughts and behaviors.

• Family therapy: Focuses on solutions at the family level, such as improving communication and feelings of support, and promoting healthier family interactions.

• Peer group therapy: Often focuses on developing stress management, interpersonal, and social skills in a supportive group setting.

Support groups, mindfulness-based therapy, and internet-based therapy are other potentially beneficial options.^[6]

Medication

Certain medications may also be used for adjustment disorder, depending on the specific symptoms. They’re typically used when severe symptoms or co-occurring issues are present.

Examples of these medications include:^[2][5][6]

• Antidepressants, particularly selective-serotonin reuptake inhibitors (SSRIs) and selective-norepinephrine reuptake inhibitors (SNRIs)

• Anti-anxiety medications, such as benzodiazepines (typically for short-term use only)

• Sleep aids

Living with Adjustment Disorder

In addition to professional treatment, the following tips may help support your recovery when living with adjustment disorder:

• Seek support from family and friends

• Join a support group

• Practice a healthy lifestyle as much as you can

• Engage in hobbies and enjoyable activities, even if they don’t feel as rewarding right now

With professional treatment and the right support, most people can recover from adjustment disorders within six months. Stay in close contact with your healthcare providers, and don’t hesitate to ask questions or reach out when you need to - they’re there to help.