Adjustment Disorder: Signs, Symptoms, & Treatments

What Is Adjustment Disorder?

Adjustment disorder is a maladaptive response to an identified stressor. It may be a traumatic event such as a near-death experience or life threatening situation, or it might be related to a non-traumatic event.² The signs and symptoms can vary, but the response to the stressful event is disproportionate to what would be typically expected, taking into account sociocultural considerations. The level of stress experienced impairs a person’s ability to continue functioning well.¹

Adjustment Disorder Vs. PTSD

Adjustment disorder occurs after undergoing a stressful experience (which can be traumatic), but PTSD specifically refers to a condition that develops after undergoing a trauma. Sometimes, symptoms overlap and can be mistaken for one another. Unlike PTSD, people with adjustment disorder generally do not experience the same heightened flashbacks, nightmares, and ruminating thoughts.

Adjustment Disorder Vs. Major Depressive Disorder

A diagnosis of adjustment disorder is in response to difficulties adjusting due to a specific trigger (i.e. changing jobs, experiencing a breakup, or coping with a financial setback). However, major depressive disorder does not necessarily have a defined cause. That said, it is possible to have the subtype of an adjustment disorder with depressed mood.

Symptoms of Adjustment Disorder

Two of the predominant symptoms of adjustment disorder are preoccupation with the stressor and failure to adapt after the stressor. Failure to adapt means that a person’s functioning is affected or impaired by their difficulty coping with the stressor. For example, a person may have difficulty sleeping or an inability to concentrate.⁴

Other symptoms of adjustment disorder may include:

• Feeling sad or depressed
• Feeling worried or anxious
• Reluctance to talk about the stressor
• Avoidance or fear of the stressor
• Nervousness or restlessness
• Difficulty concentrating
• Irritability
• Changes in behavior
• Trouble sleeping
• Difficulty completing daily living tasks

The symptoms of adjustment disorder depend on the type of adjustment disorder, and will differ from person to person. What is common amongst all adjustment disorders is the excessive reaction in response to a stressful event, after taking into account social and cultural expectations. Adjustment disorders affect how you feel, and your actions or behavior may be impacted by your thoughts and emotions.⁵

Types of Adjustment Disorder

There are six different types of adjustment disorders:¹

1. Adjustment disorder with depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
2. Adjustment disorder with anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant.
3. Adjustment disorder with mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
4. Adjustment disorder with disturbance of conduct: Disturbance of conduct is predominant.
5. Adjustment disorder with mixed disturbance of emotions and conduct: Both emotional symptoms (like depression and anxiety) and a disturbance of conduct are predominant.
6. Adjustment disorder unspecified: For maladaptive reactions that are not classifiable as one of the above specific subtypes of adjustment disorder.

Causes of Adjustment Disorder

A stressor may be a single, recurrent, or continuous event which occurs, and it may affect one or multiple people. Many people will experience these types of situations without having any major issues or an adjustment disorder because they are able to maintain the same level of functioning as prior to the stressful event.

Potential Triggers of Adjustment Disorders

Examples of stressors that cause adjustment disorder include:

• Loss of employment or job change
• Ending a relationship
• A cross-country move
• An injury or illness
• Natural disaster
• Living in difficult conditions (like a neighborhood with lots of crime)
• Difficulty at school or work
• Family problems
• Financial difficulties
• Death of a loved one

Risk Factors for Developing an Adjustment Disorder

Experiencing prolonged stress after a change is one of the most significant risk factors for developing an adjustment disorder. This risk may be heightened when the change was spontaneous or unwanted. In addition, people may experience adjustment disorder symptoms in response to several different transitions happening simultaneously, even if they don’t realize it at the time.

RIsk factors of developing an adjustment disorder include:

• Lack of social support
• Preexisting mental health problems
• Coinciding financial stress
• Medical issues
• Needing to be a caregiver during the time of adjustment
• Chronic stress

Adjustment Disorder Examples

Adjustment disorder can show up in many different ways. Symptoms may occur just after the stressful event, but they can also take a few weeks or months to really emerge. In all cases, the stress response is considered disproportionate to the situation, and the stress also leads to impairments within life functioning.

Adjustment Disorder With Anxiety

Someone who has an adjustment disorder with anxiety will likely exhibit symptoms of hypervigilance and excessive worry. They may struggle to focus on basic tasks, and they can also experience panic attacks, sleep problems, and chest tightness. Children may show symptoms of separation anxiety as well as physical symptoms, including stomachaches and headaches.

Adjustment Disorder With Depressed Mood

Someone who has an adjustment disorder with depressed mood will have persistent feelings of sadness and apathy. They may cry more frequently or have thoughts that life is meaningless. In serious cases, this can coincide with self-harm or suicidal ideation. Children may withdraw from their typical relationships and stop caring about their academic or athletic performance.

Adjustment Disorder With Disturbance of Conduct

Someone who has an adjustment disorder with disturbance of conduct will display certain behavioral symptoms that look impulsive and erratic in nature. They may engage in dangerous behaviors like reckless driving or picking fights with others. Or, they might become combative with loved ones and defiant towards authority. These symptoms may be mixed with depression and anxiety symptoms.³

Long-Term Complications of Unaddressed Adjustment Disorder

Untreated adjustment disorder can lead to various problems, including low self-esteem, academic or occupational impairment, and relationship issues. Adjustment disorder symptoms can also aggravate other mental health symptoms. Some people may turn to self-destructive behaviors like disordered eating, self-harm, or substance use to cope with their discomfort, which can also create numerous consequences.

How Is Adjustment Disorder Diagnosed?

A formal diagnosis of adjustment disorder requires the development of symptoms to occur within three months of the stressor and resolution of symptoms within six months following the conclusion of the stressful event. These symptoms must be out of proportion to the intensity of the event, create significant impairment in functioning, or both.¹

Adjustment Disorder Treatments

Treatment for adjustment disorder seeks to relieve symptoms, enhance coping skills, alleviate stress, and improve functioning. Psychotherapy is used to treat adjustment disorder and medication may also be used to treat specific symptoms, such as anxiety. Complementary techniques such as mindfulness, meditation and breathing exercises can help with symptom management and relief.

Therapy for Adjustment Disorder

• Cognitive behavioral therapy: Cognitive behavioral therapy is a type of psychotherapy that is effective in treating adjustment disorder.² This therapeutic technique deals with the connection between thoughts, feelings, and behaviors. A person with adjustment disorder may benefit from this approach because it explores a person’s thoughts about the stressor, the feelings that arise because of the thoughts, and the resulting maladaptive behaviors. Clients are then taught how to identify these thoughts, analyze them and their meaning, and then reframe them in a way that reduces distress.
• Family therapy: Family therapy helps family members understand and support one another amid an adjustment disorder diagnosis. Rather than blaming one individual for the distress, a family therapist helps each person understand their role in the dynamic and take steps to implement healthy boundaries and goals for change.
• Peer group therapy: Peer group therapy comes in many forms, but therapy groups may focus on pertinent topics like self-esteem, healthy relationships, coping skills, distress tolerance, and psychoeducation. Connecting with like-minded individuals can be an important part of the recovery process.

Medication

Medication may be recommended as part of treatment for adjustment disorder. The type of medication depends on the specific disorder and the presenting symptoms. Antidepressants are used to reduce symptoms associated with depression, and sometimes anxiety. There are many types of antidepressant medications, which work in slightly different ways, and may have side effects. Anti-anxiety medication is used to reduce symptoms of anxiety, such as excessive worry, panic, and fear.⁶

There are benefits and drawbacks to taking medication, and it is very important to consult with a psychiatrist or primary care physician to talk about the appropriateness of medication for symptom relief.

5 Practical Ways to Cope With Adjustment Disorder

The strong reaction experienced by people with adjustment disorder can make it difficult to function well. Strong negative emotions may feel overwhelming at times, resulting in behavioral changes which affect overall well-being. It may be hard to stay hopeful that things will change, but it is important to realize that adjustment disorder is temporary, and with treatment it can improve.

Along with psychotherapy, and sometimes medication, here are five practical ways to cope with adjustment disorder:

1. Acknowledge How You’re Actually Feeling

It can be helpful to acknowledge how you are feeling and why you are feeling that way. This gives validation to your experience. You may not be able to control how you feel, but once you are able to articulate your feelings, you can begin to control your response to them.

2. Accept the Situation for What It Is

Acceptance does not mean that you are choosing to feel the way that you do, or that you want to feel this way. Acceptance means that you are not actively fighting back against or trying to change the reality of the situation.

3. Start a Mindfulness Practice

Mindfulness is conscious, non-judgmental awareness; it is a state of being fully present in the moment. There are many positive impacts that mindfulness can have on mental health. People who practice mindfulness may have greater ability to focus on the present moment and have less worry about the past or future. Mindfulness can help enhance the healing process because it can increase acceptance and tolerance, rather than avoidance.

4. Focus on Deep Breathing When You’re Stressed

Deep breathing encourages full oxygen exchange, which can help slow down heart rate, lower blood pressure, increase relaxation, and distract from negative thoughts. Deep breathing techniques take practice because it can feel unnatural to take in deep breaths, especially when stressed. Focusing on deep breathing can help to invoke a relaxation response in the body.

5. Take Care of Your Body

Good self-care includes getting enough sleep, eating healthy foods, avoiding harmful substances, practicing good hygiene, and staying current on important tasks related to daily living. Many forms of aerobic exercise, such as jogging, bicycling, dancing, gardening, and walking have been proven to improve depression and anxiety.⁷ All of these things, as part of a comprehensive treatment plan, can help to improve adjustment disorder.

Can Adjustment Disorder Be Prevented?

There’s no evidence that a mental illness can ever be prevented. It’s important to avoid blaming yourself if you’re struggling. Instead, experts tend to examine protective factors that may improve how someone copes with change. These protective factors may enhance someone’s overall resilience, which can strengthen their mental health and improve their prognosis.

Protective factors that may help someone avoid developing adjustment disorder include:

• Have a strong support system: Support can be integral when it comes to coping with adversity, so try to lean on loved ones as you move through new transitions.
• Develop a self-care routine: Grounding yourself to a positive self-care routine can help you feel like yourself even when change is happening. It’s also a way to practice self-compassion.
• Make healthy lifestyle choices: Try to look after your physical health as much as possible. Doing so may help you feel better mentally and emotionally, too.

How to Get Help for Someone With Adjustment Disorder

One of the best ways to help someone with adjustment disorder is to encourage them to seek treatment from a mental health professional. An important thing to remember is that it is common for a person who is suffering not to take initiative to seek help. They may not have enough energy, or they may feel overwhelmed by their feelings.

If you feel that your loved one may benefit from support, begin with an open and honest conversation about your concerns. If they are open to exploring treatment, it can be helpful to your loved one to assist with the logistics of finding a therapist and scheduling an initial appointment. It may also be helpful to offer to accompany them to the appointment.

Some additional ways to support a loved one dealing with adjustment disorder include:⁸

• Learning about adjustment disorder so you understand your loved one’s condition
• Encourage your loved one to create a plan for improvement and support them as they take action
• Ask permission to help with tasks and activities that may feel stressful to your loved one
• Encourage and actively participate in healthy lifestyle changes.
• Be a good listener