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Adjustment Disorder

By

John W. Barnhill

, MD, Weill Cornell Medical College and New York Presbyterian Hospital

Last full review/revision October 2018 by John W. Barnhill, MD

Adjustment disorders involve markedly distressing and impairing emotional and/or behavioral symptoms caused by an identifiable stressor.

(See also Overview of Trauma- and Stress-Related Disorders.)

People often become sad, angry, or otherwise upset when unpleasant things happen. Such reactions are not considered a disorder unless the reaction is more intense than what is typically expected in the person's culture, or when the person's ability to function is significantly impaired.

Stressors may be a single, discrete event (for example, losing a job), multiple events (for example, both financial and romantic setbacks), or ongoing problems (for example, caring for a significantly disabled family member). Stressors do not have to be overwhelming traumatic events as in posttraumatic stress disorder (PTSD).

Death of a loved one can be a precipitant of an adjustment disorder. However, clinicians must take into account the wide variety of grief reactions considered typical in different cultures and diagnose a disorder only if the bereavement response is beyond what is expected.

Adjustment disorders are common and are present in an estimated 5 to 20% of outpatient mental health visits.

Symptoms and Signs

Symptoms of an adjustment disorder typically begin shortly after the stressful event and do not continue beyond 6 mo after the stressor has stopped. 

There are many manifestations of an adjustment disorder, common ones include

A person may have several manifestations. 

There also is an increased risk of suicide attempts and completed suicide.

Diagnosis

  • A doctor's evaluation based on specific criteria

Doctors base the diagnosis on criteria recommended by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

People must have

  • Emotional or behavioral symptoms within 3 months of having been exposed to a stressor

Symptoms must be clinically significant as shown by one or more of the following:

  • Marked distress that is out of proportion to the stressor (taking cultural and other factors into consideration)
  • The symptoms significantly impair social or occupational functioning

People who have impairment or marked distress following a traumatic event but without meeting criteria for PTSD or ASD may be diagnosed with an adjustment disorder.

Treatment

  • Psychotherapy
  • Sometimes drugs to treat certain symptoms

Adjustment disorders must be thoroughly evaluated and treated. However, there is limited evidence supporting any particular treatment for adjustment disorders. A wide variety of individual and group psychotherapies, including brief psychotherapy, cognitive-behavioral therapy, and supportive psychotherapy, have been used successfully. It is not uncommon for therapy to target a specific issue, such as grief. 

Drugs are often used to treat symptoms such as insomnia, anxiety, and depression.

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