How to Manage Adjustment Disorder
Stressful situations may lead to anxiety, depression, and behavioral issues
Medically reviewed by Michael MacIntyre, MD
Adjustment disorder (AD) is a mental health condition in which a person develops emotional and behavioral symptoms in response to a stressful event. These responses may be disproportionately more severe than typically expected. Symptoms develop within three months of the stressful trigger and usually resolve by six months after the stressor is gone.
There are several different types of adjustment disorder, such as adjustment disorder with anxiety and adjustment disorder with depressed mood. While AD is a common disorder, there is a lack of quality research, clarity in diagnostic criteria, and consensus among researchers and mental health professionals.
This article goes over the different types of adjustment disorders, their symptoms, and what causes them. It also discusses diagnosis and treatment.
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Adjustment Disorder Symptoms
AD is characterized by a maladaptive (negative) reaction to a stressful event. For example, someone with AD may be preoccupied with the event or its consequences.
Symptoms of adjustment disorder can vary from person to person. Some people may feel anxious while others may feel irritable or sad. Most experience excessive worry and repeated distressful thoughts about the stressor.
While everyone experiences and reacts to stressful things, people with AD have a response that is disproportionately extreme to the severity of the stressor, the person's previous functioning, and the expected reaction of the typical person. Difficulty adapting to the stressor can cause serious functional impairments in several areas, such as at home, work, school, or in personal life.
The specific, predominant symptoms associated with AD can include:
Tearfulness
Feeling hopeless
Low/depressed mood
Nervousness
Jitteriness
Worry
Separation anxiety from major attachment figures
Reckless or destructive behavior
Violating the rights of others
Violating societal norms and rules (such as skipping school, vandalism, fighting, reckless driving, etc.)
Social withdrawal or difficulty engaging in regular activities, such as work or school
Symptoms Can Differ
Symptoms are subjective and can vary between people. There can also be differences in symptoms, severity, duration, and outcome of AD between adolescents and adults. Children and adolescents tend to have more behavioral symptoms (such as "acting out"), while adults often experience more emotional symptoms, such as depression.
Duration of Symptoms
Symptoms of AD begin within three months of the stressful trigger. However, acute stressors (such as losing a job) tend to bring on symptoms quickly.
AD typically resolves by six months after the stressor (and its consequences) are removed. If the stressor is ongoing, the reaction may last longer as well.
If symptoms last longer than this, another condition may be present, such as an anxiety or mood disorder. in these cases, a new diagnosis should be explored.
AD can have serious consequences and has been associated with an increased risk of suicide.
Help Is Available
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database.
Adjustment Disorder Causes
A 2018 review likens AD to an analogy of the flu. While most people experience short-term symptoms of the flu and then recover, some people develop serious and/or lasting complications.
While the flu is a vastly different condition than AD, the comparison fits. Everyone experiences stressful events, and most people respond proportionately with coping strategies. People with AD have an overactive, maladaptive response to a stressor.
With AD, the stressor is identifiable, and the reaction is to a specific event or trigger. This might include:
Divorce or relationship breakup
Illness
Financial difficulties
Conflicts at home
Problems at work
Moving
Retirement
Job loss
Disability
For children and adolescents, examples of stressors may include:
Parental divorce/breakup
Moving
Birth of a sibling
Illness
Loss of a pet
How common is adjustment disorder?
There is limited data on the prevalence of AD. Some studies estimate AD affects about 1% to 2% of the general population, but this number appears to increase significantly in clinical settings.
Risks Factors for Adjustment Disorder
Risk factors for AD are not well-known, and more research is needed. Some studies suggest it is more common in women, while others indicate it occurs equally in men and women.
Some findings indicate it's more common in older adults, while others show it is common in children and adolescents.
AD occurs in all cultures, but the stressors and symptoms are influenced by cultural factors that need to be considered.
Complications of Adjustment Disorders
Untreated adjustment disorder can lead to more serious mental health problems, such as:
Alcohol and drug use
Anxiety disorder
Major depression
Diagnosing Adjustment Disorder
There are no widely accepted diagnostic tools currently specifically used for AD. It is viewed as a sub-threshold condition, meaning that if symptoms meet the diagnostic criteria for another disorder, AD cannot be diagnosed.
AD is also sometimes considered a transient diagnosis. This means it's used to identify early or temporary mental states that do not yet meet all of the criteria of a major mental health disorder.
Before diagnosing AD, a healthcare provider or mental health professional may:
Discuss symptoms
Discuss medical and family histories
Do a physical examination
Run tests, such as blood labs, to look for a physical reason for the symptoms
Do a mental status examination
Where to Find Support
Talk therapy can help you understand and cope with your condition. Your therapist can help you learn how to manage and overcome your symptoms.
It is also important to reach out to friends and family and ask for help when you need it. Joining a support group can also help.
Types of Adjustment Disorder
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the American Psychiatric Association handbook for diagnosing mental disorders, identifies six subtypes under the heading of AD:
Adjustment disorder with depressed mood
Adjustment disorder with anxiety
Adjustment disorder with mixed anxiety and depressed mood
Adjustment disorder with disturbance of conduct
Adjustment disorder with mixed disturbance of emotions and conduct
Unspecified
Adjustment disorder can be short-term or long-term.
Adjustment Disorder Treatment
Treatment for AD has not been well-studied.
While AD tends to get better on its own, it can cause significant disruption while present. Treatments such as psychotherapy (talk therapy) may help manage AD.
Psychotherapy
Psychotherapy is the preferred treatment for AD. The person with AD and their healthcare provider or mental health professional will decide together which type will be the most beneficial.
Cognitive behavioral therapy (CBT) is a common choice. With the help of a therapist, CBT helps the person with AD recognize the maladaptive thoughts and feelings, then helps teach the person how to change them into healthy coping behaviors and thoughts.
Other forms of psychotherapy that may be used include:
Solution-focused therapy (a goal-directed and collaborative approach that focuses on the solution instead of the stressor)
Family therapy
Couples therapy
Long-term therapy
Self-help or support groups
Related: Types of Therapy for Mental Health
Medication
Medication is not typically recommended for treatment of AD.
When medication is warranted, it is used alongside psychotherapy to manage specific symptoms, such as:
Insomnia and sleep problems
Significant anxiety or depression symptoms
Online Therapy
Research is promising for the use of self-help and/or internet-based interventions for AD. These programs vary in the amount of therapist involvement. This model may make therapy accessible to more people.
Preventing Adjustment Disorder
Adjustment disorder is not always something that can be prevented. However, people who are at higher risk for developing an adjustment disorder can learn coping skills that will help them recover more quickly when a stressful event happens. It's also important to have a strong support system in place consisting of friends and family who are willing to offer help when needed.
If you are at higher risk for developing an adjustment order and are anticipating a stressful event, ask your friends and family for support before and during the event. If you feel you may need to speak to a mental health care provider, don't wait until you have symptoms before making an appointment.
Coping With Adjustment Disorder
In addition to seeking care from your healthcare provider or mental health professional, some ways to cope with AD include:
Developing and maintaining supportive relationships with friends and family
Getting plenty of sleep
Exercising
Eating nutritious foods
Practicing mindfulness techniques, such as meditation and yoga
How do you help someone with an adjustment disorder?
The best thing you can do for someone with AD is offer them support. Be there to listen, support them in their treatment (including going to therapy with them if want), and provide encouragement.
Summary
Adjustment disorder is a common but under-researched mental health condition. It is characterized by a disproportionate response to a stressful event. Symptoms may include anxiety, excessive worry, trouble concentrating, and feeling overwhelmed. These symptoms are out of proportion to what might normally be expected from someone who has experienced a stressful event.
AD falls into subsets of symptom groups, namely anxiety symptoms, depression symptoms, disturbance of conduct, or a combination of these symptoms.
Research on the treatment of AD is lacking, but psychotherapy, such as CBT, is most commonly recommended. AD usually resolves within six months.
Read the original article on Verywell Health.
