Adjustment disorder is a stress-related condition that is caused by a serious life event. Learn more about the types of adjustment disorder, symptoms, and treatment. Adjustment disorder (AD) is a mental health condition in which a person develops emotional and behavioral symptoms in response to a stressful event. These responses may be disproportionately more severe than typically expected. Symptoms develop
Adjustment disorder (AD) is a mental health condition in which a person develops emotional and behavioral symptoms in response to a stressful event. These responses may be disproportionately more severe than typically expected. Symptoms develop within three months of the stressful trigger and typically resolve by six months after the stressor is gone.
While AD is a common disorder, it is significantly under-researched. There is a lack of quality research, clarity in diagnostic criteria, and consensus among researchers and mental health professionals. More research has been proposed to find more accurate and reliable ways to diagnose and treat AD.
Read on to learn more about AD and its management.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the American Psychiatric Association handbook for diagnosing mental disorders, identifies six subtypes under the heading of AD:
AD is characterized by a maladaptive (negative) reaction to a stressful event, such as a preoccupation with the event or its consequences. This may include excessive worry and repeated distressful thoughts about the stressor.
While everyone experiences and reacts to stressful things, people with AD have a response that is disproportionately extreme to the severity of the stressor, the person's previous functioning, and the expected reaction of the typical person. Difficulty adapting to the stressor can cause serious functional impairments in several areas, such as at home, work, school, or in personal life.
The specific, predominant symptoms associated with AD depend on which subtype is present.
With depressed mood:
With mixed anxiety and depressed mood:
With disturbance of conduct:
With mixed disturbance of emotions and conduct:
Symptoms are subjective and can vary between people. There can also be differences in symptoms, severity, duration, and outcome of AD between adolescents and adults. Children and adolescents tend to have more behavioral symptoms (such as "acting out"), while adults often experience more emotional symptoms, such as depression.
Symptoms of AD begin within three months of the stressful trigger. However, acute stressors (such as losing a job) tend to bring on symptoms quickly.
AD typically resolves by six months after the stressor (and its consequences) are removed. If the stressor is ongoing, the reaction may last longer as well.
If symptoms last longer than this, another condition may be present, such as an anxiety or mood disorder, and a new diagnosis should be explored.
In some cases, AD has been associated with an increased risk of suicide.
A 2018 review likens AD to an analogy of the flu. While most people experience short-term symptoms of the flu and then recover, some people develop serious and/or lasting complications when they get the flu.
While the flu is a vastly different condition than AD, the analogy fits. Everyone experiences stressful events, and most people respond proportionately with coping strategies. People with AD have an overactive, maladaptive response to a stressor.
With AD, the stressor is identifiable, and the reaction is to a specific event or trigger. This might include:
For children and adolescents, examples of stressors may include:
Risk factors for AD are not well-known, and more research is needed.
Some studies suggest it is more common in women, while others indicate it occurs equally in men and women.
Some findings indicate it's more common in older adults, while others show it is common in children and adolescents.
AD occurs in all cultures, but the stressors and symptoms are influenced by cultural factors that need to be considered.
There are no widely accepted diagnostic tools currently specifically used for AD. It is viewed as a sub-threshold condition, meaning that if symptoms meet the diagnostic criteria for another disorder, AD cannot be diagnosed.
AD is also sometimes considered a transient diagnosis, used to identify early or temporary mental states that do not yet meet all of the criteria of a major mental health disorder.
To explore a diagnosis of AD, a healthcare provider or mental health professional may:
Treatment for AD has not been well-studied.
While AD tends to get better on its own, it can cause significant disruption while it is present. Treatments, such as psychotherapy (talk therapy), may help manage AD.
Psychotherapy is the preferred treatment for AD. The person with AD and their healthcare provider or mental health professional will decide together which type will be the most beneficial.
Cognitive behavioral therapy (CBT) is a common choice. With the help of a therapist, CBT helps the person with AD recognize the maladaptive thoughts and feelings, then helps teach the person how to change them into healthy coping behaviors and thoughts.
Other forms of psychotherapy that may be used include:
Medication is not typically recommended for treatment of AD.
When medication is warranted, it is used alongside psychotherapy to manage specific symptoms, such as:
Research is promising for the use of self-help and/or internet-based interventions for AD. These programs vary in the amount of therapist involvement. This model may make therapy accessible to more people.
In addition to seeking care from your healthcare provider or mental health professional, some ways to cope with AD include:
Adjustment disorder is a common but under-researched mental health condition. It is characterized by a disproportionate response to a stressful event.
AD falls into subsets of symptom groups, namely anxiety symptoms, depression symptoms, disturbance of conduct, or a combination of these symptoms.
Research on the treatment of AD is lacking, but psychotherapy, such as CBT, is most commonly recommended. AD usually resolves within six months.
If you are having a difficult time managing your response to a stressful event, it's worth discussing with your healthcare provider to see if AD may be present. If you are experiencing AD, the chances are high that it will resolve within six months, but treatment may help you feel better and learn valuable coping skills.
The biggest thing you can do for someone with AD is offer them support. Be there to listen, support them in their treatment (including going to therapy with them if wanted), and provide encouragement.
The main difference between AD and post-traumatic stress disorder (PTSD) is the nature of the stressful event involved. AD stressors tend to be less severe and less traumatic than the stressful events associated with PTSD.
There is limited data on the prevalence of AD. Some studies estimate AD affects about 1% to 2% of the general population, but this number appears to increase significantly in clinical settings.