Adjustment Disorder

For a variety of reasons, people are better able to handle stress more effectively at some points in their lives compared to others. In moments that require adaptability, people are able to adjust quickly to a “new normal” following events or situations that cause a significant change or major disruption to their lives. At other times, though, people can have great difficulty coping with major life events and significant changes like accepting a new job. Adjustment difficulties that are long-lasting or negatively impact a person’s daily life or overall well-being could indicate the presence of a mental health condition known as Adjustment Disorder.

What is Adjustment Disorder?

The American Psychiatric Association (APA) defines adjustment disorder as the “impairment in social or occupational functioning and unexpected severe emotional or behavioral symptoms occurring within three months after individual experiences a specific identifiable stressful event, such as a divorce, business crisis, or family discord.” In other words, people with adjustment disorder will take longer to accept or deal with stressors or life changes, their psychological distress will be more severe, and their quality of life will suffer.

Unlike many mental illnesses, adjustment disorders generally aren’t attributed to genetics or brain structure. Instead, work with a mental health professional can usually help people trace the cause back to an identifiable stressor. This stressor may be a difficult event, situation, or significant change in a person’s life, such as:

• Being laid off or terminated from a job or starting a new job
• The death of a loved one
• Diagnosis of a serious illness for yourself or a family member
• A traumatic event like an accident or being the victim of a crime
• A significant life change like marriage, childbirth, or retirement
• Divorce or the breakup of a romantic relationship
• Living through a fire or natural disaster
• Impacts of a global pandemic

For adolescents, additional causes of significant stress may include:

• Family problems or fighting
• Problems in school or with friends
• Anxiety over sexuality

Adjustment disorders are usually short-lived and acute conditions, with the adjustment difficulty developing within one to three months after the stressful event and lasting no more than six months. However, the disorder can be classified as a chronic condition (chronic adjustment disorder) if symptoms persist longer than six months.

Adjustment disorder has been recognized in the psychiatric community for decades, although the diagnostic criteria for the disorder have evolved in the past 30 years. In 2013, the fifth edition of the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) changed the name of adjustment disorder to “stress response syndrome,” a title that’s still gaining acceptance.

How common is Adjustment Disorder?

Adjustment disorder is a common diagnosis among both adolescents and adults, affecting people of all races, genders, and backgrounds. Some estimate the prevalence of adjustment disorder as impacting up to 21% of the United States population. Adult women receive a diagnosis of adjustment disorder at nearly twice the rate of adult men. In adolescents, though, diagnosis is split more evenly among males and females.

Common Symptoms of Adjustment Disorder

Symptoms of adjustment disorder are similar to the symptoms of several other mental disorders, including post-traumatic stress disorder (PTSD), major depressive disorder, or anxiety disorder. In fact, mental health professionals categorize symptoms of adjustment disorder into mild depressive symptoms, anxiety symptoms, traumatic stress symptoms, or a combination of the three.

In adults, emotional, behavioral, and physical symptoms of adjustment disorder will be unusual or out of character for the person and may include:

• Sadness or feelings of hopelessness
• Nervousness, anxiety, or worry
• Social isolation or withdrawal from people and social activities
• Frequent crying
• Changes in appetite and sleep patterns
• Stomachaches, headaches, or heart palpitations
• Increased alcohol or drug use and other uncharacteristic destructive behavior

Where adults’ symptoms tend to be more emotional (depressive symptoms or anxiety), in adolescents, the symptoms of adjustment disorder tend to be more behavioral. These may include acting out in school, skipping class, or engaging in disruptive behavior.

For a diagnosis of adjustment disorder, the APA’s DSM-5 requires that one or both of the following diagnostic criteria is met:

• Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
• Significant impairment in social, occupational, or other important areas of functioning.

The DSM-5 also requires that healthcare providers rule out other mental health conditions, including predictable grief after a significant loss.

Types of Adjustment Disorder

The DSM has designated six distinct subtypes of adjustment disorder. Different symptoms characterize each of these subtypes. The 2013 fifth edition of the DSM, DSM-5, added more detail to the diagnostic criteria of these subtypes compared to their definitions in the earlier version (DSM-IV). The subtypes are named “Adjustment disorder With …” followed by the predominant symptoms.

• With depressed mood: Low mood, crying, or feelings of hopelessness are typical of this subtype, which psychologists, counselors, and other mental health professionals sometimes refer to as situational depression or reactive depression.
• With anxiety: With this subtype, patients may feel nervous, worried, or agitated. Their anxious mood may also include irritability.
• With mixed anxiety and depressed mood: This subtype includes a combination of depression and anxiety symptoms of the first two subtypes.
• With disturbance of conduct: Disturbance of conduct, according to one source, is defined as “responding to stress leads to infringement on others’ rights, or rebellion against normal rules of conduct” and can include behaviors like reckless driving, skipping school, or fighting. 
•  With mixed disturbance of emotions and conduct: With this subtype, both emotional symptoms (like depression and anxiety) and a disturbance of conduct are present.
•  Unspecified: If a person’s adjustment difficulties can’t be classified as one of the other subtypes of adjustment disorder, it falls under this category. This subtype may also include physical symptoms like fatigue, indigestion, or body pain.

Do I have an Adjustment Disorder?

Only a qualified healthcare provider or mental health professional can make a diagnosis of adjustment disorder, so the best way to determine if you have the disorder is to allow clinicians to rule out other medical conditions or mood disorders. However, if you’ve experienced a single event, stressor, or situation in the last three to six months that has led to a significant difference or disturbance in your normal mental and emotional health, you may be experiencing adjustment difficulties. Additionally, if these difficulties are negatively impacting your quality of life or your social relationships, you are more likely to have an adjustment disorder.

Treatment for Adjustment Disorder

Like other psychiatric disorders, adjustment disorder is treatable with psychotherapy, medications, or a combination of both. Some patients will quickly benefit from short-term counseling and medication, while others, including those with ongoing stressors or chronic adjustment disorder, may need a longer period of treatment.

Psychotherapy, also known as talk therapy, involves working with a psychologist, counselor, therapist, or other mental health professional to better understand how the stressful event or situation has affected your life and create or improve your coping strategies. Talk therapy has proven helpful for people with adjustment disorder, as has counseling in a group setting. Medication can complement therapy by controlling depressive symptoms, anxiety symptoms, or sleeping problems. Complete recovery from adjustment disorder is entirely possible.

Common Barriers to Adjustment Disorder Treatment

If you believe you may be suffering from adjustment difficulties or adjustment disorder,  don’t hesitate to seek mental health treatment. If left untreated, adjustment disorder could develop into major depression or another depressive disorder. Some individuals may turn to other sources as coping mechanisms and in turn, develop a problem with substance abuse.

If you’ve never participated in therapy or counseling, you may put off seeking mental health treatment for the first time because you:

• Believe there is a stigma associated with psychiatric disorders
• Hope that your symptoms will eventually resolve themselves
• Think you’ll never find the “right” therapist
• Worry about fitting therapy into your busy schedule

Overcoming these perceived barriers to mental health treatment is why we created WithTherapy. WithTherapy’s innovative matching service helps you narrow down local therapists based on a wide variety of important factors, including race, gender, specialty, sexual orientation, education, and more. When you find a therapist you’ll be comfortable with, you can schedule a convenient appointment directly through the site.

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To get started, visit WithTherapy today to find and schedule a meeting with a therapist near you.

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