Definition

Adjustment disorder is an excessive, lengthy reaction to a stressful event or situation. It could be one stressor or a combination of stressors affecting one person or a group of people. This reaction seriously damages social and occupational functioning.

There are several subtypes of the disorder, including adjustment disorder with:

• Depressed mood
• Anxiety
• Mixed anxiety and depressed mood
• Disturbance of conduct
• Mixed disturbance of emotions and conduct

Causes

Adjustment disorders develop in reaction to stressful life events or major life changes. Some common stressors are:

• Relationship problems
• Financial difficulties
• Family conflict
• School issues
• Work changes
• Major life changes
• Health problems
• Divorce
• Death of loved ones
• Moving
• Combat
• Sexuality issues

In some cases, ongoing problems, such as living in an unsafe, crime-ridden neighborhood, may cause the development of an adjustment disorder over a longer period of time.

Risk Factors

Women may be at a higher risk for adjustment disorder than men. However, risk for boys and girls is similar. Other factors that may increase your risk for adjustment disorder may include:

• Genetics
• Lack of emotional flexibility
• Intelligence
• Social skills
• Coping strategies

People who face certain stressors like medical problems or living in challenging environments may be at greater risk.

The stressor itself may also interfere with an individual’s support network.

Certain early-childhood family history factors seem to increase the chance that a person may suffer from an adjustment disorder in the future. These include:

• Frequent moves as a child
• Abusive family of origin
• Overprotective family of origin
• Coming from a disadvantaged background
• Prior exposure to extreme trauma, such as war, without having previously developed either an adjustment disorder or post-traumatic stress disorder (PTSD)

Individuals who are at higher risk for adjustment disorders often have other conditions, such as a history of anxiety, depression, bipolar disorder, or eating disorders.

Symptoms

Adjustment disorder symptoms are expected to begin within 3 months and disappear within 6 months after the causing stressor and/or its results have been removed. In the case of chronic adjustment disorder, the symptoms may last longer than 6 months. In general, they are related to ongoing persistent stressors like a chronic medical disability.

Symptoms may vary, but are similar in that the reaction to the stressor is worse or more excessive than expected. In order for a diagnosis of adjustment disorder to be made, symptoms must interfere with an individual’s social or work functioning.

Symptoms include:

• Depressed or fixed mood, sadness
• Difficulty breathing
• Chest pain
• Anxiety or worry
• Feeling of inability to cope
• Feeling of inability to plan ahead
• Feeling of inability to continue in present situation
• Some degree of disability in the performance of daily routine
• Conduct disorders
• Disturbance of other emotions and conduct

Diagnosis

Your doctor will perform an exam. It will be used to assess whether your symptoms follow a recent stressful event, and if the symptoms are more severe than what is normal for you. You will also be evaluated to make sure there are no underlying disorders or disease, such as depression, an anxiety disorder, or post-traumatic stress disorder. Your doctor may refer you to a psychiatrist for diagnosis and treatment.

Treatment

The main goal of treatment is to resolve symptoms and return the person to a normal level of functioning. Treatment is important so that the disorder doesn’t become a larger illness, like major depression. Treatment options include:

Prevention

While there is no known way to prevent adjustment disorders, the prognosis is good. Adjustment disorders generally resolve with treatment and time.

Substance Abuse and Mental Health Services Administration http://www.samhsa.gov

Health Canada http://www.hc-sc.gc.ca

Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment Disorder: Epidemiology, diagnosis and treatment. Clin Pract Epidemiol Ment Health. 2009;5:15.

Kocalevent RD, Mierke A, et al. Adjustment disorders as a stress-related disorder: A longitudinal study of the associations among stress, resources, and mental health. PLoS One. 2014;9(5):e97303.