Adjustment Disorders: Causes, Symptoms & Treatment

Adjustment Disorders Overview

Adjustment disorders are intense responses to distress. The signs could include excessive negative thoughts, strong emotions, and maladaptive behaviours.  

The response to stimuli in adjustment disorders is much more intense than expected. For example, receiving criticism in school can compel a student to leave the classroom without notice or burst out in front of the teacher.

Hence, adjustment disorders can cause issues and conflicts in various aspects of life, such as school, the workplace, social settings, family, and friends.

Work problems, harassment from co-workers, bullying, illness, or any type of intense life change can cause stress.  

Most of the time, people get used to these changes and adapt to them effectively. However, if you have an adjustment disorder, you may struggle with your emotions and exhibit behavioural responses that can further trigger your anxiety or depression.  

Professional therapy can help you regain control of your emotions and behaviours. Treatment options could include a combination of psychotherapy and medications. 

What Are the Types of Adjustment Disorders?

The DSM-5 (diagnostic manual used by Therapists to diagnose mental health conditions) lists several types of adjustment disorders.  

These types and associated symptoms include:

• Adjustment disorder with depression: Feelings of hopelessness, despair, crying, and lack of joy or interest in things previously enjoyed.
• Adjustment disorder with anxiety: Feeling stressed, worried, overwhelmed, and having racing thoughts. Children usually experience separation anxiety along with adjustment disorders.  
• Adjustment disorder with anxiety and depression: Feeling symptoms of both depression and anxiety along with adjustment disorder.  
• Adjustment disorder with maladaptive conduct: This type includes behavioural issues such as rebelliousness, destructive habits (eg smoking, self-harm), and being reckless or impulsive. Teenagers with this type of adjustment disorder may often steal things, damage properties, or skip school.
• Adjustment disorder with troubled emotions and conduct: Feelings of anxiety, depression, and experiencing behavioural issues all at the same time.
• Adjustment disorder unspecified: Those diagnosed with unspecific adjustment disorder may have physical signs such as chronic pain, headaches, muscle pain, stomach issues, heart palpitations or issues at work, school, or with family.  

Symptoms of Adjustment Disorders

The signs can differ depending on the type of adjustment disorder. For example, someone with adjustment disorder with anxiety may have racing thoughts and uncontrollable sweating in comparison to someone with the subtype of depression.  

Symptoms of adjustment disorder can cause more stress than we usually experience in daily life, which can severely affect various aspects of life.  

Adjustment disorders can affect our thoughts and feelings about ourselves and the world. It can also influence our outlook and perspective.  

For example, someone with an adjustment disorder may think that the world is a horrible place just because they received a low grade in one subject.  

The disorder can cause negative and catastrophising thoughts about regular and expected inconveniences.  

Symptoms of adjustment disorders start within three months of a traumatic or stressful event and usually last no longer than six months.  

However, if you have any other mental health issues like addictions along with an adjustment disorder, you may take a longer time to cope with the symptoms.  

Some common symptoms of an adjustment disorder include:

• Feeling sad, hopeless, or losing joy and happiness
• Having regular crying spells
• Worrying or feeling anxious and emotional all the time
• Feeling irritable or like you cannot handle anything
• Having a lack of control over your emotions and thoughts
• Experiencing sleeping difficulties (eg sleeping too much or too little)
• Not eating enough or struggling with an eating disorder
• Having difficulty paying attention or focusing
• Struggling to engage in daily activities like maintaining hygiene or health
• Withdrawing from loved ones
• Thinking about suicide or having suicidal ideations 

Causes of Adjustment Disorders

The main cause of adjustment disorders could be the build-up of stress over time. For example, a person with a severe workload may manage short-term but repress their stress every month.

This repressed stress can directly lead to harmful thoughts and behaviours. Over time, this person may think that their effort will never be enough even if they work efficiently. They may think, “I suck at my job,” or “I am not good enough.”

Stress can also influence everyone differently. Sometimes, many distressing events can occur simultaneously, and you simply wouldn’t have the time to take care of yourself.

However, not all stressors are traumatic and dangerous. ‘Good stress’ can help you in times of threat. But if the stress takes over your mind for more than 2 months, you may want to consider seeking psychotherapy.  

Common causes of adjustment disorders may include:

• Unemployment or losing a job suddenly
• Getting married without understanding the marriage roles and expectations
• Relationship issues like narcissistic gaslighting or breakups
• Dealing with a physical health issue
• Facing difficulties at school or work
• Financial issues
• Not having your emotional or social needs met (eg having no friends) 

Diagnosing Adjustment Disorders

A psychologist or a psychiatrist (ie a medical doctor) usually makes the diagnoses for all types of mental health issues, including adjustment disorders.  

The professional may conduct a comprehensive psychiatric or clinical evaluation and interview you to understand the severity of your symptoms and how they affect your daily life.  

The DSM-5 manual is used to make sure that your symptoms match the criteria of the particular disorder.

During the clinical interview, your psychologist may aim to obtain a detailed personal history of your development, life experiences, emotions, thinking patterns, behaviours, past relationships, triggers, and any identified stressful events.  

The information you provide will help the psychologist analyse your condition accurately. Based on the diagnosis, they may design a personalised therapeutic plan.  

Adjustment Disorders Dsm-5 Criteria

DSM-5 is the APA’s Diagnostic and Statistical Manual of Mental Disorders. The diagnostic criteria for adjustment disorders include:

• Your symptoms (emotional and behavioural) developed within three months of the first time you experienced a traumatic or stressful event.
• The intensity of your emotional or behavioural symptoms exceeds what would typically be expected during stress, severely influencing all aspects of your life.  
• Your signs do not meet the diagnostic criteria of any other mental health issue, and the symptoms are not a result of a situational event or a flare-up of an existing issue.  
• Your symptoms are not part of the normal grieving process.  

Adjustment disorders can further be classified as acute or chronic. If your symptoms last less than six months, you may have an acute adjustment disorder.

If your symptoms last more than six months, you may have a chronic adjustment disorder.  

Moreover, your cultural and environmental background may affect how you grieve or handle stress.  

Hence, your Therapist will take into account all the factors above to determine if your response to stress is your typical response or if it’s more severe than expected.  

Adjustment Disorder Treatment

If you are diagnosed with adjustment disorder, you may wish to review the types of treatment options available.  

Sometimes, you may require short-term therapy, especially if you have an acute adjustment disorder.  

However, in most cases, your Therapist will recommend that you consider long-term psychotherapy along with mediation.  

1. Therapy

Therapy, or talk therapy, is a primary intervention used for adjustment disorders.  

Your Therapist may help you return to a normal state of functioning by addressing your unique needs and problems.

During therapy, you can gain emotional and unconditional support and understand the causes and triggers of your disorder.  

Gaining clarity about yourself in a safe and non-judgemental environment plays a crucial role in developing healthy coping mechanisms.  

Moreover, you may also gain therapeutic skills to cope with future distress independently.  

TYHO counsellors offer several kinds of therapeutic interventions. These include:

• Psychotherapy
• Cognitive behavioural therapy
• Family counselling
• Couples counselling
• Interpersonal therapy (short-term therapy treatment)
• Child counselling 

2. Medications

Some people with adjustment disorder may respond better to a combination of psychotherapy and medications. In comparison, others may only require therapy.  

What works for you can depend on your preferences, intensity of symptoms, and personal needs.  

Medications are supportive treatments that can help reduce an adjustment disorder’s physical symptoms.  

Hence, if you have any concerns or questions, try to have an open discussion with your healthcare doctor or Therapist to determine the best treatment plan for you.  

In general, medications can also help reduce symptoms of insomnia, depression and anxiety. If you have multiple mental health conditions, medications might be more effective in regaining control of your life.  

Some of the commonly prescribed medications include:

• Benzodiazepines
• Nonbenzodiazepine anxiolytics
• SSRIs or SNRIs 

Remember that only a medical professional can prescribe and adjust the dosage of your medications.  

Adjustment Disorder Prevention

Controlling or preventing all the triggers of your disorder alone can be difficult. However, you can take some steps to reduce your stress and better adapt to the changes in your life.  

Some of the self-care tools for better mental health include:

• Building a support system: Try to engage more with your loved ones. You can host parties, talk to more friends, spend quality time with your family, or visit your grandparents once in a while. Maintaining open communication and relying on your people can help you feel safe and loved.  
• Engage in self-care regularly: Although journalling every day without a goal might not help reduce stress, engaging in intentional and meaningful self-care habits that work best can contribute to developing a healthier mindset. Work on your inner self, analyse your thought patterns, maintain a diary to track your mood, or go for a walk when you feel distressed.  
• Maintain a healthy lifestyle: A healthy lifestyle could include a proper diet, maximum movement, a healthy mindset, and a good social life. Try to exercise regularly and include more fibre and protein in your daily diet.  

If the preventative methods are not helping you, you may want to consider seeking professional help.  

Reach out to us if you need help selecting the right Therapist! You are not alone.