Adjustment disorder is among the most frequently diagnosed mental health conditions in clinical practice (APA). (1) Adjustment disorder is characterized by an emotional and/or behavioral reaction to an identifiable life stressor that is disproportionate to what would be expected and results in significant functional impairment. Symptoms of adjustment disorders vary depending on how the disorder manifests, as it can be present with anxiety, depressed mood, disturbance of emotions and conduct, or combinations of these conditions.
This care guideline offers a brief summary of the evidence-based, best practices for the effective treatment of adjustment disorder in adults.
Diagnostic Considerations for Adjustment Disorder in Adults
In response to an identifiable stressor that has happened within the last 3 months, is your client experiencing:
- A level of distress that presents as out of proportion to the severity of the stressor?
- Have the distress and associated negative symptoms impacted the client’s ability to function in important areas of life, such as in relationships, at work, at school or complete activities of daily living (such as hygiene, keeping up with responsibilities, etc)?
It’s important to note, the diagnosis of an adjustment disorder is often accompanied by a specifier, such as “with anxiety”, “With depressed mood” or “with disturbance of conduct”, as well as the severity of “acute” versus “chronic”.
Symptoms of adjustment disorder may also be attributable to an alternative disorder (such as acute stress disorder or prolonged grief disorder). As a result, a clinical best practice is to engage in a differential diagnostic assessment prior to determining if adjustment disorder is the clinically indicated diagnosis.
For complete diagnostic criteria of Generalized Anxiety Disorder, consult the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association. (2022). https://doi.org/10.1176/appi.books.9780890425787
| When documenting care, be sure to include the specific symptoms of Adjustment Disorder the client is experiencing. This ensures your note aligns with the diagnosis and demonstrates the medical necessity for the service. |
Symptom Screening and Monitoring
While symptom presentation of adjustment disorder may vary based on specifier, there are two more commonly referenced measurement tools available to screen and monitor symptom progression. The Adjustment Disorder New Module (ADNM - 20) and The International Adjustment Disorder Questionnaire (IADQ) are simply worded, client self-report instruments for assessing adjustment disorder. If a client presents with specifiers of anxiety or depression, use of the GAD-7 (Generalized Anxiety Disorder - 7 item) and/or PHQ-9 (Patient Health Questionnaire - 9 item) may also be of clinical value, particularly in monitoring for increases in symptom severity and risk of suicidality. You can learn more about strategies for incorporating Measurement Informed Care (MIC) into your practice here.
Evidence-Based Approaches to Treatment
Psychotherapy
Research demonstrates that adults with adjustment disorder can be effectively treated through psychotherapy, particularly using cognitive-behavioral (CB), solution-focused (SFT), or Interpersonal (IP) approaches. For example, here's how CBT can be helpful in the context of adjustment:(3)
- Identification of negative thought patterns related to the stressor or change.
- Adaptive coping and problem-solving skills
- Behavioral Activation
- Breaking down larger challenges into smaller, more manageable steps, which builds a sense of competence and control
- Mindfulness and Relaxation Techniques
Family therapy can also be used to treat adjustment disorder, as it focuses on making needed changes within the family system like improving communication skills, modifying family interactions, and increasing support among family members.
Medication
Treatment of adjustment disorder does not typically call for the use of prescription medications, but in some cases, medication may be helpful in addressing moderate to severe depression or anxiety that may be associated with the disorder. When medication is used, it is almost always in addition to psychotherapy.
| As a reminder, it is beyond the scope of a psychotherapist to suggest specific medications, groups of medications, specific supplements, or advise on the frequency of taking or stopping medications. These discussions must only be carried out by a medical provider. |
Assessing Risk and Higher Level of Care Needs
The same stressful life events and experiences that can lead to a potential adjustment disorder diagnosis (such as divorce, job loss, medical diagnosis, or sudden shifts in environment) can also contribute to increased client risk including thoughts of suicide, suicide attempts, self-harm behaviors, and substance abuse. It is important for therapists to engage in (and document) regular assessment of risk, completion of a safety plan, and referral for additional services (such as IOP, PHP, Group therapy, etc) if clinically indicated.
| Rula’s team of care coordinators is available to support your client in accessing these additional clinical services outside of Rula. Click here to learn more about how to easily refer your client for a Higher Level of Care (HLOC). |
Cultural Considerations
There is often variability across cultures as to what is considered a “normal” response to an identifiable stressor, as well as the nature and meaning of the stressor itself. For example, in some cultures, having limited family or community support may be a significant contributor to the likelihood of developing an adjustment disorder in the presence of a new stressor, particularly in collectivist or socio-centric societies. In other cultural groups, however, individualistic attitudes are more dominant, and dissociative symptoms may be more prominent symptom expression.(5) As a result, It is important to always consider the social and cultural contexts of a client's treatment needs as part of the diagnostic process.
“When a mental health professional understands the role that culture plays in the diagnosis of a condition and incorporates cultural needs and differences into a person’s care, it significantly improves outcomes.”(6)
Disclaimer: Adjustment Disorder in Children and Adolescents
This care guide focuses on best practice guidelines for treating adults with adjustment disorder, however, adjustment disorders are predominantly diagnosed in children and adolescents. (4) Children and teens with adjustment disorders tend to display more physical and behavioral symptoms of stress than adults do - such as somatic symptoms (stomach aches), sleep disturbance, frequent crying, social withdrawal, angry outbursts, conflict with authority figures, or physical altercations with peers. These behaviors are often markedly different compared to before the stressor occurred. (2) For information on providing effective care for children and adolescents with adjustment disorders, check out the below resources:
- Adjustment disorder in the pediatric population (Pediatric Medicine)
- What Are Adjustment Disorders? (Child Mind Institute)
- Adjustment disorder in youth populations (Virginia Commission on Youth)
Downloadable Digital Guide
Click HERE for a downloadable digital copy of this guide.
References
- American Psychological Association. Zelviene, P., & Kazlauskas, E. (2018). Adjustment disorder: Current perspectives. Neuropsychiatric Disease and Treatment, 14, Article 375-381. https://psycnet.apa.org/record/2018-04820-001
- Child Mind Institute. https://childmind.org/guide/adjustment-disorders-in-children-quick-guide/
- Journal of Environmental and Occupational Health, 2023 https://www.jenvoh.com/jenvoh-articles/evaluation-of-the-effectiveness-of-cognitive-behavioural-therapy-for-patients-suffering-from-an-adjustment-disorder.pdf
- Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders (Johns Hopkins)
- World Psychiatry. https://onlinelibrary.wiley.com/journal/20515545
- National Alliance on Mental Illness (NAMI). (n.d.). Identity and Cultural Dimensions. https://www.nami.org/your-journey/identity-and-cultural-dimensions/