What is Adjustment Disorder?
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Adjustment disorder is sometimes referred to as a situational depression. Unlike regular depression, the cause(s) of which may be ongoing and/or unspecified, adjustment disorder is an abnormal emotional and/or behavioral response to stressors that are present in a particular period of a person’s life, often surrounding a major life event.
For example, a person may experience stressors that give rise to adjustment disorder after a major life change, such as a breakup, divorce, marriage, having a baby, or moving house, or after an unfortunate event that involves stress, such as a car accident. It is also possible to develop the condition following a career change or break, especially one which alters a person’s daily environment or routine, such as discharge from military service or becoming unemployed.
Symptoms of adjustment disorder or situational depression include:
- Psychological symptoms associated with depression, such as a depressed mood and hopelessness. These can result in behaviours such as social withdrawal and introversion, but can also, less commonly, lead to irritable mood, aggressive behavior or acting out.
- Psychological symptoms associated with anxiety, such as nervousness and worry.
These symptoms will normally begin within three months of the onset of the stressor; for example, after moving home; and last for no longer than six months after the stressor or event has ended.[1]
Adjustment disorder is most common in children and adolescents, but adults may often also develop the condition. The treatment goal for adjustment disorder is to relieve the symptoms. A typical treatment program for adjustment disorder will normally feature a course of talking therapy, such as cognitive-behavioral therapy (CBT) or group therapy, and may include prescription medications and prescribed exercise.[2][3]
Symptoms of adjustment disorder
The symptoms of adjustment disorder will usually appear within three months of the stressful event or life change and disappear within six months. Most commonly, adjustment disorder that does not resolve after six months may develop into depression.
Generally, the symptoms of adjustment disorder will significantly interfere with the functioning of a person’s life, for example by making it difficult to socialize, work or attend school.
Symptoms of adjustment disorder may vary according to the age of the person experiencing the condition. Children and adolescents may be more likely to display behavioral symptoms, such as acting out, school problems, and sleep disturbances, whereas adults often tend to experience more emotional symptoms, such as anxiety and a depressed mood.[4][5]
6 subtypes of adjustment disorder can be found according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association (DSM-5).[5][6]
Adjustment disorder with depressed mood
Symptoms of adjustment disorder with a depressed mood may include feelings of depression, sadness, and hopelessness. People who are affected may also be highly tearful and experience frequent bouts of crying.
Adjustment disorder with anxiety
Symptoms of adjustment disorder with anxiety may include feelings of nervousness, apprehension, and worry. People may also be excessively jittery and fearful of separation, from parents or other significant people.
Adjustment disorder with mixed anxiety and depressed mood
A person who is affected by adjustment disorder with mixed anxiety and depressed mood will experience a mixture of the symptoms of adjustment disorder with anxiety and those of adjustment disorder with depressed mood. People with this form of the condition may be affected by different symptoms or combinations of symptoms.
Adjustment disorder with disturbance of conduct
A person who is affected by adjustment disorder with disturbance of conduct will experience a change in behavior. This is typically characterized by:
- A lack of respect for the rights and feelings of others
- A lack of respect for social norms and rules
Adjustment disorder with mixed disturbance of emotions and conduct
A person affected by adjustment disorder with mixed disturbance of emotions and conduct may experience a combination of the possible symptoms of adjustment disorder with depressed mood, anxiety or disturbance of conduct.
Adjustment disorder unspecified
In the case of adjustment disorder unspecified, a person experiences a severe reaction to a stressor, but it does not fit into any of the above categories.
Causes of adjustment disorder
Adjustment disorder is a reaction to a particular stressor, whether a stressful life event or a major life change. In both children and adults, adjustment disorder can be caused by any event which feels greatly significant to the particular person, regardless of whether or not this event appears significant to others.[7]
Common stressors that may lead to adjustment disorder in a person of any age include:[8]
- Giving birth
- Marriage
- Unemployment
- Retirement
- Divorce or relationship problems
- Illness and health issues
- Moving to a new house or new location
- Financial difficulties
- The death of a loved one
Common stressors that may affect a child or young adult include:
- Parental divorce or separation
- Moving to a new house, neighborhood or new town
- Problems at school, such as not being able to keep up with demands from school, changing schools or not being able to connect with peers
- Health issues and/or sexuality issues, i.e. uncertainties related to sexual orientation
- Death of a close relative or friend
Risk factors
There is no clear way to identify why some people develop adjustment disorder in response to a given stressor and why others do not. Factors, such as a person’s coping skills, past experiences and social skills are among many others, all thought to play a role.
A person is at greater risk of experiencing adjustment disorder than the general population if they meet any one or more of the following criteria:[9][8][10]
- Being female
- Being affected by other psychological conditions
- Experiencing long-term stressors, such as financial strain, a long-term illness, having an illicit love affair or domestic problems
- Lacking a social support system
- Having experienced certain types of stress during childhood, including sexual or physical abuse, other traumatic events, frequent house moves or overprotective parenting
- Being single
- Being at a low educational level
- Living in an urban area
Diagnosing adjustment disorder
A diagnosis of adjustment disorder usually requires a full psychological evaluation by a psychiatrist or other mental health professional. This evaluation will typically take into account past experiences, behaviors, emotions and sources of stress, among other factors. When diagnosing children or adolescents, parents may also be present during the evaluation.[11]
The key diagnostic criteria for adjustment disorder are:
- The symptoms must have begun to appear within three months of the stressor occurring
- The condition must be characterized by stress that is in excess of what would be considered normal under the circumstances and which leads to significant impairment of a person’s personal life, social functioning, their work or school performance and/or attendance
- The symptoms must be distinct from similar disorders, such as post-traumatic stress disorder (PTSD)
Differential diagnosis: adjustment disorder vs. post traumatic stress disorder (PTSD)
Although adjustment disorder and post-traumatic stress disorder (PTSD) can have overlapping symptoms, the key difference between the two conditions is their cause. Adjustment disorder is typically triggered by a stressful event or phase, but one that is within the normal everyday range of human experience, such as a marriage breakup or financial difficulty.
Conversely, PTSD is caused by an exceptional, traumatic event. This is normally one involving the threat of death, serious injury or violence to oneself, or an event which involves witnessing the same happening to a very close or loved person. Experiencing this severe threat causes retrospective feelings of extreme fear, horror and helplessness.
PTSD can also be a long-term condition that may not present itself until several months or years after the initial event. Adjustment disorder, on the other hand, must present itself within three months of the triggering event.[^9][12]
Differential diagnosis: adjustment disorder vs. depression
Adjustment disorder – especially the depressed mood subtype – and depression are similar conditions. To properly differentiate them, a thorough evaluation by a medical professional is needed.
One major, generally accepted difference between the two conditions is that adjustment disorder is triggered by an identifiable stressful event or phase, and this will be clear-cut and easy to pinpoint. In contrast, when depression develops, the exact causes of the condition or the current depressive episode are often unclear. Adjustment disorder will also generally be a more short-term condition. However, the same time frame could apply to a depressive episode, which makes it all the more important that a person undergoes a proper medical evaluation and receives an accurate diagnosis.
Good to know: If a person who has been diagnosed with adjustment disorder (AD) continues to experience mental distress after six months, it is likely that the AD has developed into another mental health condition, most often depression. In this event, a new diagnosis will be considered. Other conditions developing from AD are usually anticipated to be longer-lasting and to require ongoing treatment. [13][14] If you think that you, or a loved one, may be affected by depression or another mental health condition, you may begin a free symptom assessment with Adoctor conditions and symptoms.
Treating adjustment disorder
The chosen treatment method for adjustment disorder will usually depend on a variety of factors, including:[15]
- Age
- Severity of symptoms
- The subtype being experienced
- Specific factors contributing to the development or worsening of the condition
Taking these factors into consideration, a psychiatrist or other mental health professional will recommend a treatment route.[16][17]
Individual psychotherapy
Individual psychotherapy may take a cognitive-behavioral therapy (CBT) approach, particularly in the U.K., buy in the U.S., other kinds of talk therapy may often be recommended, too. Because the condition is defined as short-term, this will typically be solution-focussed, short course of psychotherapy. The treatment goal is to equip the affected person to understand how to overcome adjustment disorder by teaching them techniques for dealing more effectively with their particular problem and its effects on their life.
Family therapy
Family therapy will generally be recommended in cases of childhood or adolescent adjustment disorder. It is designed to overcome conflicts in family life and improve communication skills among family members. It may also be useful in teaching family members how to support the child/adolescent who is experiencing adjustment disorder.
Group therapy
In some cases, sharing challenge and coping techniques with a group of people also experiencing the condition can equip a person to understand how to overcome adjustment disorder in a practical sense and to apply this to their own life. Group therapy can also help the person improve their communication skills and can be a useful source of support and encouragement.[18]
Medication
Although supportive, solution-oriented psychotherapy is the first-line treatment for adjustment disorder, medications are sometimes additionally prescribed.[19]
When medications are prescribed, they are used in order to treat specific symptoms of adjustment disorder ‒ for example, if a person is sleeping badly, is experiencing nerves or anxiety most of the time or is excessively depressed.[8] It is for this reason that medications are usually only prescribed in severe cases, are carefully evaluated by a person’s medical care team and are most likely an adjunct to rather than a replacement for talk therapy, which targets the condition’s root cause.[20]
Medications which may be used in the treatment of adjustment disorder include:[8][19][20]
- Antidepressants. These will usually only be prescribed if depressive symptoms are still having a major impact on a person’s life three months after beginning non-medication-based treatment for adjustment disorder.
- Benzodiazepines. These medications may help alleviate anxiety and problems sleeping in the short-term. However, they are not recommended for long-term use due to their addictive potential and should only be prescribed and taken after careful evaluation by a doctor.
Good to know: There are some herbal remedies which are being investigated for their potential effects on adjustment disorder symptoms, especially those of anxiety and insomnia. These particular herbal remedies include extracts of passiflora and valerian. However, overall, these substances have not been sufficiently scientifically researched and evaluated for their safety and efficacy to be generally recommended. Always consult a doctor before using any type of herbal preparation, as they may not be safe for particular people or in combination with certain medications.[19]
Preventing adjustment disorder
There is no known way to prevent the onset of adjustment disorder. Identifying the condition early and seeking professional help can be effective in reducing the severity of adjustment disorder and improving general wellbeing, however.
Adjustment disorder FAQs
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Clinical Practice & Epidemiology in Mental Health. “Adjustment Disorder: epidemiology, diagnosis and treatment.” June 26, 2009. Accessed October 2, 2017. ↩
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Johns Hopkins Medicine. “Adjustment Disorders.” Accessed October 2, 2017. ↩
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Medscape. “Adjustment disorders treatment and management.” 01 November 2016. Accessed: 17 January 2019. ↩
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Johns Hopkins Medicine. “Adjustment Disorders.” Accessed October 2, 2017. ↩
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Medscape. “Adjustment disorders.” 01 Nov 2016. Accessed: 17 January 2018. ↩ ↩
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013. 286-9. ↩
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Child Mind Institute. “Adjustment disorder: what is it?” 2019. Accessed: 17 January 2019. ↩
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MedlinePlus. “Adjustment Disorder.”.” 07 January 2019. Accessed: 17 January 2019. ↩ ↩ ↩ ↩
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Asian Journal of Psychiatry. “Adjustment disorder: Prevalence, sociodemographic risk factors, and its subtypes in outpatient psychiatric clinic.” August 2017. Accessed: 22 August 2018. ↩
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Virginia Commission on Youth. “Adjustment disorder.” 2017. Accessed: 17 January 2019. ↩
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Johns Hopkins Medicine. “Adjustment Disorders.” Accessed October 2, 2017.
http://vcoy.virginia.gov/documents/collection/019%20Adjustment2.pdf[^9]: Pubmed Health. “Post-traumatic stress disorder.” 2005. Accessed October 2, 2017. ↩ -
MedNStat Reviews for the Boards. “USMLE* PTSD vs. acute stress disorder vs. adjustment disorder.” 30 June 2017. Accessed: 22 August 2018. ↩
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Cleveland Clinic. “Recognition and Treatment of Depression.” August, 2010. Accessed October 2, 2017. ↩
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Healthy Place. “Adjustment Disorder with Depressed Mood.” August 30, 2016. Accessed October 2, 2017. ↩
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Johns Hopkins Medicine. “Adjustment Disorders.” Accessed October 2, 2017. ↩
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Clinical Practice & Epidemiology in Mental Health. “Adjustment Disorder: epidemiology, diagnosis and treatment.” June 26, 2009. Accessed October 2, 2017. ↩
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Johns Hopkins Medicine. “Adjustment Disorders.” Accessed October 2, 2017. ↩
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Mental Health. “Adjustment Disorder: Treatment.” 1990. Accessed October 2, 2017. ↩
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The World Journal of Biological Psychiatry. “Pharmacotherapy of adjustment disorder: a review.” 2018. Accessed: 17 January 2019. ↩ ↩ ↩
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Medscape. “Adjustment disorders treatment and management.” 01 November 2016. 17 January 2019. ↩ ↩
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“Adjustment disorders.” Medscape. 01 November 2016. Accessed: 06 February 2019. ↩
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“Adjustment disorder: epidemiology, diagnosis and treatment.” Clinical Practice and Epidemiology in Mental Health. 26 June 2009. Accessed: 06 February 2019. ↩
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**What is Adjustment Disorder?**
**Definition**
Adjustment disorder is a mental health condition that develops in response to a stressful life event or change that occurs within three months of the stressor. It’s characterized by intense emotional distress and difficulty adjusting to the new situation.
**Causes**
* Major life events: moving, job loss, divorce, death of a loved one
* Traumatic events: natural disasters, accidents, physical or sexual abuse
* Chronic stressors: financial hardship, illness, relationship problems
**Symptoms**
* Anxiety and depression
* Irritability and anger
* Difficulty concentrating and sleeping
* Social withdrawal and isolation
* Changes in appetite and weight
* Physical symptoms: headaches, stomach aches, fatigue
**Types of Adjustment Disorders**
* **With Depressed Mood:** Predominant symptoms include sadness, hopelessness, and loss of interest.
* **With Anxiety:** Predominant symptoms include excessive worry, nervousness, and panic attacks.
* **With Mixed Anxiety and Depressed Mood:** Combines symptoms of both types.
* **With Disturbance of Conduct:** May involve impulsive and aggressive behaviors that violate societal norms.
* **Unspecified:** Symptoms do not fit into any of the specific types.
**Diagnosis**
A mental health professional, such as a psychiatrist or psychologist, will diagnose adjustment disorder based on the following criteria:
* Presence of a stressful life event
* Symptoms develop within three months of the stressor
* Symptoms are excessive and beyond what would be expected in response to the stressor
* The symptoms cause significant distress or impairment in daily functioning
**Treatment**
Treatment for adjustment disorder typically involves:
* **Psychotherapy:** Cognitive behavioral therapy (CBT) and interpersonal therapy are effective in reducing symptoms.
* **Medication:** Antidepressants or anti-anxiety medications may be prescribed in some cases.
* **Lifestyle changes:** Stress management techniques, such as exercise, mindfulness, and sleep hygiene, can be beneficial.
**Recovery**
Most people with adjustment disorder recover within a matter of months, especially if they receive proper treatment. However, symptoms may persist or worsen if the underlying stressor is not addressed or resolved.
**Prevention**
Preventing adjustment disorder is not always possible, but coping strategies can help individuals manage stress and reduce their vulnerability to the condition. These strategies include:
* Developing healthy coping mechanisms
* Seeking support from family, friends, or a therapist
* Engaging in activities that bring pleasure and relaxation
* Maintaining a healthy lifestyle
* Being proactive in addressing potential stressors
Adjustment Disorder is a mental health condition that can develop in response to a stressful life event.