Adjustment Disorder

Adjustment disorder is a mental health condition that is characterized by a limited ability to adjust or cope with a significant, negative life event. It is classified in the Diagnostic and Statistical Manual of Mental Disorders as a trauma- or stressor-related disorder. Any stressful event or series of situations that contribute to a stressful environment can trigger this condition, causing distress and making it difficult to maintain normal functioning.

Adjustment disorder doesn’t typically last longer than six months, as long as the stressor is relieved or removed. Many patients do benefit from treatment, though. Treatment with therapy, lifestyle changes to reduce stress, social support, and learning and using healthy coping mechanisms can help relieve symptoms and restore function in all areas of life.

When adjustment disorder is diagnosed it may also be given a specifier. This describes a specific aspect of a person’s mood and symptoms and further breaks down the condition into six subtypes:

• With depressed mood. Symptoms are characteristic of major depression and may include sadness, hopelessness, and an inability to enjoy or get pleasure from activities and other aspects of daily life.
• With anxious mood. This type is characterized by symptoms of anxiety, including nervousness, worrying, a feeling of being overwhelmed, and difficulty thinking or concentrating.
• With mixed anxiety and depressed mood. A person may experience both depression and anxiety symptoms with adjustment disorder.
• With disturbance of conduct. This specifier is used when the symptoms are largely behavioral. Any behaviors that are out of character for an individual can be used to make this diagnosis. Examples include aggression or violence, poor performance in school, or engaging in risky activities.
• With mixed disturbance of emotions and conduct. Some people with adjustment disorder will have a mix of depression and anxiety symptoms along with behavioral disturbances.
• Unspecified. Adjustment disorder is considered unspecified when a patient’s symptoms don’t match any of the above descriptions. But this person will still experience dysfunction in relationships, home life, work or school.

Adjustment disorder can be a debilitating condition, causing significant impairment and distress. It is also fairly common.

• Across the general population the rate of adjustment disorder is close to 12 percent.
• In clinical settings adjustment disorder may occur in up to 23 percent of patients.
• The most common subtype of adjustment disorder is depression, followed by anxiety, anxiety with depression, and conduct disturbance.
• One study found that 38 percent of active duty military personnel hospitalized for mental health reasons were diagnosed with adjustment disorder.
• There are also higher rates of adjustment disorder in patients with cancer and patients suffering from severe burns as compared to the general population.

The symptoms that someone with adjustment disorder experiences vary to some extent by individual and by type. For instance, someone with the depressive type is likely to have more sadness and depression-like symptoms than someone with the conduct disturbance specifier. But generally the symptoms of adjustment disorder include:

• Sadness and hopelessness, and crying a lot
• Difficulty sleeping
• Worrying a lot and feeling stressed most of the time
• Lack of appetite
• A feeling of being overwhelmed
• Being unable to concentrate on tasks
• Withdrawal from friends and family
• Impaired functioning at home, work, or school
• Avoiding responsibilities
• Suicidal thoughts or behaviors

Diagnosing adjustment disorder can be challenging because the symptoms are similar to other conditions, such as major depression, anxiety disorders, post-traumatic stress disorder, and personality disorders. The criteria for diagnosing adjustment disorder include the following:

• There is an identifiable source of stress and an onset of symptoms within three months of the onset of that stress.
• The distress caused by the stressor must be out of proportion to the actual situation or cause significant impairment in one or more areas of a person’s life.
• The symptoms cannot be those of normal bereavement if the source of stress is the loss of a loved one.
• The symptoms cannot be better explained by another mental illness.
• The symptoms must last for no longer than six months after the source of stress is removed.

Causes and Risk Factors

The underlying cause of adjustment disorder is stress. The stress may be caused by one specific event, or it may be ongoing, persistent stress that creates continuously stressful circumstances. Some examples of events that may trigger adjustment disorder include problems at work or home, the breakup of a relationship, moving or starting a new job, retirement, being chronically ill, or anything else that causes stress. A traumatic event, such as being a victim of an assault or living through a natural disaster, may also cause this condition.

Not everyone who experiences stress will develop this condition. The reasons that some people are more vulnerable are not fully understood. Several factors may come into play, including past life experiences, genetics, environmental factors, and temperament and personality. Someone who has not learned healthy coping mechanisms for stress, who has a poor support network, or who has another mental illness may be at a greater risk. In general, the more stressful events a person experiences, the greater the risk is of developing an adjustment disorder.

Co-Occurring Disorders

Adjustment disorder is triggered by stress or trauma, so it is possible that it may co-occur or precede the development of a similar condition like acute stress disorder or posttraumatic stress disorder. Unrelated conditions that are commonly diagnosed in people who also struggle with adjustment disorder are personality disorders, depression, and anxiety disorders. As much as 70 percent of people diagnosed with adjustment disorder are also diagnosed with other mental illnesses.

Also commonly co-occurring with adjustment disorder are other mental health disorders. In trying to cope with stress, it is not unusual for someone who lacks healthy strategies to turn to alternative ways to self-soothe. This can be an unhealthy coping mechanism that only exacerbates mental health issues.

Comprehensive treatment for adjustment disorder aims to relieve symptoms, provide better stress coping mechanisms, alleviate distress, and restore function. Therapy is the main component of treatment, but medications may be used for specific symptoms, such as depression. A treatment plan should also include evaluation, diagnosis, and management of any other mental illnesses.

Therapy for adjustment disorder is typically some type of behavioral therapy but may also include group therapy, family therapy, and support groups. Cognitive behavioral therapy helps patients look at stressors and figure out ways to reduce or eliminate them. Patients also analyze the stressor to try to determine why it has such a profound effect. It is important to learn to reframe the stress and what it means.

Behavioral therapy is also important for helping patients learn better coping skills. There are positive and productive ways to manage stress, such as breathing techniques, meditation and mindfulness, social support, exercise, and journaling. When an individual can learn and put into practice better coping strategies, they can learn to overcome the current stress and deal productively with future stressors.

Medications may be used to manage adjustment disorder, but they are not always necessary. Antidepressants can be used for someone with ongoing depression and anxiety symptoms. Anti-anxiety medications can be used in the short-term to help manage stress and nervousness. Any medications that may be necessary to manage other mental illnesses may also be used, depending on the patient.

The prognosis for someone seeking treatment for adjustment disorder is very positive. This is a mental health issue that responds well to therapy and professional support, especially when all mental illnesses are identified and treated. Patients who commit to regular treatment, make lifestyle changes, and practice good coping strategies at home have the best outcomes. In general, treatment for this condition is not long-term, and symptoms resolve within a few months or less.