What Is Adjustment Disorder (Stress Response Syndrome)?
Adjustment disorder is when your body and brain have an extreme reaction to stress. This can affect your thoughts, feelings, and how you act. You may also hear this called stress response syndrome. Experts are still learning more about this condition, but early data suggests that it affects about 2% of people around the globe.
Usually, when something stressful happens, most people are able to adjust their thoughts and feelings and "bounce back." If you have adjustment disorder, you may get "stuck" in your stress response and have a hard time feeling or acting like your usual self.
For some people, the symptoms of adjustment disorder overlap with those of clinical depression. For instance, you might feel hopeless and lose interest in activities you usually enjoy. Because of that, adjustment disorder is sometimes called "situational depression."
Adjustment disorder vs. major depression
Despite some ways that they're alike, adjustment disorder isn't the same as major depression. Adjustment disorder doesn't involve as many of the physical and emotional symptoms of clinical depression (such as changes in sleep, appetite, and energy.) And its symptoms aren't as intense or severe. For instance, suicidal thoughts or behavior is common in major depression but not as common in adjustment disorder.
Adjustment disorder vs. PTSD
Adjustment disorder is also different than posttraumatic stress disorder (PTSD). PTSD is a reaction to seeing or going through a really scary, stressful event. Symptoms can start within a month, but for some people, they don't emerge until years later. Once they begin, PTSD symptoms can sometimes last for over a year.
Adjustment disorder usually happens within 3 months of a stressful event, and the symptoms usually don't last more than 6 months.
Adjustment Disorder Types
According to the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5), common types of adjustment disorder include:
Adjustment disorder with anxiety
You might worry about things that haven't happened yet, feel overwhelmed, have a hard time sitting still, and find it tough to focus on school or work. Kids with this type of adjustment disorder often have separation anxiety -- they feel really upset when they have to be apart from a loved one.
Adjustment disorder with depressed mood
This type resembles depression. You could feel waves of sadness that make it hard to get through your daily routine.
Adjustment disorder with anxiety and depressed mood
If you have this type of adjustment disorder, you have a mix of symptoms. For instance, you could feel very worried and very sad at the same time.
Adjustment disorder unspecified
If your response to a stressful event doesn't fit into any of the above categories, you could be diagnosed with this type.
- Adjustment disorder with disturbance of conduct. This could look like "acting out" -- breaking rules, destroying things, or acting recklessly.
- Adjustment disorder with mixed disturbance or emotions and conduct. If you or your child have this type, your symptoms could include anxiety, depression, and behavior that's impulsive or careless.
Adjustment Disorder Symptoms
Adjustment disorder is different than feeling "stressed." It temporarily changes the way you feel and think about the world and your place in it.
If you have adjustment disorder, your reaction to a stressful event exceeds what is typical or expected. Your symptoms may make it hard for you to get through your day. For example, you might struggle to sleep, work, or study. Everyone is different, but the range of symptoms you could have can include:
- Feeling hopeless
- Anxiety (feeling nervous and worried)
- Body aches or sore muscles
- Feeling irritable (quick to anger)
- Heart palpitations (skipped or racing heart beat)
- Avoiding loved ones and activities you usually enjoy
- A new pattern of absence from work or school
- Not taking care of important tasks, such as paying bills
- New and out-of-the-ordinary dangerous or destructive behavior, such as fighting or reckless driving
- Changes in appetite (loss of appetite or overeating)
- Problems sleeping
- Feeling tired or without energy
- Using alcohol or other drugs more than usual
In kids and teens, adjustment disorder tends to show up most in how they behave. Some common signs include skipping school, fighting, and acting out. Adults, on the other hand, tend to have more emotional symptoms, such as sadness and anxiety.
How long do symptoms last?
For many people, adjustment disorder symptoms usually end once the source of stress ends, or you adjust to it. But if you're not back to your usual self in 6 months, you may have what's called chronic adjustment disorder. This is an ongoing condition that you may need some extra support to manage.
When to Call a Doctor
For most people, adjustment disorder is a short-term condition. Your symptoms will probably go away when the source of your stress ends or you get used to it. But it's always a good idea to talk to your doctor. They can suggest some treatments to help you feel better faster.
Seek emergency help if you're having thoughts of hurting yourself.
Call or text 988 to reach the Suicide & Crisis Lifeline. It's free and open 24 hours a day, 7 days a week. You can also chat with a crisis counselor at 988lifeline.org.
In an emergency, call 911.
Adjustment Disorders Causes
Although an adjustment disorder can occur at any age, it's more common at times of major transitions, such as adolescence, midlife, and late life.
The type of stress that can trigger an adjustment disorder varies from person to person but can include:
- The end of a relationship
- Losing or changing a job
- Death of a loved one
- A serious illness (yourself or a loved one)
- Being a victim of a crime
- Having an accident
- Living through a natural disaster, such as a fire, flood, or hurricane
- Money problems
- A big move
- Being bullied
- Facing challenges at work or school
- Living somewhere where you don't feel safe
- More than one stressful event happening at once
It's important to realize that stress can be negative or positive. Either type can trigger adjustment disorder. For instance, getting married, having a baby, or getting a new job could all set symptoms in motion.
Adjustment Disorder Risk Factors
Adjustment disorder can affect anyone, regardless of gender, age, race, or lifestyle. But it does seem more common in people who are assigned female at birth (AFAB).
A few other factors could also raise your risk of adjustment disorder, including:
- Your personality
- Your temperament (how you behave around others or react to situations)
- Your life experiences. One study found that not having a strong support system of loved ones and being out of work were both risk factors.
- Your genes. More studies need to be done, but some early data shows that a risk of adjustment disorder could be passed down in families.
- Your mental health. For instance, having another condition, such as an anxiety disorder or depression, can make an adjustment disorder more likely.
More research needs to be done to pinpoint other specific risk factors.
Adjustment Disorder Diagnosis
If you think that you have an adjustment disorder, see your doctor. If you have physical symptoms, they'll do an exam and ask questions about your medical and mental health. Although there aren't imaging or lab tests to diagnose adjustment disorder, your doctor may use lab tests, including blood tests or imaging tests such as CT or MRI scans, to rule out other conditions (like a head injury) that could be causing changes in your mood or behavior.
Once other conditions have been ruled out, your doctor will probably refer you to a psychiatrist, psychologist, or other mental health expert who's trained to help people manage stressful life events. They’ll also look for other mental health conditions, such as PTSD, major depression, or an anxiety disorder.
Adjustment disorder criteria
To be diagnosed with adjustment disorder, your symptoms will have to match the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
- A change in emotional or behavioral symptoms that happens within 3 months of a stressful life event
- A level of distress that’s more intense than would typically be expected in response to what happened
- Major issues in your personal life and/or at work or school
- Symptoms that aren’t related to another physical or mental health issue
- Symptoms that aren't part of the typical grieving process
Adjustment Disorder Treatment
If you have adjustment disorder, your doctor could suggest:
- Psychotherapy or talk therapy. A counselor can teach you new ways to solve problems and deal with your stress. A few weeks of therapy may give you many tools to help you feel better.
- Medications. Prescription drugs aren't always needed for adjustment disorder, and many kinds take weeks to start working. But if your symptoms are severe, your doctor may suggest anti-anxiety medication, antidepressants, or a drug that will help you get a good night's rest.
- Support groups. Talking to others who are also dealing with adjustment disorder can help you feel less alone. Support groups have been found to be especially useful for teens.
Building your resilience, which refers to your ability to adapt to stressful events, can also help you feel better. To do that, try to:
- Connect with your friends and family.
- Find activities that give you purpose.
- Eat healthy foods.
- Get regular exercise.
- Make sleep a priority.
- Practice your coping skills.
- Remind yourself, "I can get through this" when you're faced with stress.
- Recognize and build on your strengths.
- Try to problem-solve.
- Treat yourself like you would a good friend. Try to be kind, not critical.
Most people with adjustment disorder recover completely. In fact, treatment for adjustment disorder may help you learn new skills that actually allow you to function better than before your symptoms began.
Adjustment Disorder Prevention
There's no guaranteed way to prevent adjustment disorder, but a few things can help shore up your defenses. You can:
- Make healthy choices. Eating well, getting enough sleep, and getting regular exercise can benefit your mental and physical health. If you're not sure where to start, ask your doctor for some tips.
- Tap into your support system. Turn to friends and family when you're feeling low. Talking with them can help you feel less alone, and let them better understand how they can support you.
- Be kind to yourself. Self-care is key to your mental health, and you don't need a spa day to do it. Anything that makes you happy or relaxed (whether that's going for a walk, watching a funny video, or taking a long, hot shower) counts.
- Plan ahead. Stress is a part of life. You can't get rid of all of it. But you can learn to plan ahead. Think about how you can respond the next time a stressful event comes up. Your counselor can help you talk through new and better ways to manage stress.
Adjustment Disorder Complications
If you suspect you have adjustment disorder, seek help as soon as you can. If left untreated, it can turn into:
- Anxiety disorder
- Major depression
- Substance abuse
- Suicidal thinking
Adjustment disorder is when you have a hard time dealing with a big change, major loss, or other stressful event. Seek help as soon as you can because therapy, and sometimes medication, can help you bounce back faster. While adjustment disorder sometimes goes away on its own, it could also turn into another condition such as depression or substance abuse.