Adjustment Disorder: When We Struggle to Adapt to Change

An adjustment disorder is defined by difficulty adjusting to life stressors. Moving to a new city, changes in a relationship, or shifting to a new career are just a few examples of stressors that may cause someone to experience mood or behavioral disturbances.

For more than 50 years, clinicians have been using the term to describe individuals who are struggling to deal with a particular stressful situation or ongoing circumstance that causes distress.

Adjustment disorders are among the most commonly diagnosed mental health issues and they may be diagnosed in children, adolescents, and adults. Most studies report about 1% of the population may have an adjustment disorder at any given time.

Adjustment Disorder Symptoms

According to the DSM-5, the newest diagnostic manual used by clinicians to diagnose mental illness, the criteria for adjustment disorder includes:

• The development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor
• The symptoms and behaviors must be clinically significant as evidenced by one or both of the following; marked distress that is out of proportion to the severity or intensity of the stressor and/or significant impairment in social, occupational, or other important areas of functioning

The symptoms must not persist for more than six months after the stressor has ended. They must also be out of proportion for the person’s culture and cannot represent normal bereavement. The disturbance also must not meet criteria for another mental disorder (like depression or anxiety).

Clinicians specify how the symptoms affect an individual’s functioning by indicating if the adjustment disorder is:

• With depressed mood – low mood, tearfulness, or feelings of hopelessness are predominant
• With mixed anxiety and depressed mood – a combination of depression and anxiety is predominant
• With disturbance of conduct – Behavioral changes are predominant
• With mixed disturbance of emotions and conduct – Both emotional symptoms (depression, anxiety) and a disturbance of conduct are predominant
• Unspecified – For maladaptive reactions that are not classifiable as one of the specific subtypes of the adjustment disorder

Here are some examples of times when an adjustment disorder diagnosis may be warranted: 

• A 6-year-old moves to a new town and starts a new school. He starts exhibiting aggressive behavior, uses baby talk, and becomes defiant.
• A 10-year-old’s grades decline after her parents’ divorce. She feels sad much of the time and can’t concentrate on her school work.
• An 18-year-old moves into the college dorm. She feels anxious about being away from home and has trouble making friends.
• A man gets laid off from his job. For several months, he lacks motivation to look for a new job and has difficulty getting anything done.
• A woman’s house gets ruined by a fire. She struggles with the loss of her possessions and she feels displaced in her new situation. She experiences a lot of sadness and anxiety that make it difficult for her to perform well at her job.

Causes

Adjustment disorders can stem from a variety of stressful situations and experiences. Some of them may be single events, like a natural disaster, changing jobs, moving to a new city, or getting married. At other times, adjustment disorders stem from ongoing difficulties, like the stress associated with launching a business or moving away to college.

While any stressful life circumstance can place you at risk of developing an adjustment disorder, the way you cope with the stress plays a role in whether you develop an adjustment disorder. Additionally, these factors may also impact your adjustment:

• Past life experience – Significant stress during childhood may place you at a greater risk of developing mental health problems, including an adjustment disorder
• Difficult life circumstances – Having more stress on a day-to-day basis in your life may make it more difficult for you to tolerate one more stressful change.

Diagnosis

There isn’t a specific test used to diagnose adjustment disorders. Instead, a physician or mental health professional will conduct an interview to assess your symptoms.

A physician may run routine tests to ensure your symptoms aren’t caused by an underlying health issue. Once a physician rules out medical illnesses, you may be referred to a mental health professional for further assessment.

A mental health professional may ask you to complete some forms or questionnaires so information can be gathered efficiently. You may also be interviewed about your symptoms and the stressful life experience you encountered (you might not recognize a stressful life experience causing the adjustment disorder).

The clinician will use the DSM-5 to determine if you meet the criteria for an adjustment disorder based on the information you provided.

Adjustment Disorder Treatment

Many people with adjustment disorders find that treatment helps ease their distress and assists them in moving past a stressful event in a more productive, helpful way. Treatment often consists of talk therapy, medication, or a combination of the two.

Talk Therapy

Talk therapy is typically the preferred course of treatment for an adjustment disorder. The type of therapy used may depend on the therapist’s expertise and the individual’s needs. In general, talk therapy may provide emotional support, assist with identifying healthy coping skills, teach stress management strategies, and help you establish healthy habits.

If you’re the parent or partner of someone with an adjustment disorder, you may be invited to attend therapy as well. Family therapy may teach you the best way to support an individual who is experiencing an adjustment disorder.

Medication

Medication may be used to address depression or anxiety that accompanies an adjustment disorder. Antidepressants or anti-anxiety medication may only be needed for a short time but make sure to speak with your physician before adjusting any dosages or discontinuing any medications.

Coping

If you notice you aren’t bouncing back from a stressful event as well as you might like, you can take steps to improve your resilience and help you feel better. These strategies may help you cope with the adjustment issues you’re experiencing:

• Participate in leisure activities. Doing fun things can reduce your stress level. Identify activities that are good for your well-being and schedule time to do them.
• Practice good self-care. Get plenty of sleep, eat a healthy diet, and get plenty of physical activity.
• Turn to healthy coping skills. Whether you relieve stress by listening to the music or you enjoy meditating in the morning, find strategies that help you relax, unwind, and boost your mood.
• Cut out unhealthy coping skills. If you’ve been turning to coping skills that do more harm than good—like eating too much or drinking alcohol—make a conscious effort to cut back. Unhealthy coping skills only create new problems in the long-term.
• Seek social support. Spend time with friends and family who are good for you. Whether they give you honest advice or they simply listen to you share your concerns, reach out to healthy people. Attending a support group (either online or in-person) might help you learn from people who have been through similar experiences, such as divorce or the loss of a loved one.
• Engage in problem-solving. Whether you’ve got a stack of bills stressing you out or a difficult phone call you don’t feel like making, don’t avoid things that cause you stress. Tackle your problems head-on and you’ll save yourself a lot more stress in the long run.

If you’re struggling to feel better on your own, reach out to a mental health professional who can assist you in finding strategies that help you feel better.

It’s likely that most people will experience an adjustment disorder at one point or another in their lives. It’s not a sign of weakness. If you’re struggling don’t beat yourself up by thinking you should be doing better. Instead, get proactive about taking care of yourself and seek professional help to support your efforts.