Adjustment disorder

Definition

Adjustment disorder is an emotional and behavioral reaction that develops within 3 months of a life stress, and which is stronger or greater than what would be expected for the type of event that occurred.

Causes, incidence, and risk factors

Adults often develop adjustment disorder due to marital or financial problems.

In adolescents, common stressors include:

• Family conflict
• School problems
• Sexuality issues

Other stressors for people of any age include:

• Death of a loved one
• General life changes
• Unexpected catastrophes

There is no way to predict which people who are affected by the same stress are likely to develop adjustment disorder. Financial conditions, social support, and career and recreational opportunities can influence how well a person reacts to stress. A person's susceptibility to stress may be influenced by factors such as:

• Coping strategies
• Intelligence
• Flexibility
• Genetic factors
• Social skills

Symptoms

For a diagnosis of adjustment disorder, a person's symptoms must be severe enough to affect his or her work or social life. Some of the symptoms include:

• Agitation
• Conduct disturbances
• Depressed mood
• Palpitations
• Physical complaints
• Trembling or twitching

Symptoms of adjustment disorder typically begin within 3 months of the stressor, and usually do not last longer than 6 months, unless the stressor continues to be present (such as an illness or living in a dangerous neighborhood).

On occasion, symptoms can be severe and the person may have thoughts of suicide or make a suicide attempt.

Signs and tests

The following criteria need to be met to establish a diagnosis:

• The symptoms clearly follow a stressor
• The symptoms are more severe than would be expected
• There do not appear to be other underlying disorders
• The symptoms are not part of normal grieving for the death of a loved one

Treatment

The main goal of treatment is to relieve symptoms and help the person return to a similar level of functioning as before the stressful event occurred.

Individual therapy can help the person:

• Get support
• Identify his or her abnormal responses to the stressor
• Maximize the use of his or her strengths

Most mental health professionals recommend some type of talk therapy to help the person identify or learn different responses to the stressors in their life. Types of therapy may include:

• Behavior therapy
• Individual psychotherapy
• Family therapy
• Self-help groups

When medications are used, they are usually in addition to other forms of treatment. Depending on the symptoms, these may include:

• Anti-anxiety medicines
• Antidepressant medicines
• Antipsychotic medicines (rarely)
• Stimulants (for patients who are very withdrawn)

Expectations (prognosis)

Adjustment disorders usually get better quickly without any remaining symptoms.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of adjustment disorder.

Prevention

There is no known way to prevent this disorder. Strong support from friends and family can help.

References

Powell AD. Grief, Bereavement, and adjustment disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 38.