Divorce, illness, or a new job can spark an extreme emotional response called adjustment disorder. But the condition is treatable.
Major life events — such as getting a divorce or moving somewhere new — can be stressful for most people. But if you find that you feel deeply sad or anxious or have trouble performing daily activities, you might have an adjustment disorder.
Adjustment disorder affects both children and adults. The condition — sometimes called situational depression — involves a severe emotional or behavioral reaction to a specific life stressor or series of stressors.
The life stressor can be a negative event, such as:
- losing your job
- having relationship problems
- getting a divorce
- being diagnosed with an illness
Or, it can be an event that’s generally considered positive but is emotionally charged and changes your routines, such as:
- having a baby
- getting married
- starting a new job
- retiring from your job
People with an adjustment disorder respond to life stressors in ways that are well above what’s culturally or socially expected or struggle in their daily lives. For instance, they might have a hard time studying or focusing at work.
People with an adjustment disorder can also experience anxiety and depression. They might behave inappropriately, run into problems at school or work, and withdraw from others.
People with the condition can also experience physical symptoms, such as:
Adjustment disorder symptoms vary widely. A person’s temperament, vulnerability, and coping skills often determine the disorder’s severity.
Age can make a significant difference, too. For instance, children and teens typically have behavioral symptoms, such as:
- not wanting to go to school
- picking fights with siblings
- having frequent crying spells
Adults, on the other hand, experience more depressive symptoms, such as feeling:
- deeply sad
Symptoms begin within
Adjustment disorder consists of six distinct subtypes based on the major symptoms a person is experiencing:
- With depressed mood: depressed mood, feelings of hopelessness, and tearfulness
- With anxiety: worry, nervousness, fear of separation, and jitteriness
- With anxiety and depressed mood: a combination of the depressed mood and anxiety subtypes
- With disturbance of conduct: violating others’ rights or society’s rules or norms, such as reckless driving, skipping school, vandalism, or fighting
- With mixed disturbance of emotions and conduct: a combination of the above subtypes, such as depressed mood, anxiety, and disruptive conduct
- Unspecified: symptoms outside the above subtypes, such as withdrawing from others or pulling away from activities, like school or work
A significant life event always triggers adjustment disorder.
In adults, common stressors may include:
- divorce or relationship problems
- death of a loved one
- having a baby
- losing a job or unemployment
- illness or health issues
- financial difficulties
- being discharged from the military
In children and teens, common stressors may include:
- parents’ separation or divorce
- school stressors, including social or academic difficulties
- moving to a new house, neighborhood, or city
- health or sexuality issues, such as being uncertain about sexual orientation or gender identity
- death of a close relative or friend
It’s unclear why some people develop adjustment disorders after a particular event and others don’t. However, several factors seem to play a role and increase risk, including:
- being female
- living in an urban area
- lacking social support
- having a low education level
- having another mental health condition
- experiencing long-term stressors, such as financial difficulties, a chronic illness, domestic abuse, or
socioeconomic or political instability
- having a history of childhood abuse, other traumatic events, frequent house moves, or overprotective parenting
Adjustment disorder is usually diagnosed by a psychologist or other qualified mental health professional following a complete mental health evaluation.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), adjustment disorder is classified alongside post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) in trauma- and stressor-related disorders.
Adjustment disorder includes these criteria:
- symptoms started within 3 months of the stressor occurring
- symptoms are above what’s considered typical under the circumstances or significantly impair your personal life, social functioning, work or school performance or attendance
- symptoms are distinct from similar disorders, such as PTSD or depression
- symptoms don’t represent typical bereavement
Adjustment disorder can sometimes look like other disorders, such as PTSD, ASD, or depression. This is why a thorough evaluation is critical for a correct diagnosis.
These conditions share similar symptoms, including anxiety and low mood. But the key difference is in the cause and symptom duration:
- Adjustment disorder is triggered by a stressful event within the realm of typical human experience, such as a job loss or divorce. In contrast, both PTSD and ASD are caused by a traumatic event, such as the threat of death, serious injury, or violence to yourself or someone else.
- ASD occurs within 3 days and 1 month following trauma, and may involve more shock-related feelings, such as not knowing where you are or feeling like you’re outside your body.
- PTSD occurs if symptoms have lasted for at least 1 month. In fact, sometimes PTSD doesn’t show up until months or years after the traumatic event.
Is it adjustment disorder or depression?
Adjustment disorder may also look like depression. A major difference between the two is that adjustment disorder develops in direct response to a stressful life event, while the cause of depression may be unclear or biological.
In addition, adjustment disorder tends to be relatively brief, while depression can be either short or long term.
In some cases, adjustment disorder can develop into depression, and there’s a unique specifier for adjustment disorder with depression. So, if your symptoms last longer than 6 months, consider seeing a mental health professional for a new evaluation and treatment. Depression is highly treatable.
Treatment for adjustment disorder may depend on several factors, including:
- symptom severity
- disorder subtype
- specific factors that contributed to the development or worsening of the disorder
Research on treatments for adjustment disorder is limited. In a
Still, treatments are available and may include:
- Individual psychotherapy. Typically, the first-line treatment is short-term, solution-focused psychotherapy that helps you better understand the stressful life event, reduce difficult symptoms, and problem solve. Cognitive behavioral therapy (CBT) can help you develop stronger stress management, communication, and problem-solving skills. CBT can also help you form healthy habits, manage anger, and navigate unhelpful thoughts.
- Family therapy. This is often recommended for children and teens. Family therapy helps parents, children, and close relatives improve communication, resolve conflict, and support each other in healthy ways.
- Peer group therapy. This helps with sharpening social and communication skills, particularly for teens. In general, it’s often helpful and encouraging to share challenges and coping strategies with people experiencing the same condition.
- Medication. Doctors usually don’t prescribe medication for adjustment disorder. When they do, it’s typically used to treat specific debilitating symptoms, such as insomnia or excessive anxiety.
Children and adults with adjustment disorder have a severe or not-as-common emotional or behavioral reaction to a significant life stressor. Symptoms might include anxiety, excessive worry, sadness, and behavioral changes, such as acting out or withdrawing from daily activities.
Adjustment disorder typically doesn’t last longer than 6 months unless the stressful event is ongoing. The best treatment for adjustment disorder is brief, solution-focused therapy, which helps you explore the stressful event, use effective coping strategies, and reduce difficult symptoms.
If you think you or your child might have an adjustment disorder, consider contacting a mental health professional for a thorough evaluation — in person or online. If you’re looking for mental health support but not sure where to start, you can check out Psych Central’s Find Help resource page.
With treatment, you can absolutely get better, learn to adapt to stress and heal.