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Stress is an inevitable part of the human experience, but each of us responds to it in a unique way. For some, recovering from a stressful experience, such as a death, job loss or divorce, can be a struggle that affects day-to-day functioning, also known as adjustment disorder—a mental health diagnosis that may follow a significant life change.
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What Is Adjustment Disorder?
Adjustment disorder can be described as “an emotional or behavioral response to an identifiable stressor that occurred within three months of symptom onset,” says Paul Poulakos, M.D., a psychiatrist in Greenwich Village, New York City. Your resulting distress, he adds, is disproportionate to the event itself. The disorder is one of the most common mental health conditions in the U.S., affecting nearly 7% percent of the adult population, according to the Center for Behavioral Health Statistics and Quality[1].
Though this diagnosis may sound like an anxiety disorder, there are key differences:
- Timing: Anxiety symptoms present with adjustment disorder generally persist for no longer than six months, says Dr. Poulakos. Conversely, in order to diagnose general anxiety disorder, symptoms must be present for longer than six months.
- Triggers: Adjustment disorder is triggered by a stressful event, such as the death of a loved one, illness or unemployment. “The anxiety seen in other psychiatric disorders is often brought on in the anticipation of a future event, or in response to a psychological stressor that very well might not be based in reality,” Dr. Poulakos says. Unlike these conditions, adjustment disorder is a reaction to a stressful life event, rather than the anticipation of it.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) notes adjustment disorder as having six subtypes, which include depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct and unspecified. However, additional research has noted there is too much correlation within these subtypes and not enough evidence to differentiate between them. The International Classification of Diseases, Eleventh Edition (ICD-11) also does not recognize these subtypes and has removed mention of them from its definition.
What Causes Adjustment Disorder?
A host of experiences may trigger adjustment disorder, including the following:
- Marital difficulties
- The death of a loved one
- Illness
- Major life changes, such as ending a relationship or moving to a new home
- Financial trouble
Who Might Have Adjustment Disorder?
“Most people have probably had an adjustment disorder at some point in their lives but didn’t know it,” says Hailey Shafir, a licensed clinical mental health counselor and supervisor in Raleigh, North Carolina. And, though anyone can receive this diagnosis, a recent study in Lithuania found certain factors may put people at increased risk for developing adjustment disorder. These include:
- Being older in age
- Having a college education
- Exposure to a stressful job-related event
- Exposure to a stressful health-related event
The study, along with other research, also notes females as being specifically associated with higher risk of developing the disorder[2].
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What Are Symptoms of Adjustment Disorder?
Symptoms of adjustment disorder vary depending on the person, the event they experienced and how they respond to stress. “Some may experience classic symptoms of anxiety, including feeling worried, tense and nervous,” says Shafir. “Others will feel depressed, down, irritable or have trouble focusing.” The disorder can cause significant disruptions to work, school or daily life as well.
Other symptoms of adjustment disorder include:
- Defiance or impulsivity
- Withdrawing from others
- Crying and/or feeling hopeless or sad
- Physical symptoms such as skipped heartbeats, twitching or trembling
- The emotional and behavioral response appears excessive compared to the stressful event
How Is Adjustment Disorder Diagnosed?
Diagnosis of adjustment disorder begins with an open and honest conversation with a mental health counselor or therapist, says Myisha Jackson, a licensed professional counselor based in Monroe, Louisiana. Clients should feel encouraged to talk through any symptoms and their duration, as well as major life changes or stressors they may be experiencing, she says.
After your initial meeting, the therapist or counselor will determine if a diagnosis of adjustment disorder is appropriate. The diagnosis will be based on if you have symptoms such as anxiety or depression, without additional symptoms that might point to a different psychiatric condition, Jackson adds.
If you suspect you may be struggling with adjustment disorder, it’s important to seek help from a mental health provider and receive a proper diagnosis. “If left untreated, an adjustment disorder can progress into a more long-lasting, chronic mental disorder such as generalized anxiety disorder, panic disorder or major depressive disorder,” says Dr. Poulakos.
What Are Treatment Options for Adjustment Disorder?
Though adjustment disorder disorder is temporary by nature, there are reliable treatments available to help ease the symptoms and improve your quality of life.
Psychotherapy
Psychotherapy, or talk therapy, is the standard treatment for patients struggling with adjustment disorder. In her practice, Jackson leans on solution-focused therapy and cognitive behavioral therapy to help patients adjust to the stressful experience and change response patterns to it.
Medication
When symptoms persist beyond six months, medications may be warranted, says Dr. Poulakas. Your provider may prescribe the following to help you find relief:
- Antidepressants: Your provider may suggest antidepressants to ease depressive symptoms, especially if you experience a persistent stressor.
- Benzodiazepines: These medications are frequently prescribed to ease anxiety symptoms associated with adjustment disorder. However, benzodiazepines are recommended only for short-term use–and only after other treatment options have been explored–as they can be extremely habit-forming.
While adjustment disorder may affect how you live your life for a short period of time, many of the symptoms are completely normal human responses to stressful life experiences. It’s crucial to keep in mind that adjustment disorder is a highly treatable condition with a positive prognosis. In any case, a mental health professional can offer guidance, treatment options and assistance on your road to recovery.
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