Adjustment Disorder

An adjustment disorder is a short-term condition that occurs when a person is unable to cope with, or adjust, to a particular source of stress, commonly a major life change, loss or event. Because people with adjustment disorders often have symptoms of depression—such as tearfulness, feelings of hopelessness, and loss of interest in work or activities—adjustment disorder is sometimes called "situational depression." Unlike major depression, however, an adjustment disorder is triggered by an outside stressor and generally goes away once the person has adapted to the situation.

Stressors vary with the person but might include:

• Ending of a relationship or marriage
• Losing or changing jobs
• Losing a loved one
• Developing a serious illness (yourself or a loved one)
• Being a victim of a crime
• Having an accident
• Undergoing a major life change (such as getting married, having a baby or retiring from a job)
• Living through a disaster, such as a fire, flood or hurricane

A person with an adjustment disorder develops emotional and/or behavioral symptoms as a reaction to the stressor. These symptoms generally begin within three months of the event and rarely last for longer than six months after the event or situation is over. In an adjustment disorder, the reaction to the stressor is greater than what is typical or expected for the situation or event. In addition, the symptoms might cause problems with daily functioning; for example, the person might be unable to sleep, work or study.

An adjustment disorder is not the same as post-traumatic stress disorder (PTSD). PTSD generally occurs as a reaction to a life-threatening event and tends to last longer. An adjustment disorder, on the other hand, is short-term, rarely lasting longer than six months.

What are the symptoms of an adjustment disorder?

An adjustment disorder can have a wide variety of symptoms, which might include:

• Feeling of hopelessness
• Sadness
• Frequent crying
• Anxiety (nervousness)
• Worry
• Headaches or stomachaches
• Palpitations (an unpleasant sensation of irregular or forceful beating of the heart)
• Withdrawal or isolation from people and social activities
• Absence from work or school
• Dangerous or destructive behavior, such as fighting, reckless driving and vandalism
• Changes in appetite, either loss of appetite or overeating
• Problems sleeping
• Feeling tired or without energy
• Increase in the use of alcohol or other drugs

Symptoms in children and teens tend to be more behavioral in nature, such as skipping school, fighting or acting out. Adults, on the other hand, tend to experience more emotional symptoms, such as sadness and anxiety.

What causes an adjustment disorder?

An adjustment disorder is a reaction to stress and is caused by a breakdown in a person’s normal process of dealing with stressful events or situations. Other factors that can contribute to how a person reacts to stress include the person’s age and level of maturity, current economic and living situation, coping skills, and the availability of social or family support, as well as work/school and recreation opportunities.

How common are adjustment disorders?

Adjustment disorders are very common and can affect anyone, regardless of gender, age, race or lifestyle. About 10 percent of adults and 32 percent of adolescents suffer from adjustment disorders. Although an adjustment disorder can occur at any age, it is more common at times in life when major transitions occur, such as adolescence, mid-life and late-life.

How is an adjustment disorder diagnosed?

If symptoms are present, the doctor will perform a complete medical history and physical examination. Although there are no imaging or laboratory tests to specifically diagnose an adjustment disorder, the doctor might use some diagnostic tests—such as blood tests or X-rays—to rule out physical illness as the cause of your symptoms. The doctor also will rule out other, more serious mental disorders, such as post-traumatic stress disorder, major depression or an anxiety disorder.

The doctor bases his or her diagnosis of an adjustment disorder on the patient’s report of the intensity and duration of symptoms—including any problems with daily functioning caused by the symptoms. The doctor then determines if the patient’s symptoms and degree of dysfunction indicate an adjustment disorder. The standard reference manual used for the diagnosis of recognized mental illnesses in the United States is the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association.

In general, an adjustment disorder is diagnosed if the level of distress is more intense than would normally be expected, given the stressor, or if the symptoms interfere with normal functioning.

How is an adjustment disorder treated?

A person with an adjustment disorder might be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses.

The goal of treatment for an adjustment disorder is to return the person to his or her pre-stressor level of functioning. Psychotherapy (a type of counseling) is the most common treatment for an adjustment disorder. Therapy helps the person understand how the stressor has affected his or her life. It also helps the person develop better coping skills.

Support groups also can be helpful by allowing the person to discuss his or her concerns and feelings with people who are coping with the same stress.

In some cases, medication might be used to help control anxiety symptoms or sleeping problems.

Complications of an adjustment disorder

Major depression might develop if treatment for an adjustment disorder is not sought. Further, a substance abuse problem might result if the person turns to alcohol or drugs to help him or her cope with stress and anxiety.

What is the outlook for people with adjustment disorders?

Most people with adjustment disorders recover completely. In fact, a person who is treated for an adjustment disorder might learn new skills that actually allow him or her to function better than before the symptoms began.

Can an adjustment disorder be prevented?

There is no known way to prevent an adjustment disorder. However, strong family and social support can help a person work through a particularly stressful situation or event. The best prevention is early treatment, which can reduce the severity and duration of symptoms, and teach new coping skills.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/28/2005…#9554