Adjustment Disorders: Signs, Causes, & Treatment Options
Life can throw a lot at us. Finding and losing love, celebrating and grieving, settling and moving – these are all highs and lows that are part of the normal human experience. Change is inevitable, and while some people can adapt with little difficulty, it’s not so easy for others.
Adjusting to change is key, but it’s perfectly normal to take time and space to do so. But what about those who find it extremely difficult to adapt?
When change causes extreme stress, some people experience significantly strong emotions, negative thoughts, and behavioral changes. As a result, even small transitions can be incredibly difficult to cope with. Symptoms such as these in response to life transitions could indicate an adjustment disorder.
If you or someone you care about is feeling like the world has been turned upside down by change, and it’s impacting mental health, an adjustment disorder may be present. A mental health professional can help you regain control and a sense of stability.
This page can also work as a useful guide to understanding adjustment disorders, as it covers:
- How to understand adjustment disorders
- Common symptoms of adjustment disorders
- Causes and risk factors for adjustment disorders
- Strategies for coping with life changes
- Therapy and care plans for adjustment disorders
- Where to find professional support
Understanding Adjustment Disorders
Adjustment disorders are one of the most common mental health conditions, and yet they often go unseen. The American Psychological Association (APA) highlights that adjustment disorders come about when someone struggles with life changes or stressors to the point where they interfere with day-to-day life. In such cases, emotional, cognitive, or behavioural symptoms become an obstacle to living well.1
Everyone experiences stress at some point. But you’ll no doubt have observed how some people seem cool and collected in the face of stress, while others visibly fret, become nervous, or display a low mood. Such reactions may be because people with adjustment disorders tend to react to change in an intense way – beyond what’s considered expected for the situation at hand.2
You might have already experienced life changes or stressful events that caused you intense distress, and different forms of change can affect people differently. However, studies show that some of the most impactful forms of change include relocation, career transitions, relationship breakdowns, or bereavement.³ Any of these situations could lead to symptoms of an adjustment disorder, which we discuss in detail next.
Signs of Adjustment Disorders
We mentioned earlier how life changes can evoke intense symptoms and distress in those with attachment disorders. These symptoms are usually emotional or behavioral in nature – or a combination of both.
For example, there are subtypes of adjustment disorders that can impact symptoms. These include adjustment disorder with…
- Depressed mood
- Anxiety
- Mixed anxiety and depressed mood
- Disturbed conduct
- Mixed disturbance of emotions and conduct
- Unspecified characteristics
Each subtype can have a unique profile of emotional and behavioral features, leading to individualized treatment approaches.9 However, there are still general observable patterns in adjustment disorder, which we’ve broken down into emotional and behavioral categories.
Emotional Symptoms of Adjustment Disorders:
- Anxiety: Feeling excessively nervous and stressed
- Depression: Ongoing low mood or feelings of hopelessness that interfere with day-to-day life
- Emotional dysregulation: Emotional responses that are out of proportion to the situation at hand, such as irritability, aggression, or teariness
- Overwhelm: Feeling unable to cope with a stressor, leading to difficulty concentrating
Behavioral Symptoms of Adjustment Disorders:
- Social withdrawal: Avoiding or turning down social events and occasions with friends and loved ones due to loss of interest, worry, or sadness
- Reduced productivity: When struggling to cope with a life change, it’s often hard to focus on tasks at hand, potentially leading to procrastination or slowing down
- Risky behaviours: When someone is going through a period in which they feel hopeless or excessively stressed, they may seek escape through behaviors which can further damage their mental and physical well-being4
- Sleep and appetite problems: Excessive worry, stress, or sadness can disrupt sleep as people can have trouble drifting off with a racing mind. Likewise, the desire to eat well can be diminished8
The good news is that adjustment disorders, unlike some other psychiatric conditions, are linked to identifiable causes. In fact, studies show that adjustment disorders typically occur within three months after a triggering event.5
It’s also worth noting that beyond six months of the stressful event ending, clinicians often look to alternative diagnoses, like depressive or anxiety disorders. This is because there may be evidence of a more long-term condition or risk.
Causes and Risk Factors of Adjustment Disorders
We mentioned how adjustment disorders are typically brought about by specific life events and big changes. But current environmental stressors aren’t the only risk factors for this disorder; we also should think about how vulnerable someone may be to change and their life circumstances.
For instance, people can form an adjustment disorder in response to major stressors, such as big life events like divorce, death, or career change. However, someone may also form it as a reaction to smaller stressors, like academic challenges or workplace conflicts. Plus, some may find that they struggle with multiple smaller stressors that build up over time. Therefore, it’s clear that some people may be more prone to developing an adjustment disorder.
In terms of individual vulnerability, it’s good to get an idea of someone’s circumstances and how these increase the risk of having an attachment disorder. We detail some of these below to help people better understand why they may have more intense reactions to stress or change.
Risk Factors for Adjustment Disorders:
Research shows that common risk factors for adjustment disorders include:
- A history of previous mental health difficulties: Such as being prone to anxiety or depression
- Limited coping resources: For example, not having adequate access to healthcare and mental health support when times get tough. A lack of psychoeducation or awareness of stress management techniques may also play a role7
- Low social support: Isolation and not having a decent support network, like close friends and family to turn to, may increase vulnerability to stress
- Childhood trauma: Particularly if unresolved, experiencing trauma in the formative years of youth can cause stressors in later life to be especially triggering and impactful
- Genetic predispositions: Genetics can play a role in how likely someone is to develop heightened stress or mental health conditions
- Chronic exposure to stress: Long-term stress can cause the nervous system to remain in flight, flight, freeze mode. So, further stressors or big changes may cause shock to a system that’s already under duress 6
In short, yes, the causes of adjustment disorders usually point to a stressful life event or change. However, how prepared someone is mentally and physically to cope with change, given their past experiences and current circumstances, could make them more predisposed.
Coping With Life Changes
The key to managing adjustment disorders is learning how to cope with stress and change. Fortunately, studies show that coping strategies can reduce the impact of stress significantly and speed up recovery from stressful events.10
Moreover, strategies that are problem-focused, like developing well-structured action plans and breaking tasks into small, manageable steps, have been shown to be especially effective.10 For instance, if the day ahead feels too daunting to cope with, you could aim to create a hierarchy of tasks, starting with the least overwhelming and shifting up to the most. This way, you can “tick” off the less challenging objections and feel more confident tackling more challenging ones.
Emotion-focused strategies are also equally important. We discuss stress management techniques below, but mindfulness, journaling, and relaxation exercises are also effective evidence-based strategies. Again, the research is positive as it shows these strategies result in faster symptom relief and fewer long-term complications from stress-related disorders.11
Stress Management Techniques for Daily Life
Stress management techniques are essential tools for people dealing with adjustment disorders and can include:
- Mindfulness meditation: Distraction-free moments of reflection can help someone realize thought patterns, often resulting in enhanced awareness and reduced anxiety14
- Structured routines: Studies show that having a well-thought-out routine promotes predictability and reduces overwhelm20
- Physical activity: Regular exercise can improve mood and reduce stress hormone levels20
- Social engagement: Meaningful connections with peers, family, or support groups can normalize emotions, improve bonds, and reduce stress
- Expressive writing: Writing can promote the processing of emotions and identifying practical coping strategies. For instance, you could practice journaling and record a few sentences about thoughts and feelings a day, such as before going to bed
A mix of practical and emotional approaches may be ideal, as you can focus on tackling emotional overwhelm while also implementing practical strategies for coping with stress and change. However, if an adjustment disorder is creating significant distress, professional support may be required for regaining a sense of stability.
Therapy for Adjustment Disorders
Therapy can be invaluable when managing any form of mental health condition, and adjustment disorder is no exception. The following therapy options are evidence-based and can be incorporated into a range of treatment plans:
Cognitive Behavioural Therapy (CBT)
CBT is one of the first-line therapies for addressing unhelpful thought patterns. Put simply, it’s hard for someone to live a well-adjusted life when they’re stuck in a negative mental loop. For example, during times of stress or change, their inner narrative may fuel inaccurate thoughts, which make the situation worse.
CBT provides a space where people can discuss the kind of thoughts they have, and a licensed therapist will guide them through reframing these so they’re more realistic and positive. Studies back up the benefits of CBT, showing that it helps people challenge their negative thoughts and hone their problem-solving skills.12
Mindfulness-Based Therapy
Broadly speaking, most therapy involves mindfulness techniques. However, mindfulness therapy incorporates a therapeutic approach with these techniques, helping reduce stress by improving focus on the here and now. In fact, studies show that people who practice being mindful are more likely to have reduced anxiety and depressive symptoms, as well as improved resilience and ability to cope.14
Psychoeducation
Psychoeducation allows someone to gain a more detailed understanding of how their mind works and why they might be more prone to certain emotional and physical reactions to stress. As a result of increased understanding, someone with an adjustment disorder can recognize how to prevent and manage their difficulties in response to stress. Plus, studies show that psychoeducation can normalize intense reactions, which can reduce feelings of shame and isolation.13
These therapies are by no means the only options for adjustment disorder treatment. A mental health professional can discuss the best fit for your needs, as well as how to incorporate it into an effective adjustment disorder care plan.
Developing an Adjustment Disorder Care Plan
If you or a loved one is concerned about an adjustment disorder, then a well-structured care plan overseen by a healthcare professional is a good place to start recovery.
An adjustment disorder care plan typically starts with an assessment – a list of questions that gives a thorough idea as to the current state of mental well-being. For example, a professional may ask about your current situation, medical history, social support, and so on.
After this stage, a treatment plan based on the best fit for someone’s unique needs is drawn up, whether this involves therapy, medication, mindfulness, or so on. A provider will likely discuss your options with you.
Treatment goals are best when they’re decided in collaboration between the client and the healthcare provider, with a focus on symptom reduction and coping strategies.15 Therefore, follow-up is also usually part of adjustment disorder care plans. Therefore, healthcare providers will likely touch base during and even after recovery to ensure long-term success.
Effective care plans may include:
- Individual therapy, such as CBT, behavioral therapy, and mindfulness-based therapy
- Group therapy for social support and shared experiences
- Family therapy to enhance communication and reduce familial stress
- Practical stress management strategies, such as yoga, breathing exercises, and structured routines
However, if symptoms of an adjustment disorder are severe, more intensive programs may be considered, which we discuss next.
Mental Health Clinics and Support Programs
For those whose needs are particularly complex, certain mental health clinics may provide intensive outpatient programs for managing symptoms. Alternatively, residential programs that remove the stress of the outside world may benefit those who require a more structured, balanced environment. These clinics usually combine therapy, medication management, and social support into an overall package for those who are finding it especially hard to cope.
Transition support programs are also available, which can play a particularly important role for people who struggle with major life changes. For example, programs that focus on career transitions, relocations, and bereavement. These can reduce the risk of relapsing into adjustment disorders and can be provided in a variety of treatment packages.16
Additionally, community-based support networks can provide peer guidance in coping with life changes. They can often be provided online if accessibility is an obstacle. This form of social support is often crucial in combating stress and improving adjustment outcomes. 17
Adjustment Disorder Recovery and Long-Term Outlook
It may be encouraging to know that recovery from adjustment disorders mostly involves success stories, particularly when symptoms are caught early and intervention happens quickly. In fact, research shows that most recover within six months with the right support and treatment. Conversely, untreated disorders could lead to depressive episodes or other psychiatric conditions.18
Maintaining recovery relies on using stress management techniques, finding the right support networks, and receiving good-quality mental health care. Studies show that being proactive in this way enhances resilience and reduces the likelihood of recurrence of adjustment disorders.19
Mission Connection: Here to Help Overcome Life’s Challenges
When life throws a curveball, we’re not always ready for it. But the good news is, we can become more resilient with the right help and support. Mission Connection’s dedicated, experienced team is on hand to support you, or someone you love, through the stress of an adjustment disorder.
We provide a variety of evidence-based options that can be tailored to your specific needs, whether you require immediate support or more long-term continued help. Our telehealth services also mean that you can fit therapy into your schedule flexibly, allowing you to receive care.
By also offering comprehensive medication monitoring alongside various therapies, Mission Connection can be a guiding light toward successful and sustained healing. If you’re ready to explore our treatment options, contact us today or complete our confidential contact form for more information.
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- Casey, P. J., & Bailey, S. (2011). Adjustment disorders: The state of the art. World Psychiatry, 10(1), 11–18. https://doi.org/10.1002/j.2051-5545.2011.tb00002.x
- Perkonigg, A., Kessler, R. C., Storz, S., & Wittchen, H. U. (2000). Traumatic events and posttraumatic stress disorder in the community: Prevalence, risk factors, and comorbidity. Acta Psychiatrica Scandinavica, 101(1), 46–59. https://doi.org/10.1034/j.1600-0447.2000.101001046.x
- Malkoff-Schwartz, S., Frank, E., Anderson, B., & Kupfer, D. J. (2000). Social rhythm disruption and stressful life events in the onset of bipolar and unipolar episodes. Psychiatry Research, 93(3), 117–126. https://doi.org/10.1016/S0165-1781(00)00185-8
- Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293–319. https://doi.org/10.1146/annurev.clinpsy.1.102803.143938
- Zlotnick, C., & Mattia, J. I. (2003). Gender differences in patients with adjustment disorders. Journal of Nervous and Mental Disease, 191(7), 451–456. https://doi.org/10.1097/01.nmd.0000079473.70822.5f
- Folkman, S., & Moskowitz, J. T. (2004). Coping: Pitfalls and promise. Annual Review of Psychology, 55, 745–774. https://doi.org/10.1146/annurev.psych.55.090902.141456
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
- Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2012). Problem-solving therapy: A positive approach to clinical intervention (3rd ed.). Springer Publishing Company.
- American Psychological Association. (2022). Adjustment disorders. https://www.apa.org/topics/adjustment-disorders
- National Institute of Mental Health. (2022). Finding a mental health provider. https://www.nimh.nih.gov/health/find-help
- Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43. https://doi.org/10.1016/S0022-3999(03)00573-7
- Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Annual Review of Clinical Psychology, 3, 377–401. https://doi.org/10.1146/annurev.clinpsy.3.022806.091520
- Hilliard, R. E. (2015). Music-based interventions for adjustment disorders: A systematic review. Journal of Music Therapy, 52(2), 180–214. https://doi.org/10.1093/jmt/thv001
- Casey, P., & Doherty, A. (2012). Adjustment disorder in adults: A review of the literature. Irish Journal of Psychological Medicine, 29(3), 135–141. https://doi.org/10.1017/ipm.2012.22
- McFarlane, A. C. (2010). The long-term costs of traumatic stress: Interactions between mental health, physical health, and social functioning. International Journal of Psychiatry in Clinical Practice, 14(3), 142–148. https://doi.org/10.3109/13651501003740035
- Southwick, S. M., & Charney, D. S. (2012). Resilience: The science of mastering life’s greatest challenges. Cambridge University Press.
- Zisook, S., & Schuchter, S. (1995). Adjustment disorders: Epidemiology, clinical features, and treatment. Psychiatric Clinics of North America, 18(4), 843–857. https://doi.org/10.1016/S0193-953X(18)30236-7
- Richardson, G. E. (2002). The metatheory of resilience and resiliency. Journal of Clinical Psychology, 58(3), 307–321. https://doi.org/10.1002/jclp.10020
- Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: A unifying theory. Clinical Psychology Review, 21(1), 33–61. https://doi.org/10.1016/S0272-7358(99)00032-X
