Adjustment Disorder

Overview

What is adjustment disorder?

Adjustment disorder is a short-term condition. It’s diagnosed in an individual who experiences an exaggerated reaction to a stressful or traumatic event.

Stressors can be single events (like a bad breakup) or can be multiple events (like work problems, struggles at school, financial issues). Stressors can happen to an individual, a family or an entire group (such as disaster survivors). Stressors can also be recurrent (like factors associated with seasonal business) or with specific “milestone” events (like going to school, getting married or retiring).

Adjustment disorder is also called situational depression.

How common is adjustment disorder?

Adjustment disorder is thought to affect 2 to 8% of the general population. It can affect anyone at any age. It affects twice as many females as males.

Can adjustment disorders affect children?

Yes. Adjustment disorder can affect both adults and children. Boys and girls are equally affected.

Symptoms and Causes

What are the possible causes of adjustment disorder?

There are many possible causes of adjustment disorders. Generally, it’s any situation you perceive as stressful and that causes significant problems in your work, social or home life. They can be both positive and negative events.

Some examples include:

  • Death of a family member or friend.
  • Relationship issues, including breakups, marital problems and divorce.
  • Getting married; having a baby.
  • Serious health issues.
  • School issues.
  • Financial difficulties.
  • Work issues (job loss, failing to meet goals).
  • Living in a crime-ridden neighborhood.
  • Retiring.
  • Disaster or unexpected tragedy.

Your personality, temperament, well-being, life experiences and family history are all also thought to play a role in the possible development of adjustment disorder.

What are the symptoms of adjustment disorder?

Everyone is going to experience an adjustment disorder differently. Symptoms can vary from mild to severe, depending on the intensity of the triggering situation and the personal significance it has for you.

Common physical symptoms:

  • Being tired, but can’t sleep (insomnia).
  • Body aches and soreness; thinking that you’re sick.
  • Headaches or stomachaches.
  • Heart palpitations.
  • Sweating hands.

Common behavioral or emotional symptoms:

  • Acting rebellious, destructive, reckless or impulsive.
  • Being anxious or agitated, feeling trapped, hopeless.
  • Crying easily.
  • Trouble concentrating.
  • Being withdrawn or isolated; feeling sad; lacking energy or enthusiasm; loss of self-esteem.
  • Loss of interest in everyday activities.
  • Changes in eating habits.
  • Feeling overwhelmed and stressed.
  • Abusing alcohol or drugs.
  • Having suicidal thoughts or behaviors.

Diagnosis and Tests

How is an adjustment disorder diagnosed?

Your healthcare provider will complete a full physical and mental health exam. They may consider the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association.

To be diagnosed with adjustment disorder, you have to meet the following five DSM-5 criteria:

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

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

Your healthcare provider should also take into account your cultural background in determining if your response to a stressor is in excess of what would be expected.

Are there different types of adjustment disorders?

The DSM-5 lists six types of adjustment disorder:

  • Adjustment disorder with depressed mood: Symptoms include feelings of sadness, hopelessness, crying and lack of joy from previous pleasurable things.
  • Adjustment disorder with anxiety: Symptoms include 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: Symptoms include feeling both anxious and depressed.
  • Adjustment disorder with disturbance of conduct: Symptoms include behavioral issues such as acting rebellious, destructive, reckless or impulsive.
  • Adjustment disorder with mixed disturbance or emotions and conduct: Symptoms include anxiety, depression and behavioral issues.
  • Adjustment disorder unspecified: Symptoms include physical symptoms such as headaches, body aches, stomach aches, heart palpitations, or insomnia.

What are the complications of adjustment disorder?

If left untreated, people with adjustment disorder are at higher risk of suicide attempt or thoughts of suicide.

If your symptoms become so overwhelming that it’s difficult for you to make it through a day, call your healthcare provider. If you have suicidal thoughts, get help immediately. Call the National Suicide Prevention Lifeline at 800.273.TALK (800.273.8255).

Management and Treatment

How is adjustment disorder treated?

Adjustment disorders are best managed if caught and treated early.

Talk therapy (psychotherapy) is the main treatment. Since a situation or stress is what causes adjustment disorder, having someone to talk to that you trust and getting the tools you need to learn how to better cope with the situation can be really helpful.

Individual, family or group therapy (support groups) are also helpful. Family therapy is often used if the person is a child or teenager.

Are medications used to treat adjustment disorder?

When medications are needed, anti-anxiety medicines (benzodiazepines) are the main drugs used to treat adjustment disorder. Your healthcare provider may also prescribe medication to help you sleep. Some providers may also try antidepressant medicines. Selective serotonin reuptake inhibitors (SSRI) or serotonin and norepinephrine reuptake inhibitors (SNRI) are the drug classes more frequently tried.

Are any alternative therapies helpful for adjustment disorder?

There’s some evidence that Ginkgo biloba, kava-kava and valerian are useful in treating adjustment disorder with anxiety.

Prevention

Are there ways to prevent adjustment disorder from happening?

Although we can’t control the world around us, there are things we can do to feel better when stressors arise. Strategies include:

  • Build up your support system: Engage your family, friends and groups you’re in to support you and uplift you in troubled times.
  • Do 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 play with your pets. Take time for yourself. Do things that make you feel better and make you happy. Set a regular schedule for “me time.”

Outlook / Prognosis

What can I expect if I have a diagnosis of adjustment disorder?

Adjustment disorder goes away over time when the stressor is removed or when you adapt to the situation. Usually any medical interventions are limited and once the situation has improved, so too will your symptoms.

Frequently Asked Questions

What’s the difference between adjustment disorder and major depression and generalized anxiety disorder?

A diagnosis of adjustment disorder is based on the presence of a stressor and the fact that the condition goes away when the stressor goes away. By definition of this diagnosis, the condition must end six months after the triggering event. With major depression and generalized anxiety disorder, there doesn’t need to be an identifiable stressor and the duration of symptoms can be ongoing.

What’s the difference between adjustment disorder and post-traumatic stress disorder (PTSD)?

With adjustment disorder, the severity of the stressor doesn’t matter. With PTSD, you have to fear for your life or the life of someone else. The severity is very high.

A note from Cleveland Clinic

Adjustment disorder is usually a self-limiting disorder. Your symptoms will go away when your stressor goes away. Life is full of ongoing challenges. Both bad and good experiences can cause excessive stress. Your friends, family and religious affiliations are important in helping you celebrate your life joys and may be leaned on in troubled times. If you feel overwhelmed by a stressful event, your healthcare team is ready to see you. If you have suicidal thoughts, call for help immediately: 800.273.TALK (the National Suicide Prevention Lifeline). Help is always at your fingertips.

Last reviewed by a Cleveland Clinic medical professional on 08/20/2021.

References

  • Adjustment disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. Accessed 9/16/2021.
  • Bachem R. Casey P. Adjustment disorder: A diagnosis whose time has come. (https://pubmed.ncbi.nlm.nih.gov/29107817/) J Affect Dis. 2018;227(2):243-253. Accessed 9/16/2021.
  • Casey P. Adjustment Disorder: New Developments. (https://pubmed.ncbi.nlm.nih.gov/24748555/) Curr Psychiatry Rep. 2014;16:451. Accessed 9/16/2021.
  • Casey P, Strain J. When Someone Has an Adjustment Disorder. (https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.1a18) Psychiatric News. 2016, Jan 4. Published online. Accessed 9/16/2021.

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