Adjustment disorder is a condition related to the stress response, which can make everyday life feel unmanageable. It usually occurs after a significant change or difficult event.
In this article, we explore symptoms of adjustment disorder, stressors that can cause or contribute to it, and how doctors diagnose it. We look at its psychological and biological aspects and its relationship to depression. Finally, standard treatments for adjustment disorder are shared, alongside newer options, including ketamine-assisted therapy.
Symptoms and Causes of Adjustment Disorder
Adjustment disorder can affect emotions, behavior, and physical health. Emotional symptoms often include sadness, frequent crying, a sense of hopelessness, constant worry, or feeling overwhelmed.
Behavioral and physical symptoms might involve withdrawing from friends or family, conflict at work or school, reckless choices, trouble sleeping, headaches, or a racing heartbeat. Some people turn to alcohol or other unhealthy coping strategies like too much screentime.
There are several subtypes of adjustment disorder:
- With a depressed mood
- With anxiety
- With mixed anxiety and depressed mood
- With disturbance of conduct
- With mixed disturbance of emotions and conduct
- Unspecified adjustment disorder
Causes of adjustment disorder tend to involve major stress or a big life transition. Everyday stress is normal, but in adjustment disorder a person’s reaction is extreme and continues for longer than normal.
Triggers of Adjustment Disorder
Many situations that occur over the course of a typical life can trigger adjustment disorder. Common examples include bereavement, divorce or separation, job loss, financial strain, or a serious medical diagnosis, as well as moving to a new place, or recovering after an accident or crime.
Children and teenagers may develop adjustment disorder in response to situations outside their previous life experience. This includes parental conflict, bullying, difficulties at school, or struggles related to their self-identity and sexuality.
Typical contexts in which adults experience adjustment disorder include the aftermath of relationship breakdowns, work pressures, or when faced with long-term caregiving challenges.
Some people are more vulnerable to adjustment disorder than others. Factors that make a person more prone to developing it include having a personal history of mental health difficulties or trauma, enduring repeated exposure to stressful events, or living with limited social support.
Some personality traits, such as heightened sensitivity or pessimism, may also play a role. Women more frequently receive an adjustment disorder diagnosis than men, though everybody can be affected.
Diagnosing Adjustment Disorder
For somebody to be diagnosed with adjustment disorder, their symptoms must typically appear within three months of experiencing the traumatic life event that caused it.
A person must respond more severely than expected, in ways that are not reasonable, and this must significantly interrupt the flow and quality of their life.^3 Beyond this, certain other conditions must be ruled out for a diagnosis of adjustment disorder to be given, especially where symptoms could relate to another diagnosis, like depression, anxiety, or post-traumatic stress disorder (PTSD). Grief is also considered to be a separate diagnosis from adjustment disorder, since it has unique features.
If symptoms of adjustment disorder last fewer than six months, the disorder is called acute. If they continue for six months or longer, it is considered chronic.
Psychological Factors in Adjustment Disorder
Adjustment disorder is strongly influenced by how a person processes stress. People who have difficulty regulating emotions or who rely on avoidance to cope may struggle more when confronted with change. Negative patterns of thought can intensify distress.
Having a lack of problem-solving skills or rigid coping styles may also make it harder to bounce back from stressful life events. These psychological tendencies tend to play into both how somebody experiences stress in the first place and how long a person’s symptoms of stress persist.
Biological Features of Adjustment Disorder
When it comes to the physical symptoms of adjustment disorder, the body’s stress system also plays a role. In the neurological system, the hypothalamic–pituitary–adrenal (HPA) axis becomes activated during major life changes, typically leading to physical effects typically present in adjustment disorder, such as sleep disturbance, fatigue, and muscle tension.
Genetics may also influence a person’s sensitivity to stress, predisposing them to conditions like adjustment disorder. Equally, neurotransmitters like serotonin and dopamine affect a person’s mood stability and resilience to stress. These biological features help explain why some people develop adjustment disorder while others in similar circumstances do not.
The Relationship Between Adjustment Disorder and Depression
Adjustment disorder often overlaps with depression, but they are distinct conditions. Adjustment disorder with depressed mood involves sadness, hopelessness, and loss of interest that are directly tied to a specific stressor. Unlike adjustment disorder, major depression may arise without an external event, and it usually lasts longer than six months.
The two conditions share many symptoms; however, an adjustment disorder can sometimes progress into major depression if untreated. Distinguishing between adjustment disorder and depression at diagnosis is essential because treatment planning may differ. Early care for adjustment disorder often prevents the development of longer-term depressive disorders
Treatment Options for Adjustment Disorder
Most people with adjustment disorder benefit from treatment that aims to reduce distress, restore daily functioning, and build coping skills. Psychotherapy is usually the first line of care.
Cognitive behavioral therapy (CBT) helps people notice patterns of thinking that add to stress and replace them with healthier responses. Therapy may be individual, family-based, or group-based.
Doctors may recommend medication if symptoms are severe. Antidepressants such as SSRIs can help with low mood, while anti-anxiety medications or sleep aids may provide short-term relief.
Supportive strategies for adjustment disorder often focus on short-term goals and practical coping methods. Family and peer involvement can be crucial, especially for children and adolescents.
Ketamine Therapy and Its Potential for Adjustment Disorder
While ketamine is not a first-line treatment for adjustment disorder, it represents a promising option for people with intense or persistent symptoms. More research is needed, but its potential role in supporting faster recovery is encouraging.
Ketamine has been studied and used as a treatment for its fast-acting benefits in depression and chronic pain. Early evidence nevertheless suggests that ketamine may also help those with severe adjustment disorder who have not responded well to therapy or standard medications.
Unlike traditional antidepressants that take weeks to work, ketamine affects the brain’s glutamate system, supporting cognitive flexibility and new brain cell connectivity. By helping the brain “reset” established pathways, ketamine may ease the overwhelming stress responses that appear in adjustment disorder.
Treatment usually involves intravenous infusions given in a medical clinic, with dosing tailored to each person. Side effects are generally mild, such as brief dizziness or feeling disoriented.
Recovering from Adjustment Disorder
People usually make a full recovery from adjustment disorder. With treatment, the typical timeframe for this is six months. When therapy is part of the treatment approach, it can be targeted to build resilience against future stressors.
Treating adjustment disorder is essential, as when it is left unaddressed, it may persist or progress into other conditions. These include anxiety and depressive episodes and PTSD, and can also trigger coping strategies like substance misuse. Early treatment helps prevent these outcomes.
Key Takeaways
- Adjustment disorder is a short-term condition triggered by stress that disrupts daily life.
- Symptoms may involve sadness, anxiety, withdrawal, reckless behavior, or physical complaints.
- Triggers include life changes like loss, illness, relationship conflict, or relocation.
- Adjustment disorder and depression share features but differ in triggers and duration.
- Psychotherapy is the main treatment, with medication sometimes added.
- Ketamine therapy shows early promise as an option for severe or treatment-resistant cases.
- Most people recover within six months, though untreated cases may progress to other disorders.