Adjustment Disorders Overview

An adjustment disorder is an emotional or behavioral reaction to a stressful event or change in a person’s life. The reaction is considered an unhealthy or excessive response to the event or change within three months of it happening. Stressful events or changes in the life of your child or adolescent may be a family move, the parents’ divorce or separation, the loss of a pet, or the birth of a sibling. A sudden illness or restriction to your child’s life due to chronic illness may also result in an adjustment response.

While adults can experience adjustment disorders, it is predominantly diagnosed in children and adolescents.

Causes of Adjustment Disorders

Adjustment disorders are a reaction to an event. There is not a single direct cause between the stressful event and the reaction. Children and adolescents vary in their temperament, past experiences, vulnerability and coping skills. Where they are in their development and ability to deal with specific needs related to the stress may contribute to their reaction. Stressors also vary in how long they last, how strong they are and what effect they have. No evidence is available to suggest a specific factor that causes adjustment disorders.

Risk Factors for Adjustment Disorders

Adjustment disorders are quite common in children and adolescents. They happen equally in males and females. While adjustment disorders happen in all cultures, the stressors and signs may vary based on cultural influences.

Adjustment disorders can also happen at any age. However, it is believed that characteristics of the disorder are different in children and adolescents than they are in adults.

Symptoms of Adjustment Disorders

In all adjustment disorders, the reaction to the stressor is excessive to what would be otherwise expected. Also, the reaction should significantly interfere with social, occupational or educational functioning. Additionally, age can have an effect: Differences are found in the symptoms experienced, how long they last, how strong they are and what effect they have. Adolescent symptoms of adjustment disorders can be more behavioral, such as acting out. Adults who experience adjustment disorders exhibit more depressive symptoms.

There are six subtypes of adjustment disorder that are based on the type of major symptoms experienced. The following are the most common symptoms of each of the subtypes of adjustment disorder. However, each adolescent may experience symptoms differently:

• Adjustment disorder with depressed mood. Symptoms may include:

  • Depressed mood

  • Tearfulness

  • Feelings of hopelessness

• Adjustment disorder with anxiety. Symptoms may include:

  • Nervousness

  • Worry

  • Jitteriness

  • Fear of separation from major attachment figures

• Adjustment disorder with anxiety and depressed mood. A combination of symptoms from both of these conditions are present.

• Adjustment disorder with disturbance of conduct. Symptoms may include:

  • Violation of the rights of others

  • Violation of society’s norms and rules (truancy, destruction of property, reckless driving or fighting)

• Adjustment disorder with mixed disturbance of emotions and conduct. A combination of symptoms from all of the above subtypes is present (depressed mood, anxiety and conduct).

• Adjustment disorder unspecified. Reactions to stressful events that do not fit in one of the above subtypes are present. Reactions may include behaviors like social withdrawal or inhibitions to normally expected activities, like school or work.

The symptoms of adjustment disorders may resemble other medical problems or psychiatric conditions. Always talk with your adolescent’s health care provider for a diagnosis.

Diagnosing Adjustment Disorders

A child and adolescent psychiatrist or a qualified mental health professional usually makes the diagnosis of an adjustment disorder following a comprehensive psychiatric evaluation and interview with the child or adolescent and their parents. A detailed personal history of development, life events, emotions, behaviors and the identified stressful event is obtained during the interview.

Treating Adjustment Disorders

Specific treatment for adjustment disorders will be decided by your adolescent’s health care provider based on:

• Your adolescent’s age, overall health and medical history

• Extent of your adolescent’s symptoms

• Subtype of the adjustment disorder

• Your adolescent’s tolerance for specific therapies

• Expectations for the course of the stressful event

• Your opinion or preference

Treatment may include:

• Individual psychotherapy using cognitive-behavioral approaches. Cognitive-behavioral approaches are used to improve age-appropriate problem-solving skills, communication skills, impulse control, anger management skills and stress management skills.

• Family therapy. Family therapy is often focused on making needed changes within the family system, like improving communication skills and family interactions. An additional area of focus is to increase family support among family members.

• Peer group therapy. Peer group therapy is often focused on developing and using social skills and interpersonal skills.

• Medicine. Medicines have very limited value in the treatment of adjustment disorders

Preventing Adjustment Disorders

Preventive measures to reduce adjustment disorders in adolescents are not known at this time. However, early discovery and getting professional help for your adolescent can reduce the severity of symptoms, enhancing normal growth and development and improving your child’s quality of life.