Adjustment Disorders: Type, Symptoms, Causes, Diagnosis and Treatment

Adjustment disorders refer to a category of mental health conditions that arise as a reaction to significant life stressors or transitions. These disorders are characterized by emotional or behavioral symptoms that develop within three months of an identifiable stressor and cause marked distress or impairment in daily functioning. While adjustment disorders can affect people of all ages, they are most commonly diagnosed in children and adolescents.

Adjustment disorders manifest in various forms, like adjustment disorder with depressed mood, adjustment disorder with anxiety, adjustment disorder with mixed disturbance of emotions and conduct, and unspecified adjustment disorder. Specific symptoms characterize each type of adjustment disorder.

A person with adjustment disorder tends to feel overwhelmed and have trouble coping with the stressor, leading to symptoms such as low mood, anxiety, irritability, difficulty concentrating, changes in sleep or appetite, and withdrawal from social activities. These symptoms can sometimes be severe enough to interfere with work or school performance.

Adjustment disorders are linked to specific stressful life events or changes, such as the death of a loved one, relationship problems, major life transitions, illness, or financial difficulties, according to Agathos, J. A. et al. (2019). International Journal of Environmental Research and Public Health. While anyone develops an adjustment disorder in response to stress, factors such as social skills, coping mechanisms, and individual temperament may influence one’s susceptibility.

A mental health professional diagnoses adjustment disorders through a comprehensive evaluation, including a detailed personal history and assessment of symptoms. Treatment often involves psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy, to help individuals develop coping skills and process their emotions. In some cases, medication may be prescribed to address specific symptoms like anxiety or depression, although it is not usually the first line of treatment.

What is Adjustment Disorder?

Adjustment disorder, also known as stress response syndrome, is a mental disorder characterized by a maladaptive response to a psychosocial stressor, according to a Cleveland Clinic article titled “Adjustment Disorders.” This condition involves normal emotional and behavioral reactions that are more intense than typically expected, causing significant distress and functional impairment. The disorder is triggered by a specific event or change in a person’s life, such as the death of a loved one, divorce, or moving to a new city, and it manifests within three months of the stressor. 

The symptoms of adjustment disorder include sadness, hopelessness, anxiety, and behavioral issues like impulsivity and defiance, and they usually subside within six months if the stressor is removed. Nancy L. Nussbaum of the University of Texas at Austin, 2011 suggests in her report ADHD and Female Specific Concerns that this psychosocial stressor affects individuals of any age. However, it is commonly diagnosed in children and adolescents. Women are diagnosed with adjustment disorder twice as often as men in adulthood, while boys and girls are equally likely to be diagnosed during childhood and adolescence. 

The disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11), with six subtypes based on predominant symptoms, including depressed mood, anxiety, and disturbance of conduct.

Adjustment disorder is often considered a short-term condition, with symptoms resolving within six months unless the stressor persists, according to a Cleveland Clinic article titled “Adjustment Disorders.” However, if left untreated, it leads to more severe psychiatric disorders such as major depressive disorder or post-traumatic stress disorder (PTSD). The prognosis for adjustment disorder is relatively good compared to other mental disorders, but the severity of symptoms can vary significantly among individuals.

What is the prevalence of adjustment disorder?

 The prevalence of adjustment disorder varies, with estimates suggesting it affects 2% of the global population and accounts for 5% to 20% of outpatient mental health visits in the United States, according to a cross-mark study titled “Prevalence Estimate for Adjustment Disorders in the South African Navy” by Charles H. Van Wijk. 

The study suggests that the rates are even higher in medical settings, up to 50% in hospital psychiatric consultation services. Specific high-risk groups show elevated rates as well. For example, a study of involuntarily laid-off workers found a prevalence of 15.5%. In oncology and palliative care settings, 15-20% prevalence rates have been reported. 

The prevalence tends to be higher among younger individuals, those with lower education levels, and people living in urban areas. While estimates vary, these findings indicate that adjustment disorder is a relatively common condition, especially in clinical populations and those facing significant stressors.

What are the types of adjustment disorders?

The main types of adjustment disorder include adjustment disorder with depressed mood (F43.21), adjustment disorder with anxiety (F43.22), adjustment disorder with mixed anxiety and depressed mood (F43.23), adjustment disorder with disturbance of conduct (F43.24), adjustment disorder with mixed disturbance of emotions and conduct (F43.25) and adjustment disorder, unspecified (F43.20), according to an article on UC Health titled “Adjustment disorders.”

• Adjustment Disorder with Depressed Mood (F43.21): This type is characterized by feelings of sadness, hopelessness, and a general lack of interest in previously enjoyable activities. Individuals experience tearfulness and physical symptoms such as fatigue and sleep disturbances. It is common in adults and affects daily functioning.
• Adjustment Disorder with Anxiety (F43.22): Individuals with this type experience excessive worry, nervousness, and jitteriness. They feel overwhelmed and have difficulty concentrating or remembering things. Physical symptoms include a racing heartbeat and sweating. In children, it often manifests as separation anxiety from parents or loved ones.
• Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.23): This type combines symptoms of both anxiety and depression. Individuals simultaneously feel very worried and sad, experiencing a mix of the symptoms of both conditions. This leads to significant impairment in social, occupational, or other areas of functioning.
• Adjustment Disorder with Disturbance of Conduct (F43.24): This type is more common in children and adolescents and is characterized by behavioral issues such as impulsive actions, reckless driving, fighting, vandalism, and other forms of antisocial behavior. These behaviors significantly disrupt social and academic functioning.
• Adjustment Disorder with Mixed Disturbance of Emotions and Conduct (F43.25): Individuals with this type exhibit a combination of emotional symptoms (such as anxiety and depression) and behavioral problems. This includes impulsive actions, reckless behavior, and emotional instability, leading to difficulties in various aspects of life.
• Adjustment Disorder, Unspecified (F43.20): This type is diagnosed when the reaction to a stressor does not fit into the other specific categories. Symptoms include social withdrawal, inability to perform daily activities, and physical complaints. The reaction is excessive compared to what would be expected, given the nature of the stressor.

These types of adjustment disorders are typically short-term, lasting less than six months, but become chronic if the stressor persists or the disorder goes untreated. Treatment often involves therapy, medication, or a combination of both to help individuals cope with the stressor and alleviate symptoms.

What factors contribute to the development of adjustment disorders in children?

The factors that contribute to the Loss of appetite are one of the most common effects that children experience when their parents go through a divorce or separation.  The factors that contribute to the development of adjustment disorders are significant life changes or stressful events, such as the parent’s divorce or separation, the loss of a pet, the birth of a sibling, moving to a new home, or changing schools, according to the Child Mind Institute Journal’s “Quick Guide to Adjustment Disorders”  (Dec 2023).

• Parents’ divorce or separation: Parents’ divorce is the legal ending of a marriage or relationship between two parents, resulting in them living apart. This is often a highly stressful event for children, causing significant emotional turmoil. The breakdown of the family unit leads to feelings of insecurity, anxiety, and sadness. Children struggle to cope with changes in living arrangements, reduced time with one parent, or conflicts between parents.
• Loss of a pet: For many children, pets are important family members. The death of a beloved pet can be a profound loss, often representing a child’s first experience with death. This can trigger feelings of grief, sadness, and confusion about mortality.
• Birth of a sibling: While often a joyous occasion, the arrival of a new baby is challenging for some children. They feel displaced, jealous, or anxious about changes in parental attention and family dynamics. This shift in family structure can lead to behavioral changes or emotional distress.
• Moving to a new home: Relocating is a significant stressor for children. It often involves leaving behind familiar surroundings, friends, and routines. Children feel anxious about adapting to a new environment, making new friends, and adjusting to unfamiliar settings.
• Changing schools: This is frequently cited as a stressful event contributing to adjustment disorders. Children experience anxiety about fitting in with new peers, meeting academic expectations, and navigating an unfamiliar school environment. The loss of established friendships and routines can be particularly challenging.

These events trigger adjustment disorders because they disrupt a child’s sense of stability and security. Children struggle to process and cope with the emotions associated with these changes, leading to symptoms such as anxiety, depression, or behavioral problems.

It’s important to note that not all children will develop an adjustment disorder in response to these events. The likelihood depends on various factors, including the child’s temperament, previous experiences, support system, and coping skills. However, when a child’s reaction to such events is unusually strong or long-lasting and interferes with their daily functioning, it may indicate an adjustment disorder.

How do you diagnose an adjustment disorder?

A mental health professional diagnoses an adjustment disorder through a comprehensive evaluation that includes discussing major life stressors, assessing symptoms, and examining how they impact daily functioning, according to Carta, M. G. et al. (2009). Adjustment Disorder: Epidemiology, diagnosis and treatment. Clinical Practice and Epidemiology in Mental Health.

The diagnosis is based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which specifies that symptoms must develop within three months of a specific stressor, be more severe than expected, and cause significant impairment in social, occupational, or other important areas of functioning. 

The mental health provider will also take a detailed personal history, including development, life events, emotions, and behaviors. To confirm the diagnosis, they must rule out other mental health conditions and ensure the symptoms are not part of typical grieving. The DSM-5 identifies six types of adjustment disorders based on predominant symptoms, such as depressed mood, anxiety, or disturbance of conduct. 

Additionally, the provider will consider cultural factors that may influence how stress or grief is expressed. While adjustment disorders are common, affecting an estimated 5-20% of outpatient mental health visits in the U.S., diagnosis can be challenging due to varying diagnostic criteria and the subjective nature of stress responses, according to H. Charles,  2024, in a study “Prevalence Estimate for Adjustment Disorders in the South African Navy” Cross Mark Journal.

Is there a definitive test for diagnosing adjustment disorder?

No. According to the Cleveland Clinic 2023 article, “Adjustment Disorders, ” there is no definitive test for diagnosing adjustment disorder.” The diagnosis is primarily based on a clinical assessment by a mental health professional involving interviews and symptom evaluation. 

While doctors use lab tests like blood work or imaging scans like CT or MRI, these are mainly to rule out other potential physical causes of symptoms rather than directly diagnose adjustment disorder. 

The diagnosis relies on meeting specific criteria outlined in the DSM-5, including the onset of emotional or behavioral symptoms within three months of an identifiable stressor, symptoms that are out of proportion to the stressor, and significant impairment in daily functioning. 

A comprehensive evaluation by a psychiatrist or psychologist is necessary to accurately diagnose adjustment disorder and differentiate it from other mental health conditions.

How long can someone be diagnosed with adjustment disorder?

Adjustment disorder is diagnosed up to 6 months after the stressful event’s onset, as Carta et al. (2009) reviewed on Adjustment Disorder: Epidemiology, diagnosis, and treatment. Clinical Practice and Epidemiology in Mental Health. This timeframe is based on the expectation that symptoms will resolve as the individual adapts to the stressor or when the stressful situation ends.

However, in some cases, adjustment disorder persists beyond six months, mainly if the stressor is ongoing or chronic. This is referred to as persistent or chronic adjustment disorder. Examples of situations that may lead to a longer-lasting adjustment disorder include prolonged unemployment, long-term caregiving for a chronically ill person, or adapting to significant life changes. 

In these cases, continued treatment and reassessment may be necessary to ensure the diagnosis remains appropriate and to address any evolving symptoms or potential development of other mental health conditions.

What approaches are used to treat adjustment disorder?

The main approaches used to treat adjustment disorder are individual psychotherapy, family therapy, peer group therapy, and medication in some cases, according to Geer K.  2023 “Adjustment Disorder: Diagnosis and Treatment” in Primary Care Journal.

• Individual Psychotherapy: Individual psychotherapy, often referred to as talk therapy, is a primary treatment for adjustment disorders. It involves one-on-one sessions with a therapist, focusing on understanding the stressor, developing coping mechanisms, and managing symptoms. This personalized approach helps individuals regain emotional balance and improve their mental well-being.
• Family Therapy involves sessions with the patient and their family members. This approach aims to improve communication, resolve conflicts, and provide support within the family unit. By addressing the dynamics and stressors affecting the entire family, this therapy helps create a supportive environment for the individual dealing with adjustment disorder.
• Peer Group Therapy: Peer group therapy brings together individuals experiencing similar issues, providing a supportive community where participants can share experiences and coping strategies. This group setting fosters a sense of belonging and reduces feelings of isolation, helping individuals learn from others’ experiences and build resilience.
• Medication: Medication is defined as the use of drugs or other substances to treat and prevent illness or disease. In some cases, medication such as antidepressants or anti-anxiety drugs are prescribed to manage symptoms of adjustment disorder. These medications help alleviate severe symptoms of depression or anxiety, making it easier for individuals to engage in and benefit from psychotherapy.

The most effective approach to treating adjustment disorder is personalized and involves a combination of therapies. A proper treatment plan depends on an individual’s unique needs and circumstances.

What is the difference between adjustment disorder and generalized anxiety disorder (GAD)?

The exact difference between adjustment disorder and generalized anxiety disorder (GAD) is their cause, duration, and symptom presentation, according to a Medical News Today article titled “What to know about adjustment disorder with anxiety” by Charlotte King. ( June 2023).

Adjustment disorder is triggered by a specific stressful event or life change and typically resolves within 6 months, while Generalized Anxiety Disorder is characterized by persistent, excessive worry without a clear trigger and tends to be chronic. 

This disorder develops in response to an identifiable stressor, such as a major life change, loss, or traumatic event. Symptoms appear within 3 months of the stressor and usually improve as the person adapts. In contrast, GAD involves long-term, excessive anxiety and worry about various aspects of life, often without a clear cause. People with GAD have difficulty controlling their worry and experience symptoms for at least 6 months.

The symptom presentation also differs. Adjustment disorder symptoms are typically milder and more focused on the specific stressor, while GAD symptoms are more pervasive and severe. GAD is characterized by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. Both conditions can involve anxiety, but in adjustment disorder, the anxiety is directly related to the stressor and tends to improve as the person adapts.

Similarities between the two disorders include overlapping symptoms such as worry, nervousness, and difficulty coping with daily activities. Both can significantly impact a person’s quality of life and functioning. Complications of both disorders may include the development of other mental health conditions, such as depression or substance abuse issues. GAD is considered more severe due to its chronic nature and potential for long-term impact on a person’s life. However, both disorders can cause significant distress and impairment if left untreated. Early diagnosis and appropriate treatment are crucial for both conditions to prevent the worsening of symptoms and improve overall well-being.

What is the difference between adjustment order and major depressive disorder?

Adjustment disorder (AD) and major depressive disorder (MDD) are both mental health conditions characterized by symptoms of depression. Still, they differ significantly in their causes, duration, and severity, as reviewed on Medical News Today, “Adjustment disorder with depressed mood vs. major depressive disorder” by Bethany Juby, 2023.

Adjustment disorder, also known as situational depression, arises in response to a specific stressor or life event, such as a divorce or job loss. Symptoms typically begin within three months of the event and resolve within six months once the stressor is removed or the individual adapts to it. 

In contrast, major depressive disorder is a more severe and often chronic condition that can occur without an identifiable trigger and may require long-term treatment, including medication and therapy.  MDD is marked by more intense symptoms, such as persistent sadness, loss of interest in activities, significant changes in sleep and appetite, and frequent suicidal thoughts, which are less common in AD.

Both conditions cause significant impairment in daily functioning and share symptoms such as sadness, hopelessness, and changes in sleep and appetite. Both can be treated with therapy, though MDD often also requires medication.

If left untreated, adjustment disorder can evolve into more severe conditions like major depressive disorder, anxiety disorders, or substance abuse. Major depressive disorder, due to its severity, can lead to severe complications, including chronic health issues, significant impairment in social and occupational functioning, and a high risk of suicide.

Major depressive disorder is generally considered more harmful due to its chronic nature, severity of symptoms, and higher risk of suicide, according to Bains N et.al 2024 “Major Depressive Disorder” StatPearls Publishing Journal. Adjustment disorder, while distressing, is typically less severe and more transient, resolving with the removal of the stressor or with appropriate therapeutic interventions.

While both adjustment disorder and major depressive disorder affect an individual’s life, MDD is more severe and poses more significant long-term risks.

What is the DSM-5 code for adjustment disorder with anxiety?

The DSM-5 code for adjustment disorder with anxiety is 309.24 (F43.22), according to the Substance Abuse and Mental Health Services Administration 2016. This diagnosis is characterized by symptoms of nervousness, worry, jitteriness, or separation anxiety that are predominant in response to an identifiable stressor.

The symptoms typically develop within 3 months of the stressor’s onset and are clinically significant. They cause marked distress that is out of proportion to the severity of the stressor or substantial impairment in social, occupational, or other important areas of functioning. 

It’s important to note that the symptoms do not meet the criteria for another mental disorder and are not merely an exacerbation of a preexisting condition. The symptoms’ duration is either acute (less than 6 months) or persistent (more than 6 months). This diagnosis is part of the broader category of Trauma and Stressor-Related Disorders in the DSM-5, which recognizes the impact of external events on mental health.

What is the adjustment order in the DSM-5 for children?

Adjustment disorder in children is characterized by emotional or behavioral symptoms that occur in response to an identifiable stressor within three months of the event, as reviewed by Agathos, J. A. et al. (2019). “Adjustment Disorder: Current Developments and Future Directions” in the  International Journal of Environmental Research and Public Health. These symptoms must be clinically significant, meaning they cause marked distress that is out of proportion to the severity or intensity of the stressor, or they result in significant impairment in social, occupational, or other important areas of functioning. 

The DSM-5 outlines six subtypes of adjustment disorders based on the predominant symptoms: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, and unspecified.

The prevalence of adjustment disorders varies, with estimates suggesting that they affect approximately 2% to 8% of the population globally and between 5% to 20% of individuals in outpatient mental health settings in the United States. Children and adolescents with adjustment disorders may exhibit a range of symptoms, including sadness, anxiety, behavioral issues such as skipping school or vandalism, and physical complaints. The disorder is more common in females, affecting them at twice the rate of males. 

Diagnosis involves a comprehensive evaluation by a mental health professional, who will consider the child’s developmental history, life events, and the specific stressors involved.

Treatment for adjustment disorders in children often includes psychotherapy, which can be conducted individually, with the family, or in peer groups. Cognitive-behavioral therapy (CBT) is commonly used to help children develop coping strategies, improve problem-solving skills, and manage stress. 

Family therapy is also beneficial to address any underlying family dynamics that contribute to the child’s stress. While medications are not typically the first line of treatment, they are prescribed on a short-term basis if specific symptoms, such as severe anxiety or depression, are present. Early intervention and support from healthcare providers, family, and school staff are crucial to improving outcomes for children with adjustment disorders.

How can adjustment disorder be prevented?

Adjustment disorder can be prevented by building resilience, maintaining healthy lifestyle habits, and seeking early intervention when stressors arise, according to Geer K.  2023 “Adjustment Disorder: Diagnosis and Treatment” in Primary Care Journal. These strategies involve fostering solid social connections, practicing effective coping skills, and engaging in regular physical activity and mindfulness practices.

Building resilience is crucial for preventing adjustment disorder. This involves developing the ability to adapt to stressful events and changes. Connecting with friends and family provides emotional support and helps individuals feel less isolated during challenging times. 

Engaging in activities that give a sense of purpose and accomplishment also enhances resilience. Additionally, practicing problem-solving skills and maintaining a positive outlook can help individuals navigate stress more effectively. For example, reminding oneself of personal strengths and successes can boost confidence in handling new stressors.

Maintaining a healthy lifestyle is another critical preventive measure. Eating a balanced diet, regular exercise, and ensuring adequate sleep are fundamental to overall mental health. Physical activity, in particular, reduces symptoms of anxiety and depression, which are often associated with adjustment disorders. 

Mindfulness and relaxation techniques, such as meditation and deep-breathing exercises, can help manage stress and improve emotional regulation. These practices enable individuals to stay present and reduce anxiety, thereby mitigating the risk of developing adjustment disorder.

Early intervention is essential when facing significant life changes or stressors. Seeking professional help, such as therapy or counseling, can provide valuable tools for coping with stress. Therapists teach problem-solving techniques, stress management skills, and cognitive-behavioral strategies to reframe negative thoughts. Support groups can also offer a sense of community and shared experience, benefiting adolescents and adults alike. 

By addressing stressors promptly and learning effective coping mechanisms, individuals can reduce the severity of symptoms and prevent the progression of adjustment disorder.

What is the best treatment for adjustment disorder?

The best treatment for adjustment disorder is talk therapy, also known as psychotherapy, with Cognitive Behavioral Therapy (CBT) being particularly effective; according to Leterme, A. C. (2020), “A blended cognitive behavioral intervention for patients with adjustment disorder with anxiety: A randomized controlled trial.” Internet Interventions, 21.  Talk therapy helps individuals by providing emotional support, helping them return to their regular routines, and teaching them stress management and coping skills to handle future stressful events.

According to Leterme, A. C. of the Stress and Anxiety Unit, Department of Psychiatry, Lille University Hospital, talk therapy is considered the best treatment because it addresses the root causes of the disorder by helping individuals understand and manage their reactions to stress. It focuses on changing negative thought patterns and behaviors, improving communication skills, and enhancing problem-solving abilities. 

This therapeutic approach alleviates immediate symptoms and equips individuals with tools to handle future stressors, fostering long-term resilience and mental well-being.