Key takeaways:
An adjustment disorder is a mental health condition caused by an intense reaction to a stressful situation, such as a divorce or getting a failing grade in school.
Depending on the specific type of adjustment disorder you have, you might experience depression or anxiety or exhibit reckless behaviors.
Professionals treat adjustment disorder with psychotherapy alone or combined with medications.
Even though it is a common condition that affects many children, teens, and adults, adjustment disorder is not well-known. If you have experienced a high-stress situation that changed your mood, anxiety level, or behavior, adjustment disorder may be to blame.
Many have never heard of adjustment disorder, butas many as 20% of people who receive outpatient mental health treatment have the condition. Rates may be even higher among those in inpatient treatment.
Adjustment disorder is a serious mental health condition. Fortunately, professionals can treat it with a combination of psychotherapy and medications.
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What is adjustment disorder?
Adjustment disorder is a mental health condition that can arise after a high-stress experience or series experiences. Adjustment disorders produce unwanted emotional and behavioral changes and can affect your mood, anxiety level, and ability to relate to others. They can cause difficulty in your work life or relationships.
Adjustment disorder is not a normal reaction to high stress, though. It is a sign of excessive distress.
Mental health professionals classify adjustment disorders in the same groups as conditions linked to stress and trauma. Other mental health disorders in this group include post-traumatic stress disorder (PTSD) and acute stress disorder.
What are the symptoms of adjustment disorder?
Adjustment disorder symptoms occur within a few months of a stressful experience.
Seven general signs of adjustment disorder are:
Feeling sad or hopeless
Isolating or pulling away from friends and family
Trouble sleeping
Having physical stress symptoms such as a racing heartbeat, tremors, or headaches
Frequent crying
Being more defiant than usual or acting impulsively
Difficulty functioning in daily activities
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Symptoms vary depending on the specific type of adjustment disorder you have. There are six main types of adjustment disorder:
| Type of adjustment disorder | Main symptoms |
|---|---|
| With depressed mood | Sadness, hopelessness, tearfulness |
| With anxiety | Nervousness, feeling jittery, worrying, having trouble separating from loved ones |
| With mixed anxiety and depressed mood | Signs of both depression (sadness, hopelessness, crying) and anxiety (worry and nervousness) |
| With disturbance of conduct | Acting impulsively, challenging others, defiant actions |
| With mixed disturbance of emotions and conduct | A combination of all symptoms: low mood, anxiety, and impulsive or defiant actions |
| Unspecified | Reactions that don’t quite match the depression, anxiety, or impulsive symptoms |
What causes adjustment disorder?
The causes of adjustment disorder vary greatly. Any stress can trigger an adjustment disorder, depending on the person.
Some common stressors that can lead to an adjustment disorder include:
Death of a friend or family member
Divorce or relationship conflict
Illness in yourself or a loved one
A move or career change
Uncertainty regarding money, housing, or transportation
Some common triggers of adjustment disorder for children or teens are:
Poor school performance
Romantic breakups
Changes in peer group
Bullying
Parental divorce or separation
A stressful experience that leads to an adjustment disorder for one person might not affect another person in the same way. Everyone has some level of vulnerability to adjustment disorder, but vulnerability varies based on personality and experience. Those with strong protective factors have a lower risk of developing an adjustment disorder after stress..
Some factors that affect your risk for an adjustment disorder include:
Individual personality
Past experiences with high stress and trauma
Available emotional coping skills
Family and community support
Still, as with other mental health conditions, it is impossible to know who will develop an adjustment disorder and who will not.
How is adjustment disorder diagnosed?
Adjustment disorder is diagnosed by a mental health or physical health professional. Currently, there is not a standard test used to make this diagnosis. Providers make their determination based on an assessment of your experiences.
During the assessment, the healthcare professional will ask you about:
Symptoms, their duration, and their impact
Stressful experiences that might have triggered the reaction
Types of distress you are feeling
Behavioral changes that have started since the stress
How your symptoms affect your actions, relationships, and daily life
To be diagnosed with adjustment disorder, your stress response must be more intense or longer lasting than the typical expected response, based on age and cultural norms. Or your symptoms must interfere with your work, school, or relationships. The diagnosis cannot be based on symptoms stemming from another mental, physical, or substance use disorder.
Adjustment disorder symptoms will start within 3 months of the stressful experience and cannot last longer than 6 months after the stressful situation ends. If your symptoms have lasted longer, your provider may determine that they are caused by a different mental health condition.
You can have other conditions in addition to an adjustment disorder. In fact, about 70% of people with an adjustment disorder have at least one other mental health condition.
What are the differences between adjustment disorder and PTSD?
Adjustment disorder and PTSD are similar conditions. They are both mental health disorders triggered by intense, stressful experiences. The major difference between them is the type of event that triggers the condition.
With adjustment disorder, the stressful event is typically not seen as life-threatening, even though it greatly impacts you. With PTSD, the traumatic event causes death, serious injury, or sexual violence, or the threat of these things happening. The event might be something that happened to you or something you witnessed happening to someone else.
PTSD and adjustment disorder symptoms often overlap, but PTSD can have additional symptoms, including:
Nightmares
Flashbacks
A constant state of high alert
Avoidance of reminders of past trauma
Dissociation
The duration of symptoms is also different for each condition. Adjustment disorder occurs within 6 months of the stressor ending, while PTSD does not have a time limit.
How do you treat adjustment disorder?
Fortunately, with professional treatment, a person with adjustment disorder can get better. The best course of treatment may be a combination of therapy and medication.
Some psychotherapy approaches that can be helpful are:
Cognitive behavioral therapy (CBT): focuses on the connection between thoughts, feelings, and behaviors
Stress management therapy: works on improving symptoms by improving coping skills and relationships
Group therapy: people with similar experiences work together to identify needs and goals while increasing support for all members
Some people may find success with therapy alone. Others may add medication for increased benefits.
There is limited research on the best medications for adjustment disorder specifically. However, based on your symptoms, a prescriber may recommend:
Antidepressants
Medications that lower anxiety and agitation, such as benzodiazepines
The bottom line
Adjustment disorder is a common mental health condition that affects children, teens, and adults. Having the condition can lower your mood, increase your anxiety, and make it difficult to go about your daily life. Treatment can help, however. Therapy, with or without medications, can often help you manage your symptoms. Reach out to a mental health professional if you need support.
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References
American Psychiatric Association. (2020). What is posttraumatic stress disorder (PTSD)?.
American Psychological Association. (n.d.). Adjustment disorder.
Casey, P., et al. (2016). When somebody has an adjustment disorder. Psychiatric News.
MedlinePlus. (2022). Adjustment disorder.
Stein, D. J. (2018). Pharmacotherapy of adjustment disorder: A review. The World Journal of Biological Psychiatry.
Substance Abuse and Mental Health Services Administration. (2014). Exhibit 1.3-4 DSM-5 diagnostic criteria for PTSD. Trauma-Informed Care in Behavioral Health Services.
Substance Abuse and Mental Health Services Administration. (2016). Table 3.19 DSM-IV to DSM-5 adjustment disorders comparison. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health.
University of Rochester Medical Center. (n.d.). Adjustment disorders in children.
Virginia Commission on Youth. (2017). Adjustment disorder.
Zelviene, P., et al. (2018). Adjustment disorder: Current perspectives. Neuropsychiatric Disease and Treatment.
