Adjustment disorder (AD) is a mental health disorder that results in feelings of stress, sadness and hopelessness and usually starts to occur after a stressful event or severe life change.1. These stressors usually cause a more severe response than is anticipated.1. Adjustment disorder can affect someone at any age. Some common triggers resulting in adjustment disorder include the death of a loved one, divorce, money troubles, and health issues.1. Younger people affected by AD might be caused by school problems or family conflicts. It is important to remember that triggers can be different for everyone and are not limited to this list.1 Some common symptoms of AD include feeling sad, hopeless, worried, anxious, and noticeable impairment to daily and social functioning.2 These symptoms are common in a lot of mental health disorders. This makes diagnosing AD complex and easily confused with other disorders. Some similar disorders are major depressive disorder, personality disorder, mixed anxiety and depression, acute stress reaction, and post-traumatic stress disorder.3
According to the DSM-5, there are six subtypes of adjustment disorder. These subtypes are defined by specific symptoms. These include depressed mood, anxiety, mixed depression and anxiety, disturbed conduct, mixed disturbed conduct and emotion, and lastly, unspecified.4 Adjustment diaper is usually a short-term cognition that resolves over time as you learn to cope with the stressor that results in adjustment disorder.6 Furthermore, if your adjustment diaper is more severe or long-lasting, additional treatment may be implemented to help you cope. One of the most effective treatments is psychotherapy. Solution-based talking theories such as interpersonal psychotherapy or problem-solving therapy may be a good option to help manage your symptoms.6 Additionally, medications used for anxiety and major depressive disorder could be used to help deal with those specific symptoms. However, this will vary depending on the subtype of adjustment disorder.6 Other short-term coping methods like mediation may also be useful.6 In some cases, adjustment disorder may be prevented. Although some stressors aren't predictable, some life changes may be known about in advance. In this instance, putting supportive measures in place before the event may be enough to prevent adjustment disorder from occurring altogether.6
What is adjustment disorder?
Adjustment disorder is a psychiatric disorder that is caused by a severe response to various stressors. These stressors vary from person to person.1
The symptoms of adjustment disorder may look the same as other mental health disorders, such as major depressive disorder, personality disorder, mixed anxiety and depression, acute stress reaction, and post-traumatic stress disorder.3 Some common symptoms of adjustment disorder include:2
- Changes to appetite
- Difficulty concentrating
- Impaired daily functioning
- Withdrawal from social events and people
- Not completing important tasks, including paying bills and attending work or school.
- Suicidal thoughts
- Feeling irritable
People will experience these symptoms differently. Some people may experience them all; some may only have a few. However, if you feel like you may have an adjustment disorder and have noticed these symptoms, it is important to consult a healthcare professional who will be able to give you a diagnosis and create a treatment plan accordingly.2
Types of adjustment disorder
There are different subtypes of adjustment disorder. According to the DSM-5, there are six different subtypes. Each of these subtypes has specific symptoms that define them.4 The DSM-5 classifies each of these through the following: the presence of these symptoms:4
- Depressed mood
- Mixed anxiety and depression
- Disturbance of Conduct
- Mixed disturbance of emotions and conduct
Although the DSM-5 is specific to these subcategories, the ICD-11 (another diagnostic criterion used) does not reference any differentiation between these types.4.
Causes and triggers
Adjustment disorder can be caused by various factors, each of which is specific to each person. A trigger is a stressor, such as an event or life change that becomes too much for someone to deal with and starts presenting as adjustment disorder and its symptoms.1. These stressors look different depending on a person's life, especially their age. For younger children and teenagers, their triggers often involve their school and family life. This can include bullying, family separations or difficulties fitting in and struggling with identity issues.1. For adults, their triggers may look a little bit different. Some common causes include work problems, divorce, illness, relocation, unexpected events, or the death of a loved one.1.
Diagnosis and assessment
Adjustment disorder is a psychiatric disorder that needs to be diagnosed by a professional. The two most common diagnostic criteria are the DSM-5 and the ICD-11. However, the DSM-5 is more commonly used.3
Like other mental health disorders, the diagnostic criteria is from the DSM-5. The DSM-5 contains relevant information about diagnosing mental health disorders.2 The criteria for adjustment disorder include the following.2
- Response to stress within 3 months of onset
- Marked distress
- Significant impact on social functioning
- The stress is not explained by another disorder or bereavement
- Experiencing low mood, depressed mood, hopelessness, anxiety, maladaptive reactions.
One way to assess adjustment disorder is through a self-report assessment and, in this case, the adjustment disorder- new module 20 (ADNM-20). This involves a list of stressors and events that may be related to adjustment disorder.5 Patients are asked to use the 4-point Likert scale (1-4) to indicate how frequently these symptoms occur over a two-week period.5
The Likert scale:5
This report is used to measure a person's case against the diagnostic criteria.5
Impact on daily life
The symptoms that a person is experiencing will impact each person's daily life differently. Adjustment disorder affects your emotions and your daily behaviours. You may also have negative feelings about yourself, such as sadness and hopelessness. In severe cases, this may lead to suicidal thoughts, and in this case, it is very important to seek help as soon as possible.2 If you need assistance dealing with suicidal thoughts, there are crisis lifelines such as the Samaritans.
Adjustment disorder may also impact your ability to complete day-to-day tasks, even the important ones. This could include missing important work meetings, missing doctor appointments, not seeing family and friends, not taking care of yourself regularly, or isolating yourself from those around you.2 Missing these events may worsen the condition and further push someone into a low and depressed state or increase their anxiety.2
Prevalence and recovery
Studies show that the prevalence of adjustment disorder was 11.5%.6 It was most common amongst the younger population between the ages of 15-25 years. There is no significant data to support that adjustment disorder is more common among females or males.6 Overall, the study concluded that adjustment disorder was common and suggested that risk factors include those who are single, young, have a low educational level and are from an urban area.6 Furthermore, in terms of the most common subtype of adjustment disorder, adjustment disorder with mixed anxiety and depressed mood was most common.6
Treatment, coping strategies, prevention
Most often, adjustment disorder is a short-term problem caused by a known stressor. This usually means it can resolve over time as you learn to cope with the stressor itself.6. However, sometimes this isn't the case and further intervention is needed.
Psychotherapy is one of the best options for treating adjustment disorder. Due to the nature of adjustment disorder, it is often found that interpersonal psychotherapy or problem-solving therapy is more effective than other therapies.6 These types of therapies are more solution-based and, therefore, can target the known cause of the problem.6 Additionally, medications used to treat depression and anxiety may be used in conjunction with therapy. This will depend on the specific symptoms of the disorder.6 These therapeutic options are usually considered when the adjustment diaper is more severe or long-lasting.6
Short-term coping methods may also be useful to help you cope with the stress that causes adjustment disorder. Staying in touch with your support network is crucial when dealing with serious events or life changes. Practising meditation and mindfulness may also be useful. Furthermore, maintaining a healthy lifestyle and avoiding alcohol and drugs can help prevent symptoms from worsening.
Furthermore, prevention of adjustment disorder is also very important. Putting measures into place to cope with and manage life changes or potential upcoming stressors may be useful and stop adjustment disorders from occurring. This doesn't apply to all stressors, as some are not predictable. However, any known stressors may be avoided. This might include relocation, moving to a new school, or retirement.6
Adjustment disorder is a mental health disorder that is triggered by an intense response to a stressor. This results in feelings of sadness, hopelessness, and worry. It also can impact a person’s daily and social functioning. The type of stressor that triggers adjustment disorder varies depending on a person's life and their age. People will have different stressors at different points in their lives. Some of these stressful events include school problems, family conflicts, personal losses, financial struggles, divorce, or health issues. A healthcare professional will use diagnosis criteria such as the DSM-5 to make a diagnosis for adjustment disorder. However, diagnosis can be complex because the symptoms of adjustment disorder overlap with many other mental health conditions. This disorder can severely impact a person’s life and may even result in suicidal thoughts or complete withdrawal from society. Sometimes, adjustment disorder may be resolved when a person comes to terms with the known trigger. However, more severe and long-lasting cases may require further treatment. Typically, solution-based psychotherapies such as interpersonal psychotherapy and problem-solving psychotherapy are effective when treating adjustment disorder. Alternatively, medication may be used alongside therapy. For example, antidepressant or anti-anxiety medications may be used to help manage the symptoms of anxiety and depression. Prevention is also very important. Anticipating events that may cause this stress response and putting supportive measures in place may be enough to stop adjustment disorder from developing altogether. If you think you may be suffering from adjustment disorder, it is best to seek professional help from a specialist who will be able to give you a diagnosis and create a treatment plan according to your specific needs.
- Adjustment disorder: medlineplus medical encyclopedia [Internet]. [cited 2023 Aug 20]. Available from: https://medlineplus.gov/ency/article/000932.htm
- Administration SA and MHS. Table 3. 19, dsm-iv to dsm-5 adjustment disorders comparison [Internet]. 2016 [cited 2023 Aug 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t19/
- Patra BN, Sarkar S. Adjustment disorder: current diagnostic status. Indian J Psychol Med [Internet]. 2013 [cited 2023 Aug 20];35(1):4–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701359/
- O’Donnell ML, Agathos JA, Metcalf O, Gibson K, Lau W. Adjustment disorder: current developments and future directions. International Journal of Environmental Research and Public Health [Internet]. 2019 Jan [cited 2023 Aug 25];16(14):2537. Available from: https://www.mdpi.com/1660-4601/16/14/2537
- Lorenz L, Bachem R, Maercker A. The adjustment disorder–new module 20 as a screening instrument: cluster analysis and cut-off values. Int J Occup Environ Med [Internet]. 2016 Sep 11 [cited 2023 Aug 25];7(4):215–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817961/
- Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment Disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemiol Ment Health [Internet]. 2009 Jun 26 [cited 2023 Aug 25];5:15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710332/