Adjustment Disorder: Symptoms, Types, Causes and Treatment

Adjustment disorder is a highly prevalent yet often misunderstood mental health condition that arises in response to significant life stressors. With the world facing unprecedented changes—such as the COVID-19 pandemic—understanding adjustment disorder has become more important than ever. This comprehensive article explores the symptoms, types, causes, and treatment options for adjustment disorder, synthesizing the latest research and clinical findings. Whether you’re seeking to understand your own experience or to support someone else, this guide offers human-centered insights and evidence-based knowledge.

Symptoms of Adjustment Disorder

Adjustment disorder is primarily characterized by emotional and behavioral symptoms that develop in response to identifiable stressors. These symptoms can significantly impact a person's daily functioning and quality of life, but are distinct from those of other psychiatric disorders like depression or PTSD.

Core	Emotional	Behavioral	Source
Preoccupation	Anxiety, sadness	Avoidance, withdrawal	2 3 6 7
Failure to Adapt	Hopelessness	Impaired functioning	2 3 6 7
Distress	Irritability	Reduced performance	6 9
Intrusions	Worry	Sleep disturbance	6 7

Table 1: Key Symptoms

Core Symptoms

The latest conceptualization, especially in ICD-11, identifies two core symptoms: preoccupation with the stressor and failure to adapt. Preoccupation includes excessive worry, rumination, or distress directly linked to the stressor. Failure to adapt refers to significant impairment in personal, social, or occupational functioning that arises after the stressor and is out of proportion to what would be expected 2 3 7.

Emotional and Behavioral Manifestations

Adjustment disorder often presents with emotional symptoms such as sadness, anxiety, irritability, and hopelessness. These emotions can be intense and persistent, leading to further difficulties:

• Anxiety: Restlessness, nervousness, or excessive worry.
• Depressive mood: Feelings of sadness, tearfulness, or even despair.
• Irritability: Increased frustration or anger in situations that previously did not cause distress 6 9.

Behaviorally, people may experience:

• Avoidance: Steering clear of reminders of the stressor.
• Withdrawal: Pulling away from social contacts or previously enjoyed activities.
• Reduced performance: Noticeable decline in work, academic, or household responsibilities 6 9.

Symptom Duration and Differentiation

Symptoms typically arise within three months of the stressor’s onset and should resolve within six months after the stressor or its consequences end. If symptoms persist longer, another diagnosis may be considered 8 9. Unlike PTSD or depressive disorder, adjustment disorder symptoms are specifically linked to a stressor and lack the full constellation of symptoms seen in those other conditions 6 7.

Intrusions and Sleep Disturbance

Some individuals experience intrusive thoughts about the stressor or difficulties sleeping. Intrusions can resemble the unwanted thoughts seen in stress-response syndromes but are generally less severe than those in PTSD 6 7.

Types of Adjustment Disorder

Adjustment disorder isn’t a one-size-fits-all diagnosis. The condition can manifest in several subtypes, reflecting the dominant emotional or behavioral symptoms experienced by the individual.

Subtype	Key Features	Prevalence	Source
Mixed Anxiety & Depressed Mood	Anxiety, sadness	Most common	9 8
With Anxiety	Worry, nervousness	Common in males	9
With Depressed Mood	Sadness, hopelessness	Common in females	9 8
With Disturbance of Conduct	Behavioral issues	Less common	8
Unspecified	Non-specific sx	Variable	8 9

Table 2: Adjustment Disorder Types

Mixed Anxiety and Depressed Mood

This is the most common subtype, characterized by a blend of anxious and depressive symptoms. Individuals may feel both intensely worried and deeply sad, often leading to significant distress in daily life. Research shows this subtype is particularly prevalent among females, though it affects all genders 9.

With Anxiety

Here, anxiety is the primary feature, manifesting as constant worry, restlessness, or nervousness. This subtype is more commonly diagnosed in males and can sometimes be mistaken for generalized anxiety disorder if the link to a specific stressor is not identified 9.

With Depressed Mood

Marked by predominant feelings of sadness, tearfulness, or hopelessness, this form often resembles clinical depression but is directly linked to a life event or stressor. It is more frequent in females and may sometimes overlap with symptoms of grief 8 9.

With Disturbance of Conduct

This subtype is characterized by behavioral problems such as impulsivity, aggression, or violation of social norms. Though less common, it is important to recognize, especially in younger populations or in situations involving significant behavioral change after a stressor 8.

Unspecified

Some cases do not fit neatly into the above categories, presenting with non-specific or mixed symptoms that nonetheless cause significant distress or impairment 8 9.

Causes of Adjustment Disorder

Adjustment disorder develops as a maladaptive response to identifiable psychosocial stressors. These stressors, however, vary widely in type and subjective impact.

Cause Type	Examples	Risk Factors	Source
Life Events	Illness, job loss, divorce	Young age, low income	5 9 11
Chronic Stress	Ongoing conflict, caregiving	Female gender, prior MH dx	5 11
Acute Stress	Accidents, natural disasters	Low social support	9 11
Pandemic-related	Quarantine, loss, health risk	Prolonged exposure	1 4 5

Table 3: Common Causes and Risk Factors

Types of Stressors

Adjustment disorder can be triggered by a wide range of events:

• Major life changes: Divorce, job loss, retirement, starting school, or moving to a new place.
• Physical illness or injury: Both the diagnosis and ongoing management of illness can act as powerful stressors.
• Loss: Bereavement or loss of a significant relationship is a frequent cause.
• Pandemics and disasters: Events like the COVID-19 pandemic have led to increased cases due to isolation, fear, and economic uncertainty 1 4 5.
• Chronic stressors: Ongoing challenges such as caregiving for a family member, financial struggles, or workplace conflict 5 11.

Risk and Protective Factors

Research has identified several factors that increase susceptibility to adjustment disorder:

• Demographic risks: Young age, being single, low educational level, and living in urban settings are all linked to higher prevalence 9 11.
• Gender: Females tend to report higher rates, though some studies show no significant gender difference in risk 5 9 11.
• Mental health history: Individuals with a current or previous mental health disorder are at elevated risk 5 11.
• Low social support: Lack of supportive relationships can intensify stress responses 11.
• Prolonged or severe exposure: The longer or more intense the stressor, the greater the risk 5.

Individual Vulnerability

Not everyone exposed to a stressor develops adjustment disorder. The subjective experience of the stressor, personal coping resources, and resilience play crucial roles. For example, higher income and more face-to-face contact with loved ones serve as protective factors 5.

Treatment of Adjustment Disorder

When it comes to managing adjustment disorder, a range of psychological and (to a lesser extent) pharmacological interventions are available. The goal of treatment is to alleviate distress, improve coping, and restore functioning.

Treatment	Description	Evidence Level	Source
Psychotherapy	CBT, psychodynamic, relaxation	Moderate (CBT), low (others)	13 14
Self-help	E-mental health, self-guided	Promising, evolving	14
Pharmacotherapy	Antidepressants, etifoxine	Limited, mixed	10 13 15
Supportive Care	Social support, education	Important adjunct	10 14

Table 4: Evidence-Based Treatments

Psychotherapy

Cognitive Behavioral Therapy (CBT) is the most studied and recommended psychological intervention for adjustment disorder. CBT helps individuals identify and reframe negative thoughts, develop coping skills, and manage distressing emotions 13 14. Other psychotherapies, such as psychodynamic approaches and behavioral activation, have been used but with less robust evidence.

• Relaxation techniques (breathing exercises, mindfulness) are beneficial for anxiety symptoms.
• Behavioral therapy can help those with conduct-related symptoms 13 14.

E-mental health and self-help interventions are gaining traction, especially for those with limited access to traditional therapy. Early research indicates these approaches can be effective and scalable 14.

Pharmacotherapy

Medication is generally reserved for severe or persistent symptoms, or when psychotherapy is unavailable. Evidence supports limited use of certain antidepressants, especially for adjustment disorder with anxiety or depression subtypes. Etifoxine, an anxiolytic, has shown some benefits over other medications for adjustment disorder with anxiety. However, overall, pharmacological treatment is not strongly supported and should be used cautiously 10 13 15.

• Antidepressants: May help with prominent depressive or anxiety symptoms.
• Etifoxine: Can be considered for anxiety-predominant cases 15.
• Benzodiazepines: Generally discouraged due to dependence risk 15.

Supportive Care and Adjuncts

Non-specific interventions such as social support, psychoeducation, and stress management are crucial. Encouraging regular routines, exercise, and healthy sleep patterns can aid recovery. In some cases, brief crisis intervention or case management may be needed 10 14.

Stepped Care and Future Directions

Given the wide range of symptom severity, a stepped care model—starting with low-intensity interventions and escalating as needed—may be most appropriate. Ongoing research is needed to identify the most effective, accessible treatments for diverse populations 14.

Conclusion

Adjustment disorder is a complex, yet highly treatable, response to life stressors. Understanding its core symptoms, subtypes, causes, and treatment options empowers individuals and healthcare providers to intervene early and effectively.

Key Takeaways:

• Symptoms: Marked by preoccupation with the stressor and failure to adapt, accompanied by anxiety, depression, behavioral changes, and functional impairment 2 3 6 7.
• Types: Includes mixed anxiety and depressed mood, with anxiety, with depressed mood, with disturbance of conduct, and unspecified subtypes 8 9.
• Causes: Triggered by identifiable stressors such as life changes, illness, or disasters, with individual vulnerability and lack of social support increasing risk 1 4 5 9 11.
• Treatment: Psychotherapy (especially CBT) is the cornerstone; pharmacotherapy is reserved for select cases; supportive care and self-help can be valuable adjuncts 10 13 14 15.

If you or someone you know is struggling to adapt after a significant life event, seeking professional help can make a profound difference. With the right support and interventions, most individuals recover and regain their well-being.