Adjustment disorders

Adjustment disorders are excessive reactions to stress that involve negative thoughts, strong emotions and changes in behavior. The reaction to a stressful change or event is much more intense than would typically be expected. This can cause a lot of problems in getting along with others, as well as at work or school.

Work problems, going away to school, an illness or any number of life changes can cause stress. Most of the time, people get used to such changes within a few months. But if you have an adjustment disorder, you continue to have emotional or behavioral responses that can make you feel more anxious or depressed.

Treatment can help you regain your emotional well-being.

Symptoms depend on the type of adjustment disorder. These symptoms can vary from person to person. You experience more stress than would generally be expected in response to a trying event, and this stress causes a lot of problems in your life.

Adjustment disorders affect how you feel and think about yourself and the world. They also may affect your actions or behavior.

Some examples include:

• Feeling sad, hopeless or not enjoying things you used to enjoy.
• Crying often.
• Worrying, or feeling anxious, nervous, jittery or stressed out.
• Feeling irritable or like you can't handle anything and don't know where to start.
• Having trouble sleeping.
• Not eating enough.
• Having difficulty concentrating.
• Having difficulty with daily activities.
• Withdrawing from family and friends who support you socially.
• Not doing important things, such as going to work or paying bills.
• Thinking about suicide or acting on those thoughts.

Symptoms of an adjustment disorder start within three months of a stressful event. These symptoms last no longer than six months after the end of the stressful event. But constant or lasting adjustment disorders can continue for more than six months. This is especially true if the stressful event is ongoing, such as being unemployed.

When to see a doctor

Stressors are usually temporary. You learn to cope with them over time. Symptoms of adjustment disorder usually get better when the stress eases. But sometimes the stressful event continues to be a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again.

Talk to your doctor or a mental health professional if you continue to struggle or if you're having trouble getting through each day. You can get treatment to help you cope better with stressful events and feel better about life again.

If you have concerns about your child's behavior, talk with your child's doctor.

Suicidal thoughts or behavior

The risk of suicide can be higher in people who have adjustment disorders. If you're thinking about suicide, contact a hotline for counseling:

• In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline. It's available 24 hours a day, every day. Or use the Lifeline Chat. Services are free and private.
• U.S. veterans or service members who are in crisis can call 988 and then press "1" for the Veterans Crisis Line. Or text 838255. Or chat online.
• The Suicide & Crisis Lifeline in the U.S. has a Spanish-language phone line at 1-888-628-9454 (toll-free).

Adjustment disorders are caused by major changes or stressors in your life. Genetics, your life experiences and your temperament may make it more likely that an adjustment disorder happens.

Stressful life events and experiences ― positive and negative ― may put you at risk of having an adjustment disorder. Examples include:

• Major stress as a child, such as bullying or difficulties with school.
• Divorce or marriage problems.
• Relationship problems or trouble getting along with others.
• Major changes in life, such as retirement, having a baby or moving away.
• Bad experiences, such as losing a job, loss of a loved one or having money problems.
• Problems in school or at work.
• Life-threatening experiences, such as physical assault, combat or natural disaster.
• Ongoing stressors, such as having a medical illness or living in a neighborhood that has a lot of crime.
• More than one major change or bad experience happening at the same time.
• Other mental health conditions, such as major depression, intense anxiety or post-traumatic stress disorder.

If adjustment disorders do not resolve, they eventually can lead to more-serious mental health conditions such as anxiety, major depression, or misuse of drugs or alcohol.

There are no guaranteed ways to prevent adjustment disorders. But social support, healthy coping skills and learning to recover quickly from hard times may help you during times of high stress.

If you know that a stressful situation is coming up, such as a move or retirement, plan ahead. In advance, increase your healthy habits and ask your friends and family for support. Remind yourself that stressful situations pass in time and that you can get through them. Also, consider checking in with your health care team or mental health professional to review healthy ways to manage your stress.

A mental health professional can find out if you have an adjustment disorder by talking with you to identify major life stressors, your symptoms and how they affect your ability to live life. You likely will be asked about your medical, mental health and social history.

To help diagnose an adjustment disorder, established guidelines include:

• Having emotional or behavioral symptoms within three months of a specific stressful event.
• Having higher-than-expected stress in response to a stressful life event or having stress that causes a lot of problems in connections with others, or at work or at school.
• Symptoms are not due to another mental health problem or part of the typical grieving process.

Types of adjustment disorders

The guidelines list six types of adjustment disorders:

1. With depressed mood. Symptoms mainly include feeling sad, tearful and hopeless, very tired, and taking no pleasure in the things you used to enjoy.
2. With anxiety. Symptoms mainly include nervousness, worry, having a hard time concentrating or remembering things, and feeling overwhelmed. Children may strongly fear being separated from their parents and loved ones.
3. With mixed anxiety and depressed mood. Symptoms include a blend of depression and anxiety.
4. With disturbed conduct. Symptoms mainly involve behavioral problems, such as fighting or reckless driving. Children and teenagers may skip school or damage or destroy property.
5. With disturbed emotions and conduct. Symptoms include a mix of depression, anxiety and behavioral problems.
6. Unspecified. Symptoms do not fit the other types of adjustment disorders. But this type often includes physical problems, problems with family or friends, or problems at work or school.

Length of symptoms

How long you have symptoms of an adjustment disorder also can vary. Adjustment disorders can be:

• Short term. This is when symptoms last six months or less. These are often called acute symptoms. They should ease once the stressful event passes.
• Long term. This is when symptoms last more than six months. These are often called persistent or chronic symptoms. They continue to bother you and disrupt your life.

Many people with adjustment disorders find treatment helpful, and they often need only brief treatment. Others, including those with persistent adjustment disorders or ongoing stress, may benefit from longer treatment. Treatments for adjustment disorders include talk therapy, medicines or both.

Talk therapy

Talk therapy, also called talk psychotherapy, is the main treatment for adjustment disorders. This treatment can be provided individually, or with a group or as a family.

Therapy can:

• Provide emotional support.
• Help you get back to your typical routine.
• Help you learn why the stressful event affected you so much.
• Help you learn stress management and coping skills to deal with stressful events.

Medicines

Medicines such as antidepressants and anti-anxiety drugs may be used with talk therapy to help with symptoms of depression and anxiety. As with therapy, you may need medicines only for a few months. But do not stop taking any medicine without talking with your health care professional first. If stopped suddenly, some medicines, such as certain antidepressants, may cause physical reactions that make you feel sick.

Here are some steps you can take to care for your emotional well-being.

Tips to help make you more resilient

Resilience is the ability to adapt well to stress, hardships, a disturbing or harmful experience, or tragedy. It's the ability to bounce back after going through a very hard time. Building resilience may vary from person to person, but these strategies can help:

• Stay connected with loved ones and friends who are positive and support you in healthy ways.
• Do something that brings you joy and gives you a sense of accomplishment and purpose every day.
• Live a healthy lifestyle that includes good sleep, a healthy diet and regular physical activity.
• Practice mindfulness, such as through journaling, prayer or yoga.
• Learn from past experiences about how you can make your coping skills better.
• Be hopeful about the future and try to be positive.
• Stay away from alcohol, drugs and other addictive substances.
• Look for and develop your personal strengths.
• Face your fears and accept challenges.
• Work to achieve your goals.
• Plan to handle problems when they occur rather than not face them.

Find support

It may help you to talk things over with loved ones and friends. You also can ask for support from a faith community or find a support group for your situation.

Talk to your child about stressful events

If your child is finding it hard to adjust, try gently urging your child to talk about what they're going through. Many parents assume that talking about a hard change, such as divorce, will make a child feel worse. But your child needs to be able to express feelings of grief and hear you tell them that you'll remain a constant source of love and support.

You may start by seeing your primary care professional or a mental health specialist for evaluation and treatment. Here's some guidance to help you prepare for your appointment.

If possible, you may want to take notes during the visit or bring along a family member or friend to help you remember information.

What you can do

To prepare for your appointment, make a list of:

• Any symptoms you have, how long you've had them, and what makes them better or worse.
• Key personal information, including any major stresses or recent life changes —positive and negative.
• Medical information, including other physical or mental health conditions you have. Include any medicines, vitamins, herbs or other supplements you're taking, and the doses.
• Questions to ask to make the most of your time together.

Some questions to ask include:

• What do you think is causing my symptoms?
• Are there any other possible causes?
• Is my condition likely short term or long term?
• Do you recommend treatment? If yes, with what approach?
• How soon do you expect my symptoms to improve?
• Should I see a mental health specialist?
• Do you recommend any temporary changes at home, work or school to help me recover?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Do not hesitate to ask other questions during your appointment.

What to expect from your doctor

Your primary care professional or mental health specialist will ask several questions, such as:

• What are your symptoms?
• When did you or your loved ones first notice your symptoms?
• What major changes have recently occurred in your life — positive and negative?
• How have you tried to cope with these changes?
• How often do you feel sad or depressed?
• Do you think about suicide?
• How often do you feel anxious or worried?
• Do you have trouble sleeping?
• Do you find it hard to finish tasks at home, work or school that you used to be able to manage?
• Are you staying away from social or family events?
• Have you had any problems at school or work?
• Have you made any impulsive decisions or taken part in reckless behavior that does not seem like you?
• Do you drink alcohol or use recreational drugs? If so, how often?
• Have you been treated for other mental health conditions in the past? If yes, what type of therapy was most helpful?

Be ready to answer questions to make sure there's time to go over any points you want to focus on.