Table of Contents
Overview – Adjustment Disorder
Adjustment disorder is a common, stress-related psychiatric diagnosis characterised by emotional or behavioural symptoms that arise in response to identifiable life stressors. These symptoms are disproportionate to the severity of the stressor and may resemble depression, anxiety, or conduct disturbances, but do not meet the full criteria for another mental disorder. Importantly, adjustment disorder is time-limited and typically resolves once the stressor or its consequences have subsided.
Definition
Adjustment disorder is an acute mental health response to a significant psychosocial stressor, leading to distress and/or functional impairment. It acts as a transitional diagnosis for patients struggling with adaptation but without sufficient symptomatology to fulfil criteria for other mood or anxiety disorders.
DSM-5 Diagnostic Criteria
- A) Emotional or behavioural symptoms emerge in response to an identifiable stressor, occurring within 3 months of its onset
- B) Clinically significant symptoms evidenced by:
- Marked distress out of proportion to the expected response
- Significant impairment in social, academic, or occupational functioning
- C) Symptoms do not meet criteria for another psychiatric disorder, nor are they an exacerbation of a pre-existing condition
- D) Does not represent normal bereavement
- E) Symptoms resolve within 6 months of the termination of the stressor or its consequences
Specifiers
- With depressed mood
- With anxiety
- With mixed anxiety and depressed mood
- With conduct disturbance
- With mixed disturbance of emotions and conduct
- Unspecified
Aetiology – Common Types of Stressors
Adjustment disorder may develop in response to any significant life event, particularly when coping mechanisms are overwhelmed:
- Single stressor: e.g. relationship breakup
- Multiple concurrent stressors: e.g. financial issues and family conflict
- Recurrent stressors: e.g. seasonal unemployment or school exams
- Chronic stressors: e.g. living in a high-crime area
- Developmental transitions: e.g. starting school, marriage, retirement, parenting challenges
Clinical Features
- Emotional symptoms: low mood, worry, irritability
- Behavioural symptoms: withdrawal, avoidance, aggression
- Somatic complaints: insomnia, fatigue, poor appetite
- Typically subthreshold for diagnoses like major depressive disorder or generalised anxiety disorder
Differential Diagnosis
- Major depressive disorder
- Generalised anxiety disorder
- Acute stress disorder
- Bereavement
- Personality disorders (especially borderline personality)
- Substance-related disorders
Management
Psychological
- Psychotherapy is first-line:
- Supportive counselling
- Cognitive behavioural therapy
- Group therapy or crisis intervention
- Focus on problem-solving, stress resilience, and adaptive coping
Pharmacological
- Benzodiazepines may be considered short-term for severe anxiety (lowest dose, shortest duration)
- Antidepressants are not routinely indicated unless symptoms persist or evolve into a major depressive episode
Prognosis
- Usually self-limiting
- Symptoms typically resolve within 6 months
- Prognosis depends on resolution of the stressor and access to support systems
- Chronicity or evolution into more severe psychiatric conditions may occur if stressors persist or are unaddressed
Summary – Adjustment Disorder
Adjustment disorder is a short-term, stress-induced psychiatric condition characterised by emotional or behavioural symptoms in response to identifiable stressors. Symptoms emerge within three months of the event and typically resolve within six months once the stressor ends. Treatment focuses on supportive psychotherapy, with pharmacological intervention used sparingly. For a broader context, see our Psychiatry & Mental Health Overview page.