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Adjustment disorder

Adjustment disorder is a group of symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event.

The symptoms occur because you are having a hard time coping, and the reaction is stronger or greater than what would be expected for the type of event that occurred.

Causes, incidence, and risk factors

Many different events may trigger symptoms of an adjustment disorder. Whatever the trigger is, the event may become too much for you.

Stressors for people of any age include:

  • Death of a loved one
  • Divorce or problems with a relationship
  • General life changes
  • Illness or other health issues in yourself or a loved one
  • Moving to a different home or a different city
  • Unexpected catastrophes
  • Worries about money

Triggers of stress in teenagers and young adults may include:

  • Family problems or conflict
  • School problems
  • Sexuality issues

There is no way to predict which people who are affected by the same stress are likely to develop adjustment disorder. Your social skills before the event, and how you have learned to deal with stress in the past may play roles.

Symptoms

Symptoms of adjustment disorder are often severe enough to affect work or social life. Symptoms include:

  • Acting defiant or showing impulsive behavior
  • Acting nervous or tense
  • Crying, feeling sad or hopeless, and possibly withdrawing from other people
  • Skipped heartbeats and other physical complaints
  • Trembling or twitching

To have adjustment disorder, you must have the following:

  • The symptoms clearly come after a stressor, most often within 3 months
  • The symptoms are more severe than would be expected
  • There do not appear to be other disorders involved
  • The symptoms are not part of normal grieving for the death of a loved one

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

Treatment

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

Most mental health professionals recommend some type of talk therapy. This type of therapy can help you identify or change your responses to the stressors in your life.

Cognitive behavioral therapy (CBT) is a type of talk therapy. It can help you deal with your feelings:

  • First the therapist helps you recognize the negative feelings and thoughts that occur.
  • Then the therapist teaches you how to change these into helpful thoughts and healthy actions.

Other types of therapy may include:

  • Long-term therapy, where you will explore your thoughts and feelings over many months or more
  • Family therapy, where you will meet with a therapist along with your family
  • Self-help groups, where the support of others may help you get better

Medicines may be used, but only along with some type of talk therapy. These medicines may help if you are:

  • Nervous or anxious most of the time
  • Not sleeping very well
  • Very sad or depressed

Expectations (prognosis)

With the right help and support, you should get better quickly. The problem usually does not last longer than 6 months, unless the stressor continues to be present.

Calling your health care provider

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

References

Powell AD. Grief, bereavement, and adjustment disorders. In: Stern TA, Rosenbaum JF, Fava M, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 38.

Updated: 2/26/2013

Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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