Definition and Diagnosis
Adjustment disorder involves the development of emotional or behavioral symptoms in response to an identifiable stressor, occurring within three months of the stressor's onset, with symptoms that are out of proportion to the severity of the stressor or that cause significant impairment, and which do not meet criteria for another specific mental disorder.
Epidemiology
Adjustment disorder is common across clinical settings, with estimates suggesting it accounts for a substantial proportion of psychiatric consultations, particularly in general medical and outpatient settings, and can occur at any age.
Risk Factors
Risk factors include limited coping resources or social support, prior psychiatric history, multiple or cumulative life stressors, and certain personality traits associated with reduced stress resilience.
Symptoms and Subtypes
Symptoms can include depressed mood, anxiety, or a mix of both, along with disturbance of conduct, and are directly tied to the identified stressor, resolving within six months once the stressor or its consequences have ended (unless a chronic stressor is present).
Diagnosis
DSM-5-TR criteria require symptoms developing within three months of an identifiable stressor, marked distress out of proportion to the stressor or significant functional impairment, and exclusion of bereavement or another mental disorder that would better account for the presentation.
Treatment
Treatment is primarily psychotherapeutic, including supportive therapy, problem-solving or brief CBT-based approaches focused on coping with the stressor, with medication reserved for significant or persistent symptoms.
Prognosis
Prognosis is generally favorable, with most individuals experiencing resolution of symptoms once the stressor resolves or adaptive coping is established, though a subset may go on to develop a more persistent mood or anxiety disorder if symptoms do not resolve.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).