Adjustment Disorders

Symptoms of adjustment disorder vary in form and severity and can be classified according to subtype. The following are descriptions of the different types of adjustment disorder listed in the Diagnostic and Statistical Manual of Mental Disorders. 

Adjustment order with depressed mood 

People with this subtype may experience thoughts of hopelessness, tearfulness, and low mood. They may also have symptoms like decreased self-esteem, increased thoughts of worthlessness, or a lack of motivation, and they may struggle to find pleasure in activities that once brought them joy. Suicidal ideation may be a risk with this subtype.

Adjustment disorder with anxiety

This subtype has symptoms, including separation anxiety, jitteriness, or nervousness. People with adjustment disorder with anxiety may experience constant or near-constant worry, fear, irritability, a sense of being “on edge,” or overwhelm. This subtype can also have an increased risk of suicidal ideation.

Adjustment disorder with mixed anxiety and depressed mood

In this subtype, people experience a mixture of anxiety and depression symptoms, including excessive worry, edginess, nervousness, decreased self-esteem, and a lack of motivation. People with this subtype may feel lonely or isolated and experience sadness, low mood, or hopelessness. Like the previous two subtypes, they may also have an increased risk of suicidal behavior or ideation.

Adjustment disorder with disturbance of conduct

Adjustment disorder with disturbance of conduct can result in behavioral challenges outside the norms of society. For example, someone with this subtype may experience outbursts of anger or extreme mood swings that lead to them acting out. They may attempt to get revenge or violate the rights of others. People with the disturbance of conduct subtype may engage in substance use, which can further intensify their feelings and behavioral symptoms.

Adjustment disorder with mixed disturbance of emotions and conduct

This subtype includes emotional symptoms of depression, anxiety, and behavioral problems. 

Adjustment disorder unspecified

When the reactions of someone with adjustment disorder do not fit into any of the above categories, the condition may be classified as the unspecified type. Symptoms in the subtype may be challenging to define, but they cause functional impairment and emotional distress and affect the person’s ability to function in daily life.

Various events can cause adjustment disorder, and the cause of the stressor can vary drastically from person to person. Some stressors may include the following:

• Divorce
• Relationship conflict or challenges 
• Financial struggles
• Relocation to a different city or country 
• Major illness

More research on adjustment disorder may be beneficial, as little is known about its risk factors, prevalence, course, treatment, or what happens in the brain to cause this condition. 

Since adjustment disorder results from stress, some researchers have focused on how stress affects the body to determine how it may contribute to adjustment disorder.

The cumulative effects on the body from excess stress or inefficient management of stress, known as allostatic load, can affect the body adversely. The body’s stress response aims to achieve stability by releasing multiple chemicals, like adrenaline, corticosteroids, and cytokines, which can have far-reaching effects on the body.

Research also found that acute² and chronic stress may cause adaptive changes in the hippocampus, the part of the brain responsible for spatial memory, memory consolidation, and memory transfer. 

Researchers believe that stress may have other undetermined effects on the brain and may be a significant part of the biology behind adjustment disorder.

Because of a lack of high-quality trials, there are no clear guidelines for how best to treat adjustment disorder. 

The goal of treating adjustment disorder is to relieve symptoms and return the person to their baseline level of functioning they had before the stressful event. There may be multiple ways to meet this goal, including but not limited to the following.

Medication

Because adjustment disorder can self-resolve, randomized trials for medication and other therapies are hampered by the fact that the condition may resolve independently during trials. Some studies have demonstrated the efficacy of benzodiazepines, some antidepressants, and etifoxine in the treatment of adjustment disorder. While medication may be used, it is recommended only in addition to talk therapy and to support sleep problems, depression, or anxiety. Always consult with your healthcare provider before starting, stopping, or changing any medication.

Self-care

Not everyone with adjustment disorder may require outside treatment. Some researchers use a flu virus analogy to explain the effects of this condition. People with the flu often experience the same symptoms: fever, headache, cough, etc. Some of these people might get severe compilations and end up in the hospital, while others recover on their own at home. 

Some people with adjustment disorder may experience a significant stress response and require therapy, medication, or other healthcare services, but others living with this disorder can recover without treatment.

Because stress can be a cause of adjustment disorder, learning how to manage stress may help with symptoms. Self-care may be a beneficial approach and can include but is not limited to the following: 

• Aiming for 30 minutes of exercise a day
• Eating regular, healthy meals
• Prioritizing sleep
• Trying meditation or breathing exercises
• Journaling
• Staying connected to friends and family

According to the above study on CBT, both in-person and virtual CBT can lead to improved symptoms of adjustment disorder, with virtual therapy having significantly more significant long-term improvements. Online therapy can be a convenient way to get treatment. 

Clients who sign up for online therapy through a platform like BetterHelp can find multiple tools, including messaging with a therapist, weekly group sessions, journaling prompts, and worksheets. Below are a few other resources individuals can use: 

• If you’re interested in learning more about self-care, the National Institute of Mental Health offers tips and information on when to seek professional help. 
• Veterans experiencing adjustment disorder can reach out to Make the Connection through the US Department of Veterans Affairs for more information and support.
• Adjustment disorders can affect children differently than adults. Stanford Children’s has an informative resource explaining how it affects kids.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Despite a recent study indicating the prevalence of adjustment disorder may be as high as 9.2%, adjustment disorder has not attracted much research attention.

In the DSM-5, adjustment disorders were classified as trauma and stress-related disorders for the first time. However, there is still a lack of specific diagnostic criteria, like particular symptoms and the combinations or numbers required for a diagnosis, as there are other DSM conditions. The subtypes are not well-researched, and clear treatment guidelines do not exist. 

Some professionals believe that classifying adjustment disorder as a trauma and stress-related disorder may draw more attention from the research community. Some researchers also believe that the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11), the global standard for diagnostics, may be more accurate than the DSM-V when defining adjustment disorder.

Due to a lack of research, the diagnostic criteria in the DSM-V remain similar to the DSM-IV despite being reclassified. The DSM still focuses on adjustment disorder as impairment or distress that is judged to be excessive. The ICD-11, on the other hand, introduced changes that indicated a significant shift in its definition of the disorder. Like the DSM, the ICD also recognizes that adjustment disorder is related to a stressor, but it indicates that the condition may result from a failure to adapt. This emphasis on difficulty adapting is not mentioned in the DSM-V.

65% of cancer patients accept psychotherapy for adjustment disorder

Researchers looked at whether cancer patients with adjustment disorder would be receptive to psychological treatment. Researchers found that 65% of the participants were willing to try the intervention, highlighting psychotherapy as a promising potential treatment for cancer patients.¹

¹Support Care Cancer

Below are more key statistics on adjustment disorder: 

• Available studies show that around 9.2% of the population has adjustment disorder. 
• Rates of adjustment disorder are much higher in high-risk populations. For example, some research found it affects as much as 27% of the unemployed.
• One study examining the prevalence of adjustment disorder during the COVID-19 pandemic found that 14% of participants met the diagnostic criteria.