Adjustment Disorder (AD) is a psychiatric condition characterized by emotional and behavioral symptoms that arise in response to identifiable stressful life events. Although often underestimated, it can have significant effects on functionality. It typically emerges following experiences such as bereavement, separation, unemployment, relocation or changes in school. The individual’s response to these events is more intense than expected and impairs daily functioning. Although it can occur in all age groups, it is more frequently observed in children and adolescents due to developmental stressors specific to these periods.

DSM-5 Criteria for Adjustment Disorder

According to DSM-5, the diagnosis of Adjustment Disorder requires the following:

• The development of emotional or behavioral symptoms within three months of exposure to an identifiable stressor.
• The symptoms must be characterized by at least one of the following:
  • Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account cultural and contextual factors.
  • Significant impairment in social, occupational or other important areas of functioning.
• The disturbance cannot be explained by another mental disorder, nor is it merely an exacerbation of a pre-existing psychiatric condition.
• Symptoms do not persist for more than six months after the termination of the stressor or its consequences.

DSM-5 also specifies subtypes of Adjustment Disorder:

• With depressed mood
• With anxiety
• With mixed anxiety and depressed mood
• With disturbance of conduct
• With mixed disturbance of emotions and conduct
• Unspecified type

Adjustment Disorder Symptoms

The symptoms of AD vary depending on the stressor and the age of the individual. Common features include anxiety, depressed mood, agitation, concentration difficulties, sleep disturbances and somatic complaints. In children and adolescents, behavioral manifestations such as aggression, school refusal and substance use are more prominent.

In the subtype with depressed mood, sadness, hopelessness, crying spells and lack of interest are common, while the anxious subtype is characterized by tension, worry, restlessness and phobic avoidance. In mixed subtypes, these symptoms co-occur. The disturbance of conduct subtype, more frequent in children and adolescents, is associated with rule-breaking and interpersonal conflicts.

Etiology of Adjustment Disorder

The core etiology of AD lies in the individual’s insufficient coping response to stressors. These stressors are typically linked to environmental or life events. Frequently reported triggers include divorce, job loss, migration, financial difficulties, academic failure, parental loss and traumatic life events.

Risk factors include a history of psychiatric disorders, low social support, early-life losses, family communication problems and personality traits such as poor coping capacity and high neuroticism. Adjustment disorder often presents with comorbid psychiatric conditions, making differential diagnosis important, particularly with depression, anxiety disorders and post-traumatic stress disorder (PTSD).

Risk Factors for Adjustment Disorder

The primary risk factors contributing to the development of AD are:

• Life Events: Stressors such as job loss, divorce or the death of a loved one often serve as the precipitating factor.
• Psychiatric History: Prior depression, anxiety or personality disorders may increase vulnerability.
• Family Dynamics: Family conflict, neglect or overprotectiveness can play a critical role, especially in children and adolescents.
• Support Systems: Limited social support makes coping with stress more difficult.
• Personality Traits: Low self-esteem, dependency and heightened emotional reactivity are predisposing factors.

Diagnosis of Adjustment Disorder

Diagnosis is made based on the temporal link between the stressor and the onset of symptoms, as well as the functional impact of the symptoms. A detailed psychiatric history is required to establish the causal relationship between the stressor and the disorder.

Differential diagnosis must consider depression, anxiety disorders, acute stress disorder and PTSD. Clinical evaluation should include individual interviews, family history, psychometric testing and medical investigations if necessary. Structured interviews, such as SCID-5, may improve diagnostic reliability.

Adjustment Disorder Treatment

Adjustment Disorder is generally transient and resolves with appropriate intervention. The primary treatment goal is to enhance the individual’s coping capacity and restore emotional balance.

1. Psychotherapy (Primary Approach)

Psychotherapy is the first-line treatment for AD. The most commonly used modalities include:

• Cognitive Behavioral Therapy (CBT): Targets maladaptive thoughts and behaviors in response to stressors, with well-documented efficacy (e.g., Casey & Bailey, 2011).
• Problem-Solving Therapy: Effective in individuals with impaired functionality.
• Family Therapy: Particularly beneficial in children and adolescents, where family involvement enhances treatment outcomes.

2. Psychoeducation and Supportive Interventions

Education is provided to help differentiate between normal reactions and maladaptive responses. Social support is strengthened, and in cases related to job loss or financial difficulties, social services may be necessary.

3. Pharmacotherapy

Pharmacological treatment is generally not required. However, in cases with severe symptoms (e.g., intense anxiety, insomnia or suicidal ideation), short-term pharmacotherapy may be considered:

• SSRIs: Recommended when anxiety or depressive symptoms are predominant.
• Anxiolytics: May be prescribed for short-term use, with caution due to risk of dependency.

4. Crisis Intervention (if necessary)

In cases involving suicide risk, self-harm or severe impairment, more intensive interventions, including short-term hospitalization, may be required. Treatment must be individualized and closely monitored.

Impact on Daily Life

Although usually temporary, AD can significantly affect work, school, social relationships and family dynamics. Persistent stressors and poor coping strategies may lead to academic failure, unemployment, divorce or social withdrawal.

In children, school refusal, behavioral problems and academic decline are common, while in adolescents, substance use, withdrawal and risk-taking behaviors may occur. Adults frequently report performance decline, insomnia and relational difficulties.

Adjustment Disorder is a mental health condition characterized by maladaptive responses to life stressors. While it may appear mild or transient, if left undiagnosed or untreated, it can predispose individuals to more severe psychiatric disorders. With a psychotherapy-centered and holistic approach, individuals can largely regain emotional and social functioning. Treatment planning must take into account individual needs and the nature of the stressor.