Adjustment disorder is a condition some people may experience in the months following a stressful event or life change.
Doctors may diagnose adjustment disorder with depression, anxiety, or mixed depression and anxiety.
Also, some people may refer to adjustment disorder as situational depression. However, they are not the same conditions.
In this article, we look at the causes and symptoms of adjustment disorder, as well as the diagnosis and treatment options.
Adjustment disorder is an extreme emotional or behavioral reaction within 3 months of a stressful or monumental life event.
People may experience an abnormal reaction or a higher level of emotional disturbance than expected in response to a certain situation. This stress can cause a range of symptoms that may affect people mentally and physically.
Symptoms of adjustment disorder are not due to another mental health condition, or within the usual process of grieving or adjusting to a dramatic life change.
Even positive events can cause adjustment disorder if they are significant changes.
Examples of life events or changes that could trigger adjustment disorder include:
- moving home
- divorce or separation
- the loss of a loved one
- the birth of a child or sibling
- a serious illness or severe injury
- moving to a new school
- marital difficulties
- financial difficulties
- losing a job
- a natural disaster or traumatic event
Certain factors may increase the chances of people experiencing adjustment disorder.
Genetics, life experience, personality, and existing mental health issues can all play a part in how people react to life events.
If people experience multiple stressors at once, this may compound to cause adjustment disorder.
Children with frequent stress are more likely to develop adjustment disorder.
Adjustment disorder happens equally in both males and females.
Adjustment disorders begin within 3 months of a stressful event and do not last longer than 6 months after the event, and the consequences have stopped.
In some cases, however, chronic adjustment disorder may last longer than this timescale.
Symptoms of adjustment disorder can include:
- depressed mood
- frequent worrying or feeling anxious
- frequently feeling tearful or crying
- feeling jittery and nervous
- reckless behavior or breaking of societal rules
- social withdrawal
- suicidal thoughts or behaviors
- difficulty functioning as usual in school, college, or work
People may only have emotional symptoms, while others may only have behavioral symptoms.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
There are six different types of adjustment disorders, which doctors base on the main accompanying symptoms.
People can have the following types of adjustment disorder:
- With anxiety: Feeling nervous, worried, jittery, or having a fear of separation.
- With depressed mood: Feeling depressed, hopeless, or tearful.
- With anxiety and depressed mood: A combination of the above symptoms.
- With disturbance of conduct: Violating the rights of others, violating societal norms and rules.
- With disturbance of emotions and conduct: A combination of all the above types of adjustment disorder.
- Unspecified: Symptoms that do not fit into any of the above categories.
Symptoms of adjustment disorder can vary depending on the age of the individual.
Children and adolescents may have more behavioral symptoms, such as disruptive behavior. Adults may experience more depressive symptoms.
Children, in particular, may have the following symptoms:
- trouble sleeping
- frequent crying
- avoiding or not wanting to go to school
- isolating themselves from friends and family
- picking fights
- showing hostility
- depression and anxiety
People with adjustment disorder may have a group of symptoms that overlap with symptoms of other conditions:
- post-traumatic stress disorder (PTSD)
People may experience a depressed mood and anxiety with adjustment disorder.
Adjustment disorder has a different set of criteria than other mental health conditions, though, which allows doctors to distinguish between them.
PTSD usually happens after a life threatening event, such as war or physical assault, compared with a life change or stressor that could trigger adjustment disorder. PTSD may also last longer than adjustment disorder.
Complex PTSD can occur if a person has experienced prolonged or repeated trauma, rather than a single event.
Adjustment disorder can be difficult to separate from depressive disorders, as they can share similar symptoms.
Doctors may use a tool called the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), which lists criteria for mental health disorders. Adjustment disorder also appears in the international medical classification list known as the ICD-10.
Doctors can use these manuals to check that a person’s symptoms meet the criteria for adjustment disorder rather than another mental health condition.
A doctor will assess a person’s symptoms, ask about their medical history, and carry out a psychiatric evaluation to diagnose adjustment disorder. This examination helps rule out any other possible mental health conditions.
A doctor may interview people about any recent events that could have triggered adjustment disorder. They will also look at an individual’s personal history of emotional and behavioral patterns.
In children, doctors may check if development is as they expect, as this can affect emotional and behavioral responses.
A doctor may use the DSM-5 to check that symptoms match the criteria of adjustment disorder, rather than another mental health condition.
In some cases, they may recommend blood and urine tests to ensure that another condition is not causing the symptoms.
Psychotherapy, or talk therapy, may help people overcome adjustment disorder.
A person may meet one-to-one with a psychotherapist to work through emotional and mental symptoms of the disorder. Others may find group therapy helpful in redeveloping social and interpersonal skills.
One approach may include cognitive behavioral therapy (CBT). This technique focuses on changing thought patterns to help people problem-solve issues and develop positive coping methods.
Children or family members with adjustment disorder may benefit from family therapy.
Family members will work together with a therapist to make positive changes, such as improved communication, interactions, and greater support within the family.
In some cases, a doctor may prescribe medication alongside psychotherapy treatment for symptoms such as depression and anxiety. Medication is not usually the first line of treatment in adjustment disorders, however.
Adjustment disorder is an extreme reaction to a stressful life event or significant change. It can affect people of any age. Changes to family structures, divorce, or moving can all trigger adjustment disorder.
People may experience feelings of depression, anxiety, or hopelessness. They may withdraw socially, feel more tearful than usual, or have difficulty sleeping.
Children and teenagers, in particular, may show disruptive behavior.
Adjustment disorder happens within 3 months of a stressful event, and usually lasts no longer than 6 months after the event, and its consequences resolve.
People can see their doctor if they show symptoms of adjustment disorder. A doctor may refer them to a mental health professional, such as a psychotherapist. Talking therapies can help someone overcome adjustment disorder.