Adjustment Disorder
Overview
Among diagnosed mental disorders, adjustment disorders are one of the most common.[1] Adjustment disorders are characterized by the development of emotional or behavioral symptoms in response to a stressful event or change in an individual’s life (positive or negative).[2] Symptoms are considered maladaptive and typically develop within three months of the stressor. Examples of a stressor include divorce, family move, death of a family member, relationship issues, having a baby, or chronic illness.[3] These can be recurrent events or a single occurrence.[4]
Types of Adjustment Disorders and Symptoms
In all adjustment disorders, the reaction to the stressor is excessive and significantly impacts social, occupational, and educational functioning.[5] Further, symptoms of adjustment disorders can transpire emotionally and behaviorally. These can include:[6]
Feeling sad or not enjoying things once enjoyed
Frequent crying
Feeling anxious, nervous, jittery or stressed out
Lack of appetite
Difficulty concentrating
Feeling overwhelmed
Difficulty functioning in daily activities
Withdrawing from social supports
Avoiding important things such as going to work
The DSM-V distinguishes between five different subtypes of adjustment disorders, each having a specific set of symptoms.[7,8] Adjustment disorders can co-occur with:
Depressed mood: Symptoms include low mood, sadness, and feelings of hopelessness.
Anxiety: Symptoms include nervousness, worry, jitteriness, and feeling overwhelmed.
Anxiety and depressed mood: Symptoms include a combination of depression and anxiety.
Disturbance of conduct: Symptoms mainly include behavioral problems and violation of rules.
Mixed disturbance of emotions and conduct: Symptoms include a mixture of emotional symptoms (e.g., anxiety, depression) and behavioral problems.
Causes
Significant life changes or the occurrence of stressful events can cause adjustment disorder.[9] Temperament, past experiences, vulnerability, and coping skills may also affect the onset of adjustment disorder.[10]
Risk Factors
Children and adolescents are most at risk for developing adjustment disorder, but it can occur at any age.[11] Other risk factors include:[12]
Occurrence of a stressful event: Both positive and negative events can put an individual at risk for developing an adjustment disorder. Examples include divorce, relationship problems, family, having a baby, financial issues, life-threatening experiences, medical illness, and death of a loved one.
Life experiences: Previous life experience can affect an individual’s ability to deal with stress and can increase the risk of developing an adjustment disorder. Examples include significant stress in childhood, mental health issues, and numerous adverse experiences happening at once.
Diagnosis
A mental health professional can make the diagnosis of an adjustment diagnosis based on criteria in the DSM-5. Personal experiences, medical and social history, and mental health will be discussed to determine if one has an adjustment disorder.
The DSM-5 lists the following criteria for the diagnosis of adjustment disorders:[13,14]
Onset of emotional and behavioral symptoms within three months of stressful event.
Experiencing more stress than would be normally expected for the event and/or disruptions to social, educational, or occupational functioning.
Symptoms are not caused by another current mental health disorder or previous condition.
Symptoms that don’t persist for more than six months after initial onset.
Complications
Although adjustment disorders are common and very treatable, they can lead to complications if not resolved. These include anxiety disorders, depression, or substance abuse.[15]
Treatment options
Psychotherapy and medication are both effective at treating adjustment disorders. The duration of treatment can vary depending on the severity of the disorder. Options include:[16]
Psychotherapy (talk therapy): This is the most common treatment option for adjustment disorders. Psychotherapy can provide emotional support, facilitate the reentering of a routine, evaluate the stressful event, and advise coping skills.
Medication: Based on the severity of each case, a psychiatrist may prescribe medication. These typically include antidepressants or anti-anxiety medications to help with the symptoms of depression and anxiety.
Additionally, self-help methods can reduce the symptoms of an adjustment disorder. These include:[17]
Staying connected with social supports such as friends and family.
Doing something every day that provides enjoyment and a sense of purpose.
Maintaining a healthy diet, regular physical activity, and a consistent sleep schedule.
Developing one’s own personal strengths.
Addressing problems as they occur, instead of avoiding them.
If you think you may be experiencing an adjustment disorder and would like to explore possible treatment options, please reach out to a licensed mental health provider.
Contributed by: Amelia Worley
Editor: Jennifer (Ghahari) Smith, Ph.D.
references
1 Bachem, R., & Casey, P. (2017, October 23). Adjustment disorder: A diagnosis whose time has come. Journal of Affective Disorders. Retrieved May 25, 2022, from https://www.sciencedirect.com/science/article/pii/S0165032717315112
2 Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health National Library of Medicine. (2016). Retrieved May 25, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t19/
3 Adjustment disorders. Johns Hopkins Medicine. (2021, August 8). Retrieved May 24, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders
4 Adjustment disorder: What is it, symptoms, causes & treatment. Cleveland Clinic. (n.d.). Retrieved May 25, 2022, from https://my.clevelandclinic.org/health/diseases/21760-adjustment-disorder
5 Johns Hopkins Medicine. (2021, August 8).
6 Mayo Foundation for Medical Education and Research. (2017, October 25). Adjustment disorders. Mayo Clinic. Retrieved May 27, 2022, from https://www.mayoclinic.org/diseases-conditions/adjustment-disorders/symptoms-causes/syc-20355224
7 National Library of Medicine. (2016).
8 Mayo Foundation for Medical Education and Research. (2017, October 25). Adjustment disorders. Mayo Clinic. Retrieved May 25, 2022, from https://www.mayoclinic.org/diseases-conditions/adjustment-disorders/diagnosis-treatment/drc-20355230
9 Ibid.
10 Johns Hopkins Medicine. (2021, August 8).
11 Ibid.
12 Mayo Foundation for Medical Education and Research. (2017, October 25).
13 Ibid.
14 National Library of Medicine. (2016).
15 Mayo Foundation for Medical Education and Research. (2017, October 25).
16 Ibid.
17 Ibid.