Adjustment disorder with mixed anxiety and depressed mood criteria

Stress is unavoidable. It’s a universal response to challenges that threaten our health and well-being — some of the most common stressors being job loss, divorce, and the loss of a loved one. When confronted with a stressful event, we might feel frustrated, worried, nervous, or angry; we might lose sleep over it, lash out at our loved ones, or struggle to focus at work. 

Our stress can manifest in a number of ways, and all of these responses are normal. But when someone’s stress is next-level (i.e., when their stress escalates to a level of intensity that’s difficult to manage) and these emotional and/or behavioral responses impair their ability to function on a daily basis, they might have an adjustment disorder.

What Is Adjustment Disorder?

Adjustment disorder is characterized by emotional and/or behavioral symptoms (such as anxiety, feelings of hopelessness, and disorientation) that develop in response to an extremely stressful event or a series of stressful events. This prevents the individual from functioning well in their normal, everyday life. Prior to 1980, the American Psychiatric Association called adjustment disorder a “transient situational disturbance.”

Adjustment disorder is common — it’s estimated that 5% to 20% of people are diagnosed with adjustment disorder in outpatient mental health treatment (such as in a therapy session). They’re even more common in hospital psychiatric consultation settings, coming in at 50% and as one of the most common diagnoses.

Is Adjustment Disorder a Mental Illness?

Yes. Adjustment disorder is listed in the trauma- and stress-related disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

What Are the Signs of Adjustment Disorder?

As its definition implies, the symptoms of adjustment disorder can be both emotional and behavioral. In addition, they can vary from one person to the next – for example, anger and disruptive behavior might be at the forefront of one person’s response, while a depressed mood and frequent crying might be at another’s.

Emotional Symptoms of Adjustment Disorder 

• Changes in mood that are out of the ordinary
• Anxiety
• Anger
• Low self-esteem
• Hopelessness
• Feeling trapped and out of options
• Feeling isolated

Physical Symptoms of Adjustment Disorder

• Difficulty concentrating
• Substance abuse
• Loss of appetite
• Difficulty sleeping
• Frequent crying

Adjustment Disorder Criteria

While the above can signify adjustment disorder, you can’t be sure unless a provider assesses your symptoms and confirms that you meet the DSM-5’s diagnostic criteria (which is required for diagnosis):

• The individual develops emotional and/or behavioral symptoms in response to an identifiable stressor, within 3 months of its onset. 
• Their symptoms are clinically significant, in which 1) they experience marked distress that’s disproportionate to the severity of the stressor and/or 2) important areas of the individual’s life are significantly impaired.
• The disturbance doesn’t meet the criteria for another mental disorder nor is it an exacerbation of another, pre-existing mental disorder.
• The symptoms are not explained by normal bereavement (or the experience of losing someone close to us).
• Once the stressor is removed or its consequences subside, the individual’s symptoms go away within 6 months. 

Types of Adjustment Disorder

When assessing and diagnosing adjustment disorder, providers must specify the presentation as… 

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

What Can Trigger Adjustment Disorder?

As mentioned earlier, stressful events trigger adjustment disorder. These can be single events (going through a breakup or getting fired from a job), a series of stressors (going through a breakup and getting fired from a job), recurrent stressors (having back-to-back unfulfilling relationships or experiencing regular crises at work), or continuous stressors (dealing with disabilities caused by a chronic illness or challenges that come with living in a high crime area). 

In addition, these stressors might affect one person, a whole family, or an entire community. They might also come with specific developmental milestones like getting married, going to school, becoming a parent, or retiring.

Can Adjustment Disorder Go Away?

Adjustment disorder is short-term and does go away when the stressful event passes and/or the individual adjusts. 

That said, if or when you experience extremely stressful life events or feel overwhelmed, it’s important that you take care of yourself — therapy can both treat and prevent adjustment disorder. In addition, self-care is crucial in managing stress, whether it be in the form of mindfulness, journaling, exercise, or another activity.

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Treatment for Adjustment Disorder

Psychotherapy is usually the best treatment for adjustment disorder — the therapist works with the individual to better manage their stress and tap into healthier emotions/behaviors associated with the stressor at hand. In addition, the therapist helps the individual find a clearer understanding of the stressful situation and “bring balance and understanding into the adjustment process,” says Christine Ridley, Licensed Clinical Social Worker at Thriveworks. 

Treatment will often emphasize the significance of social support in the individual’s life and may include relaxation training and techniques. While adjustment disorder rarely extends beyond 6 months, there may be some lasting anxiety and depression or other symptoms that happen beyond that time frame. That is normal and usually not serious enough to require additional treatment.

Family therapy may be ideal for particular individuals, which is especially important if the stressor affects the whole family or if a child is the victim of the stressor. When the disorder is negatively affecting a marriage or romantic relationship, couples therapy may be ideal.

Self-Care for Adjustment Disorder

In addition to seeing a therapist or counselor, it’s also important to practice self-care: Getting plenty of exercise, following a nutritional diet, and maintaining a regular schedule are a few basics that can go a long way. Keeping a journal in order to write down feelings is often helpful, too, as is indulging in creative activities, such as art and music. Many people find that volunteering or helping others is beneficial as well. 

In addition, when facing big life changes or stressors, you might consider:

1.  Avoiding taking on additional responsibilities that could make you more anxious. Instead, focus on dealing with the change or stressor at hand.
2. Tapping into your support system. Family, friends, and any spiritual supports are critical when you’re feeling high levels of stress or going through changes in your life.
3. Joining a support group. Sometimes it helps to share your frustrations and anxieties with people who’ve been through/are going through the same situation. By hearing their stories and experiences, you may find that you don’t feel quite so alone. They can also be an inspiration.