Adjustment disorder is a type of trauma and stressor disorder which is characterised by difficulty adjusting to an event. This reaction is disproportionate to the stressor and impairs daily functioning. Typical treatment for adjustment disorder may include psychotherapy and medication. Adjustment disorder can improve with treatment; it may take anywhere from a few weeks to a few months for symptoms to improve.
If unresolved, adjustment disorders can lead to worsening feelings, emotions, and behaviors.
What Is Adjustment Disorder?
Adjustment disorder is a maladaptive response to an identified stressor. 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
The diagnostic criteria for adjustment disorder does not specify the type of stressor that must occur. 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
Examples of non-traumatic events include: a family conflict, a stressful situation at work, financial hardship, an illness or accident, a divorce, or a move to a new location. 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.
Types of Adjustment Disorder
Below are the six different types of adjustment disorders, as described in the American Psychological Association Diagnostic and Statistical Manual of Mental Disorders Fifth Edition:1
- Adjustment disorder with depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
- Adjustment disorder with anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant.
- Adjustment disorder with mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
- Adjustment disorder with disturbance of conduct: Disturbance of conduct is predominant.
- Adjustment disorder with mixed disturbance of emotions and conduct: Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
- Adjustment disorder unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
Signs of Adjustment Disorder
The signs and symptoms of an adjustment disorder will vary from person to person and depend on the type of stressor. The stressor may be a single event that occurs, (e.g., being terminated from employment) or something that is recurrent and/or continuous (e.g., struggling relationship or financial difficulties). It might be something that affects a single person (e.g., a fall resulting in injury) or multiple people (e.g., an illness affecting an entire family, a violent crime in a neighborhood, a flood).1
Adjustment disorders affect thought patterns, emotions, and behaviors. A sign that a person may have an adjustment disorder is impaired functioning in one or more areas, such as at work, in the home, during leisure time, socially, or at school.3 The impaired functioning is a noticeable change in behavior following a stressful psychosocial event.
Symptoms of Adjustment Disorder
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. According to Mayo Clinic, adjustment disorders affect how you feel, and your actions or behavior may be impacted by your thoughts and emotions.4
A formal diagnosis of adjustment disorder requires the development of symptoms to occur within three months of the psychosocial stressor and they do not last more than 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
Two of the predominant symptoms of adjustment disorder are preoccupation with the stressor, which can include rumination or distressing thoughts, 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 the inability to concentrate.5
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 subject
- Nervousness or restlessness
- Difficulty concentrating
- Irritability
- Changes in behavior
- Trouble sleeping
- Difficulty completing tasks of daily living
Causes of Adjustment Disorder
There are limitless possible causes of adjustment disorder due to the broad definition of psychosocial stressor. As discussed earlier in this article, a stressor may be a single, recurrent or continuous event which occurs, and it may affect one or multiple people.
Some examples of some types of psychosocial stressors that cause adjustment disorder include:
- Loss of employment or job change
- Ending a relationship
- Residential move
- An injury or illness
- Natural disaster
- Living in difficult conditions (e.g., neighborhood with lots of crime)
- Difficulty at school or work
- Family problems
- Financial difficulties
- Death of a loved one
There is a lot of discretion given to clinicians with diagnosing adjustment disorder as there is currently no assessment tool that is regarded as the gold-standard to use for diagnosis and diagnostic criteria does not specify the types of qualifying psychosocial stressors.5 It is up to a clinician to explore the possible causes of symptoms with their client and the potential for this person to have an adjustment disorder based on a thorough assessment.
Common Co-Occurring Disorders
Adjustment disorders can concurrently occur with most other mental disorders as long as both sets of criteria are met.1 As an example, a person may end a significant relationship and have adjustment disorder with depressed mood, and also have a diagnosis of anxiety, or a person may witness a crime and develop adjustment disorder with anxiety and already have a diagnosis of depression.
Adjustment disorders commonly occur following diagnosis of a medical issue and are considered a major psychological response to medical disorders.1
Here is a list of common co-occurring disorders that show up with adjustment disorder:
- Depressive Disorders
- Anxiety Disorders
- Substance Use Disorders
- Sleep-Wake Disorders
Treatment of Adjustment Disorder
Treatment for adjustment disorder seeks to relieve symptoms, improve 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
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 behavior. 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.
Although the diagnosis of adjustment disorder is common, there are limitations in research of evidence-based treatments, and there is opportunity for the development of other techniques and interventions for treatment.6 Current research suggests that adjustment disorder may be responsive to brief-treatment, self-directed online interventions, as well as treatment programs delivered by non-specialists.2
The intended treatment outcome is for symptoms and functioning to improve. Adjustment disorder responds well to treatment, especially when the patient is invested in their treatment plan and is committed to implementing the recommended coping skills and strategies outside of sessions with a therapist. Symptoms should improve or resolve within a few weeks or a few months. If left untreated, adjustment disorders can lead to worsening feelings, emotions and behaviors.
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.7
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. The National Institute of Mental Health recommends talking to your doctor about how medications might improve your symptoms, the possible side effects, whether there are any risk factors based on medical history, required lifestyle changes, the cost of the medication, if there are any alternatives to taking medication, and also how to stop the medication once it is started.7
Lifestyle Changes
Some lifestyle changes may help to improve adjustment disorder. Exercise, mindfulness and meditation, and good self-care can be a cost effective way to help improve mental health issues, including adjustment disorder. Many forms of aerobic exercise, such as jogging, bicycling, dancing, gardening, and walking have been proven to improve depression and anxiety.8
Mindfulness and meditation can have a positive impact on mental health and reduce stress and have been shown to be comparable to other clinically established treatments for depression, anxiety, pain and substance use.9 Mindfulness can be very helpful to reduce the severity of symptoms of adjustment disorder. 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. All of these things, as part of a comprehensive treatment plan, can help to improve adjustment disorder.
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. Psychiatrists, psychologists and Licenced Clinical Social Workers are some examples of highly skilled professionals who are trained to diagnose and treat adjustment disorder.
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, they may feel unable to take on another task, or they may be worried about asking for help because of the perception of weakness or vulnerability.
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 include:10
- 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.
Practical Ways to Cope With Adjustment Disorder
The strong reaction experienced by people with adjustment disorder can make it difficult to function well. Emotions and feelings 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, there are some practical ways to help cope with adjustment disorder.
Acknowledgement
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.
Acceptance
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.
Mindfulness
Mindfulness is conscious, non-judgemental 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.
Deep Breathing
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 envoke a relaxation response in the body.
Adjustment Disorder Statistics
According to the DSM-V, adjustment disorders are common. It is estimated that 5-20% of patients in outpatient mental health treatment have a principal diagnosis of adjustment disorder. In inpatient psychiatric hospital settings it can reach 50%.1 Adjustment disorders can happen at any age and are common in children and adolescents. There is no difference between occurrence in males and females.3
Additional Resources for Adjustment Disorders
The following are helpful additional resources for anyone affected by an adjustment disorder:
