Adjustment Disorder: Symptoms, Causes and Support

01Basics

What is adjustment disorder?

MedlinePlus describes adjustment disorder as a group of symptoms, such as stress, anxiety, feeling sad or hopeless, and physical symptoms, that can occur after you go through a stressful life event. The symptoms appear because you are having a hard time coping, and your reaction is stronger than expected for the type of event that occurred. MedlinePlus also lists the alternative names situational depression and stress response syndrome.

Mayo Clinic adds that most people get used to life changes within a few months. With an adjustment disorder, emotional or behavioral responses continue and can make you feel more anxious or depressed. The reaction can cause a lot of problems in getting along with others, as well as at work or school. Treatment can help you regain your emotional well-being.

02Triggers

What can trigger an adjustment disorder?

Many different events can trigger it, and, as MedlinePlus puts it, whatever the trigger is, the event may become too much for you. Mayo Clinic notes that both positive and negative events can play a part. Examples named by the two sources include:

• death of a loved one, divorce or relationship problems
• illness or other health issues in yourself or a loved one
• moving home or city, retirement or having a baby
• losing a job, money worries, or problems at school or work
• unexpected catastrophes and life-threatening experiences such as assault, combat or natural disaster
• ongoing stressors, such as a medical illness or living in a neighborhood with a lot of crime, or several major changes at the same time

In teenagers and young adults, MedlinePlus mentions family problems or conflict, school problems and sexuality issues. There is no way to predict which people exposed to the same stress will develop an adjustment disorder. Social skills before the event and how you learned to deal with stress in the past may play roles; Mayo Clinic also mentions genetics, life experiences and temperament.

03Symptoms

Emotional symptoms of adjustment disorder

Symptoms depend on the type of adjustment disorder and vary from person to person. Emotional symptoms described by Mayo Clinic and MedlinePlus include:

• feeling sad or hopeless, or not enjoying things you used to enjoy
• crying often
• worrying, or feeling anxious, nervous, jittery, tense or stressed out
• feeling irritable or like you cannot handle anything and do not know where to start
• difficulty concentrating

MedlinePlus also lists physical complaints, such as skipped heartbeats, and trembling or twitching. In some people symptoms become severe and include thoughts of suicide or a suicide attempt. Mayo Clinic notes that the risk of suicide can be higher in people with adjustment disorders, which is why any such thought deserves help straight away.

04Daily life

Behavior and everyday functioning

Adjustment disorders affect how you feel and think about yourself and the world, and they may also change what you do. Behavioral signs listed by the two sources include:

• trouble sleeping and not eating enough
• difficulty with daily activities
• withdrawing from family and friends who support you
• not doing important things, such as going to work or paying bills
• acting defiant or showing impulsive behavior

According to MedlinePlus, symptoms are often severe enough to affect work or social life. Mayo Clinic describes a type with disturbed conduct, with behavior problems such as fighting or reckless driving; children and teenagers may skip school or damage property.

05Timing and types

When symptoms start, how long they last and the six types

Symptoms start within three months of a stressful event, and they usually last no longer than six months after the stressful event ends. Mayo Clinic explains that adjustment disorders can be short term (six months or less, often called acute) or long term (more than six months, called persistent or chronic). Lasting symptoms are especially likely when the stressor is ongoing, such as being unemployed.

Mayo Clinic lists six types: with depressed mood; with anxiety; with mixed anxiety and depressed mood; with disturbed conduct; with disturbed emotions and conduct; and unspecified, which often includes physical problems or problems with family, friends, work or school.

These time frames describe the condition. They are not a waiting period: neither source says you have to wait a number of months before asking for help, and MedlinePlus advises contacting a provider if you develop symptoms.

06Assessment

How adjustment disorder is diagnosed

A mental health professional talks with you to identify major life stressors, your symptoms and how they affect your ability to live your life, and asks about your medical, mental health and social history. MedlinePlus notes that you may be referred to a psychiatrist to confirm the diagnosis. The criteria described by both sources are:

• emotional or behavioral symptoms that clearly follow a stressor, within three months
• symptoms more severe than would be expected, or stress that causes a lot of problems with others, at work or at school
• symptoms not due to another mental health problem
• symptoms that are not part of normal grieving for the death of a loved one

The last two points matter for the difference with other conditions. Neither source gives a side-by-side comparison with post-traumatic stress disorder (PTSD); they say only that the symptoms must not be explained by another mental health problem, and Mayo Clinic lists PTSD among the conditions that can raise the risk. Sorting this out is the job of the professional who assesses you.

08Treatment

Treatment, self-care and helping someone

The goal of treatment is to relieve symptoms and help you return to a similar level of functioning as before the stressful event. Talk therapy is the main treatment and can be individual, in a group or with the family. It can provide emotional support, help you get back to your routine, understand why the event affected you so much and learn coping and stress management skills. Cognitive behavioral therapy (CBT) helps you recognize negative thoughts and feelings and change them into helpful thoughts and healthy actions. Self-help groups may also help.

Medicines such as antidepressants and anti-anxiety drugs may be used together with talk therapy for symptoms of depression or anxiety, often only for a few months. Do not stop any medicine without talking to your health care professional, because stopping some antidepressants suddenly may cause physical reactions.

For self-care, Mayo Clinic suggests staying connected with supportive people, doing something every day that brings joy or purpose, sleeping well, eating a healthy diet, staying active, and staying away from alcohol and drugs. If you want to help someone with an adjustment disorder, encourage them to talk and to seek professional help; with children, gently invite them to express how they feel and reassure them of your support. In our psychology practice in Bilbao we offer talk therapy for adults going through a difficult life change (consultations are in Spanish).

09Sources

Where the sources differ

Role of medicines. MedlinePlus says medicines may be used, but only along with talk therapy. Mayo Clinic says treatments include talk therapy, medicines or both, while also describing medicines as used together with therapy.

Outlook. MedlinePlus says that with the right help you should get better quickly and that the problem usually does not last longer than six months unless the stressor continues. Mayo Clinic gives more room to a long-term (persistent) form lasting more than six months, and notes that people with persistent adjustment disorders or ongoing stress may benefit from longer treatment.

Who confirms the diagnosis. MedlinePlus mentions referral to a psychiatrist to confirm it; Mayo Clinic describes the diagnosis by a mental health professional through an interview. Both agree that it rests on a conversation about stressors and symptoms, not on a test.

10Summary

In summary

Adjustment disorder is a stronger-than-expected emotional or behavioral reaction to a stressful change, starting within three months of the event and causing real problems in daily life. Sadness, worry, crying, poor sleep, withdrawal or impulsive behavior are common signs.

Talk therapy is the main treatment, sometimes with medicines for a short time. Most people improve when the stress eases, but symptoms can last longer if the stressor continues. You do not need to wait to ask for help, and thoughts of suicide always need immediate support.