Adjustment Disorders

What is an adjustment disorder?

An adjustment disorder is a strong emotional or behavioral reaction to stress or trauma. It causes short-term symptoms that may make you react more than you typically would. You may cry easily or feel depressed and hopeless. You might overindulge in risky behaviors, or act recklessly or impulsively. The behaviors and feelings vary from person to person.

Sometimes, one event can cause adjustment disorder symptoms. Other times, multiple events can cause symptoms after pushing you to a breaking point. Symptoms usually lessen after six months.

Your healthcare provider might refer to an adjustment disorder as situational depression.

What are the types of adjustment disorders?

There are several types of adjustment disorders classified in the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) or the latest version, the DSM-5-TR (“TR” stands for “text revision”). This is the American Psychiatric Association’s guide to mental health conditions. Types of adjustment disorders and associated symptoms include:

• Adjustment disorder with depressed mood: Feelings of sadness, hopelessness, crying and lack of joy from things that used to bring you pleasure.
• Adjustment disorder with anxiety: Feeling worried, anxious and overwhelmed. You also have trouble concentrating. Separation anxiety is a dominant symptom in children.
• Adjustment disorder with mixed anxiety and depressed mood: Feeling both anxious and depressed.
• Adjustment disorder with disturbance of conduct: Behavioral symptoms such as acting rebellious, destructive, reckless or impulsive.
• Adjustment disorder with mixed disturbance or emotions and conduct: Anxiety, depression and behavioral issues.
• Adjustment disorder unspecified: Physical symptoms such as headaches, body aches, stomach aches, heart palpitations or insomnia.

How common are adjustment disorders?

Researchers are still learning how common adjustment disorders are. One global study found that adjustment disorders affect an estimated 2% of people around the world. A U.S. study estimated that 5% to 20% of outpatient mental health visits were for adjustment disorders.

Statistics on adjustment disorders can vary due to the different groups surveyed and varying diagnostic criteria.

What are the symptoms of adjustment disorders?

Adjustment disorder symptoms affect each person differently and vary by type. Common symptoms include:

• Feeling depressed (sad, low energy, hopeless and crying easily).
• Feeling anxious (nervous and trembling).
• Impulsive or reckless behavior.
• Difficulty concentrating.
• Feeling easily agitated.
• Feeling tired but being unable to sleep (insomnia).
• Experiencing body aches or soreness (headache, stomachache, etc.).
• Having a skipped heartbeat (heart palpitations) or an irregular heartbeat (arrhythmia).

If at any point you feel like hurting yourself or are thinking about suicide, contact a healthcare provider or contact the Suicide and Crisis Lifeline by dialing or texting 988 (U.S.). Someone is available to talk with you 24 hours a day, seven days a week.

What causes adjustment disorders?

Coping with a stressor or traumatic event causes adjustment disorders. A stressor is an event or situation that causes stress (your body’s physical and emotional reaction to change).

Common examples could include, but aren’t limited to, the following:

• Retiring, getting married or having a baby.
• Death of a loved one.
• Relationship changes, including breakups, marital problems and divorce.
• Receiving a medical diagnosis.
• Difficulty at school or work.
• Financial challenges.
• An environmental disaster.
• Not having your physical or emotional needs met.

Stress affects each person differently. Sometimes, a lot can happen at once and you simply haven’t had time to take care of yourself. Not all stressors are traumatic. They could revolve around very positive changes in your life. But when stress takes over, you won’t feel like yourself.

What are the triggers for adjustment disorders?

Triggers are reminders of a stressful event or trauma. Triggers usually come with a strong memory and can affect how you feel when you see or interact with the reminder. It can cause symptoms of adjustment disorder. Anything can be a trigger for adjustment disorder, including:

• Seeing a photo or keepsake.
• Hearing a familiar song.
• The smell or taste of a specific food.
• The texture of a piece of clothing.

This isn’t an exhaustive list, since triggers are very personal to the person they affect. Symptoms of an adjustment disorder can vary from mild to severe, depending on the intensity of the triggering situation and the personal significance it has for you.

What are the risk factors for adjustment disorders?

An adjustment disorder can affect anyone at any age — from children to adults. It’s more common among women and people assigned female at birth (AFAB) than men and people assigned male at birth (AMAB). The following may put you more at risk of developing an adjustment disorder:

• Your personality and temperament.
• Your life experiences.
• Your biological family history and genetics.
• Other mental health conditions (like depression, anxiety or post-traumatic stress disorder).

What are the complications of adjustment disorders?

Complications of adjustment disorders can be life-threatening and may include:

• Suicide, suicidal ideation or self-harm.
• Substance use disorder (SUD).
• Alcohol use disorder.

If your symptoms become so overwhelming that it’s difficult for you to make it through the day, call your healthcare provider. If you have suicidal thoughts, get help immediately. Call or text the Suicide and Crisis Lifeline at 988.

How are adjustment disorders diagnosed?

To diagnose adjustment disorder, a healthcare provider will offer a physical exam and ask you about your symptoms. They may refer you to a mental health provider like a psychologist or a psychiatrist for a mental health evaluation and to confirm the diagnosis.

Adjustment disorders DSM-5 criteria

A psychologist or psychiatrist will refer to the diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to make a diagnosis. The criteria for adjustment disorder include:

• Your emotional or behavioral symptoms developed within three months of the start of a stressful event in your life.
• Your emotional or behavioral symptoms are clinically significant. This means that your stress must exceed what would normally be expected and/or the stress is causing significant problems in your work, home or social life.
• Your symptoms don’t meet the criteria for another mental health condition and aren’t worsening symptoms or a flare-up of an existing mental health condition.
• Your symptoms aren’t part of a normal grieving process.

You may hear your provider further identify your condition as acute or chronic:

• Acute adjustment disorder means your symptoms last less than six months.
• Chronic adjustment disorder means your symptoms last six months or longer.

Your cultural background or norms may affect how you experience and express grief or stress. Your healthcare provider will take this into account when determining if your response to a stressor is more than expected.

How are adjustment disorders treated?

Treatment for adjustment disorders may include:

• Psychotherapy: Talk therapy, like cognitive behavioral therapy, can help you identify and adjust how you respond to a stressor. Individual, family or group therapy (support groups) may also help. Family therapy is a recommended treatment for a child or teenager.
• Medications: The type of medication varies based on your symptoms. Medications can help if you feel depressed, anxious or you’re having trouble sleeping, for example.

Your healthcare provider may recommend combining medications with therapy. Medications shouldn’t be the only form of treatment. Many people see success with therapy only and you might not need medications.

Since a stressful or traumatic situation causes adjustment disorders, having a trusted person to talk to and getting tools to learn how to cope with the situation can be very helpful.

What medications treat adjustment disorders?

A healthcare provider may prescribe the following medications based on what symptoms you experience:

• Anti-anxiety medications (benzodiazepines).
• Antidepressant medications (selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors).

Your healthcare provider may also prescribe medications to help you sleep.

How soon after treatment will I feel better?

Symptoms of adjustment disorder usually go away after six months. Some cases may persist beyond six months (chronic adjustment disorder). It’s common to continue treatment, like participating in a type of therapy, throughout your life. Continuing treatment even after you feel better can reduce your risk of developing symptoms when other stressors impact you.

Can adjustment disorders be prevented?

You can’t prevent all causes of adjustment disorders. But you can take steps to reduce your stress and better adapt to change, like:

• Building a support system: Engage your family, friends and peer groups to support and uplift you when you’re feeling down. Maintaining open communication allows loved ones to better know and understand how you’re feeling so they can help you when you need it.
• Practicing self-care regularly: Spend time taking care of yourself. Take a hot bath, read a book, write in a journal, go for a walk or find activities you enjoy. Do things that make you feel better when you’re upset or not having a good mental health day. Set a regular schedule for “me time.”
• Maintaining a healthy lifestyle: Eating healthy foods and exercising regularly can do a lot for your physical health as well as your mental health. If you’re unsure where to start, talk to a healthcare provider for tips on how to adjust your activities and the foods you eat to ones that can benefit your body and mind.

What can I expect if I have an adjustment disorder?

An adjustment disorder is a short-term condition. It can affect many aspects of your life, from your physical to your mental health. It can also affect your relationships and your ability to meet personal commitments while you’re experiencing symptoms.

With treatment, recovery is possible. Therapy can help you recognize when negative thoughts and feelings happen and how to react to them in a healthy way. Therapy can be challenging. It’s difficult to open up and share your thoughts and feelings with a stranger, but your therapist is a highly trained healthcare provider whose goal is to help you feel better.

You can also build a support system, like joining a support group or talking with friends or loved ones, to help you when you don’t feel like yourself.

How long does an adjustment disorder last?

An adjustment disorder goes away over time when you remove or adapt to the stressor that triggered your symptoms. On average, the condition resolves within six months. It may continue if stress persists. You may feel better sooner with treatment.

When should I see a healthcare provider?

Seek medical attention if you or a loved one experience feelings or behaviors that seem out of the norm or stronger than usual, especially after a stressful event.

Seek medical attention right away if you have suicidal thoughts or want to harm yourself. You can call or text the Suicide and Crisis Lifeline at 988. This hotline connects you to a network of local crisis centers that provide free and confidential emotional support. In an emergency, call 911 or your local emergency services number.

What questions should I ask my healthcare provider?

Questions to ask your healthcare provider include:

• What type of treatment do you recommend?
• Are there side effects of the medication you prescribed?
• How often should I see a therapist?
• Can you recommend any support groups?

Adjustment disorder vs. PTSD: What’s the difference?

Both adjustment disorders and post-traumatic stress disorder (PTSD) are mental health conditions that happen after a traumatic event. The cause of an adjustment disorder is less severe than that which causes PTSD. With PTSD, it’s a severely distressing event that causes symptoms, usually one that may be life-threatening like an accident, sexual assault or military combat. Treatment is available for both conditions.

A note from Cleveland Clinic

Life is full of ongoing and unpredictable challenges. Both bad and good experiences can cause excessive stress that leads to adjustment disorders. It helps to have the support of loved ones and healthcare providers who you can lean on when things become too stressful. Therapy and medications can help you get back to feeling like yourself. Don’t be afraid to reach out for help when you need it. If you have suicidal thoughts, call for help immediately: 988 (Suicide and Crisis Lifeline). Help is always at your fingertips.