What You Should Know About Adjustment Disorder

Adjustment disorder (AD) is a mental health condition in which a person develops emotional and behavioral symptoms in response to a stressful event. These responses may be disproportionately more severe than typically expected. Symptoms develop within three months of the stressful trigger and typically resolve by six months after the stressor is gone.

While AD is a common disorder, it is significantly under-researched. There is a lack of quality research, clarity in diagnostic criteria, and consensus among researchers and mental health professionals. More research has been proposed to find more accurate and reliable ways to diagnose and treat AD.

Read on to learn more about AD and its management.

Types of Adjustment Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the American Psychiatric Association handbook for diagnosing mental disorders, identifies six subtypes under the heading of AD:

• With depressed mood
• With anxiety
• With mixed anxiety and depressed mood
• With disturbance of conduct
• With mixed disturbance of emotions and conduct
• Unspecified
  

Adjustment Disorder Symptoms

AD is characterized by a maladaptive (negative) reaction to a stressful event, such as a preoccupation with the event or its consequences. This may include excessive worry and repeated distressful thoughts about the stressor.

While everyone experiences and reacts to stressful things, people with AD have a response that is disproportionately extreme to the severity of the stressor, the person's previous functioning, and the expected reaction of the typical person. Difficulty adapting to the stressor can cause serious functional impairments in several areas, such as at home, work, school, or in personal life.

The specific, predominant symptoms associated with AD depend on which subtype is present.

With depressed mood:

• Tearfulness
• Feeling hopeless
• Low/depressed mood

With anxiety:

• Nervousness
• Jitteriness
• Worry
• Separation anxiety from major attachment figures

With mixed anxiety and depressed mood:

• Combination of anxiety and depression symptoms

With disturbance of conduct:

• Reckless or destructive behavior
• Violating the rights of others
  
• Violating societal norms and rules (such as skipping school, vandalism, fighting, reckless driving, etc.)

With mixed disturbance of emotions and conduct:

• Combination of emotional symptoms (such as anxiety and depression) and a disturbance of conduct

Unspecified:

• Maladaptive reactions that don't fit within one of the specific subtypes
• Might include social withdrawal or difficultly engaging in regular activities, such as work or school

Duration of Symptoms

Symptoms of AD begin within three months of the stressful trigger. However, acute stressors (such as losing a job) tend to bring on symptoms quickly.

AD typically resolves by six months after the stressor (and its consequences) are removed. If the stressor is ongoing, the reaction may last longer as well.

If symptoms last longer than this, another condition may be present, such as an anxiety or mood disorder, and a new diagnosis should be explored.

In some cases, AD has been associated with an increased risk of suicide.

Adjustment Disorder Causes 

A 2018 review likens AD to an analogy of the flu. While most people experience short-term symptoms of the flu and then recover, some people develop serious and/or lasting complications when they get the flu.

While the flu is a vastly different condition than AD, the analogy fits. Everyone experiences stressful events, and most people respond proportionately with coping strategies. People with AD have an overactive, maladaptive response to a stressor.

With AD, the stressor is identifiable, and the reaction is to a specific event or trigger. This might include:

• Divorce or relationship break-up
• Illness
• Disability
• Financial/socioeconomic difficulties
• Problems at work
• Job loss
• Conflicts with others
• Moving
• Retirement
  

For children and adolescents, examples of stressors may include:

• Parental divorce/break-up
• Moving
• Birth of a sibling
• Illness
• Loss of a pet
  

Risks Factors for Adjustment Disorder

Risk factors for AD are not well-known, and more research is needed.

Some studies suggest it is more common in women, while others indicate it occurs equally in men and women.

Some findings indicate it's more common in older adults, while others show it is common in children and adolescents.

AD occurs in all cultures, but the stressors and symptoms are influenced by cultural factors that need to be considered.

Diagnosing Adjustment Disorder

There are no widely accepted diagnostic tools currently specifically used for AD. It is viewed as a sub-threshold condition, meaning that if symptoms meet the diagnostic criteria for another disorder, AD cannot be diagnosed.

AD is also sometimes considered a transient diagnosis, used to identify early or temporary mental states that do not yet meet all of the criteria of a major mental health disorder.

To explore a diagnosis of AD, a healthcare provider or mental health professional may:

• Discuss symptoms
• Discuss medical and family histories
• Do a physical examination
• Run tests, such as blood labs, to look for a physical reason for the symptoms
• Do a mental status examination
  

Adjustment Disorder Treatment

Treatment for AD has not been well-studied.

While AD tends to get better on its own, it can cause significant disruption while it is present. Treatments, such as psychotherapy (talk therapy), may help manage AD.

Psychotherapy

Psychotherapy is the preferred treatment for AD. The person with AD and their healthcare provider or mental health professional will decide together which type will be the most beneficial.

Cognitive behavioral therapy (CBT) is a common choice. With the help of a therapist, CBT helps the person with AD recognize the maladaptive thoughts and feelings, then helps teach the person how to change them into healthy coping behaviors and thoughts.

Other forms of psychotherapy that may be used include:

• Solution-focused therapy (a goal-directed and collaborative approach that focuses on the solution instead of the stressor)
• Family therapy
• Couples therapy
• Long-term therapy
• Self-help or support groups
  

Medication

Medication is not typically recommended for treatment of AD.

When medication is warranted, it is used alongside psychotherapy to manage specific symptoms, such as:

• Insomnia and sleep problems
• Significant anxiety or depression symptoms

Coping With Adjustment Disorder

In addition to seeking care from your healthcare provider or mental health professional, some ways to cope with AD include:

• Develop and maintain supportive relationships with friends and family
• Get plenty of sleep
• Exercise
• Eat nutritious foods
• Practice mindfulness techniques, such as meditation and yoga

Summary

Adjustment disorder is a common but under-researched mental health condition. It is characterized by a disproportionate response to a stressful event.

AD falls into subsets of symptom groups, namely anxiety symptoms, depression symptoms, disturbance of conduct, or a combination of these symptoms.

Research on the treatment of AD is lacking, but psychotherapy, such as CBT, is most commonly recommended. AD usually resolves within six months.

A Word From Verywell 

If you are having a difficult time managing your response to a stressful event, it's worth discussing with your healthcare provider to see if AD may be present. If you are experiencing AD, the chances are high that it will resolve within six months, but treatment may help you feel better and learn valuable coping skills.