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What Is Adjustment Disorder With Anxiety And Depression

Adjustment Disorder Criteria & Symptoms

Adjustment Disorder with Anxiety VA Disability Ratings

Although mental health disorders often overlap with their symptoms, each one has unique characteristics that set it apart. The hallmark characteristics of adjustment disorder are:

  • The patients distress outweighs the original event
  • The person experiences problems in their relationships, work, or other vital parts of their lives

These issues can manifest in several specific ways. Patients all experience adjustment disorder in unique ways. However, some common symptoms include:

  • Suicidal thoughts or attempts
  • Difficulty falling or staying asleep
  • Sleeping too much

These symptoms can indicate several other mental health disorders as well. Thats why its essential to refer to the DSM-5 for diagnostic criteria. Mental health professionals use this guide to make diagnoses so that patients get the help they need. According to the DSM-5, patients with adjustment disorder:

  • Begin experiencing their symptoms within three months after an identifiable trigger
  • Have more negative emotions than one would expect following the event
  • Experience such negative feelings that it interrupts their daily lives
  • Cannot pin their symptoms on other mental disorders, such as pre-existing depression or anxiety

Debates About Ajd Definition In Icd And Dsm

The ICD-10 and DSM-IV/DSM-5 AjD definitions attracted considerable criticism. Several authors pointed out that the definition itself is rather loose. This resulted in misuse of the diagnosis in clinical practice. Mental health professionals meet patients with AjD often, but it is difficult to use this diagnosis in a clinical practice. For example, the analysis of 2,155 psychologists from 23 countries showed that about 40% of them had a patient with ICD-10 or DSM-IV AjD diagnosis at least once per week, but they also indicated that ICD-10 AjD had low ease of use.

Because of the diagnostic challenges, findings about AjD prevalence are inconsistent across various studies. AjD was neglected in major epidemiological studies and AjD research was criticized for poor methodological design. Furthermore, the existing AjD diagnosis definitions raised constant debates about underdiagnosing AjD and pathologization of normal stress reactions. It was also proposed that health care professionals tend to use AjD diagnosis as a residual category, when the symptom profile does not match any other diagnosis.

Causes And Risk Factors For Adjustment Disorder

Adjustment disorder impacts people differently at different ages and can occur at any age. The causes and risk factors for adjustment disorder likely include a complex interplay of genetic, environmental, and physical risk factors working together.

Common types of stressors that can trigger adjustment disorder include:

  • Ending a relationship or marriage
  • Losing or changing jobs
  • Death of a loved one
  • Developing a serious, chronic illness
  • Being the victim of a crime
  • Major life changes getting married, having a baby
  • Living through a natural disaster
  • Retirement
  • Physical or sexual abuse or assault
  • Overprotective or abusive parenting as a child
  • Family disruptions as a child
  • Frequent moves in early life

Signs and Symptoms

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Also Known As Adjustment Disorder

Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

As most people know, depression is a common mental health condition in fact, according to the National Institute of Mental Health , in 2017 an estimated 17.3 million adults in the U.S. suffered from at least one major depressive episode in a 12-month time span. But not all depression is the same.

Unlike a diagnosis of major depressive disorder, you wont find the term “situational depression” in the DSM-5 .

Learn About Adjustment Disorder


Diagnosis with a chronic illness, divorce, or moving to a new city are all major life changes that can lead to feelings of stress. Usually, these feelings of stress are transient and people adjust within a few months. However, some people find that theyre having trouble adapting to their changing lives. Adjustment disorder is a group of stress-related symptoms, including sadness, hopelessness, and feelings of being overwhelmed, that occur when a person is unable to properly cope or adjust to a major life stressor or event. These feelings of stress and other symptoms are disproportionate to the precipitating event.

Sometimes referred to as situational depression, adjustment disorder often has many of the symptoms of depressive disorders, such as crying spells, loss of interest in once-enjoyable activities, and feelings of sadness. However, unlike a depressive disorder, adjustment disorder is the result of the influence of an outside stressor and tends to resolve when the person begins to adjust to the situation. The changes in a persons life become so overwhelming that they lead to serious consequences if left untreated.

There are six sub-types of adjustment disorder that feature a different focus of clinical symptoms. Subtypes of adjustment disorder include:

Adjustment disorder with depressed mood: The symptoms of depression, including loss of self-esteem, low mood, lack of motivation, are the primary complaint.


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Adjustment Disorder Vs Depression

The past 50 years of research show that doctors characterize depression as difficulty in regulating emotion. While adjustment disorder is very similar to depression on the surface, the cause and symptom durations distinguish them.

Adjustment disorder usually lasts up to 6 months and is brought on by a particular change in circumstances. Depression tends to be longer term and can be due to environmental, psychological, or genetic factors.

Recommendations advise on seeking medical and psychological help if people experience depression.

Experts sometimes refer to adjustment disorder as situational depression, as the symptoms may be similar but do not last as long as depression.

What Are The Signs Of Adjustment Disorders

Often, adjustment disorders look similar to depression or anxiety. When we look at diagnosing adjustment disorders, we can categorize and say, This is an adjustment disorder with depressed mood, or This is an adjustment disorder with anxiety, or it can be a mix of both depression and anxiety, Dr. Henderson says.

Yet, adjustment disorder is not a term most patients use when they first seek help. Most of the time, people coming into Dr. Hendersons office will say, I just cant seem to get over losing my job, or I cant seem to manage everything in my life the way I used to.

Commonly, adjustment disorders also show symptoms like trouble concentrating or trouble with memory. Gina Shuster, LMSW, a therapist at Oakland Psychological Clinic, sees patients who say Im so forgetful now and I never used to be this way I get so flustered all the time or I cant find the right words. With anxiety disorders that present as anxiety or depression, Shuster says, your body is spending so much energy just trying to maintain itself at this heightened emotional state that little things like memory and concentration start to slip. Its like juggling a bunch of different balls in the air. Eventually, some things are going to have to be let go, she says.

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Adjustment Disorder With Anxious Characteristics

An adjustment disorder happens when an individual is not capable to adapt to or make do with a specific stressor.

Adjustment disorder with anxious features is occasionally called situational depression if individuals with this illness have symptoms of depression, for example general decline of interest, desperation and weeping. Unlike major depression an outdoor stressor causes the illness and usually works out after the person can adjust to the scenario.

Its common features contain traumatic stress symptoms, and moderate symptoms of depression and anxiety or a mix of the three.

There are 9 kinds of adjustment disorders registered in the DSM-III-R. As stated in DSM IV TR, there are 6 kinds of adjustment disorders, which are defined by the following prevailing symptoms: depressed mood, stress, mixed depression and stress, mental disorder of conduct, mixed disturbance of emotions and conduct, and unspecified.

Anxiety Disorders Phobias

New one edition of the Diagnostic and Statistical Manual of Mental Disorders, has several changes to stress and anxiety disorders, including phobias. This post summarizes important changes to these states.

Specific Phobia . Special phobia symptom standards remain unchanged from the DSM IV, except grownups no longer must understand their stress or panic is excessive or inordinate.

Risk Factors For Adjustment Disorders

Adjustment Disorder with Mixed Anxiety & Depressed Mood Example Video

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.

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Types Of Adjustment Disorders

There are several types of adjustment disorder, each characterized by a different range of symptoms:

  • Adjustment Disorder with Anxiety Habitual nervousness or worry are common here. This form is often associated with separation anxiety from a comfortable, safe, or well-known environment.
  • Adjustment Disorder with Depressed Mood This type of adjustment disorder is marked by feelings of intense sorrow, grief, or hopelessness.
  • Adjustment Disorder with Mixed Anxiety and Depressed Mood This form combines feelings of anxiety with the deep melancholy of a depressed state.
  • Adjustment Disorder with Disturbance of Conduct Behavioral, rather than mood, changes are the predominant features. This may include trouble functioning in daily activities, withdrawing from social supports, avoiding important responsibilities, reckless behavior, or even suicidal thoughts or behaviors.
  • Adjustment Disorder with Mixed Disturbance of Emotions and Conduct Both emotional and behavioral problems mark this type of adjustment disorder.
  • Unspecified Adjustment Disorder This form lacks the standard emotional or behavioral symptoms, but manifests in other ways .

Adjustment Disorder With Depressed Mood

Adjustment disorders can develop when an individual faces an unanticipated or consequential life event. Thankfully, humans are inherently resilient. With time and proper support, most people continue to function successfully in spite of significant life changes.

However, people with an adjustment disorder may feel they are not managing as they should. They may complain of poor sleeping habits or overwhelming anxiety. Adjustment disorder with depressed moodoccurs when the predominant life disturbance is mood-related, and feelings of sadness or guilt overburden those affected.

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Are There Different Types Of Adjustment Disorders

The DSM-5 lists six types of adjustment disorder:

  • Adjustment disorder with depressed mood: Symptoms include feelings of sadness, hopelessness, crying and lack of joy from previous pleasurable things.
  • Adjustment disorder with anxiety: Symptoms include feeling worried, anxious and overwhelmed. You also have trouble concentrating. Separation anxiety is a dominant symptom in children.
  • Adjustment disorder with mixed anxiety and depressed mood: Symptoms include feeling both anxious and depressed.
  • Adjustment disorder with disturbance of conduct: Symptoms include behavioral issues such as acting rebellious, destructive, reckless or impulsive.
  • Adjustment disorder with mixed disturbance or emotions and conduct: Symptoms include anxiety, depression and behavioral issues.
  • Adjustment disorder unspecified: Symptoms include physical symptoms such as headaches, body aches, stomach aches, heart palpitations, or insomnia.

How Can I Help My Child Live With An Adjustment Disorder

Dsm Iv And Icd 10 Criteria For Adjustment Disorders

You can do these things to help your child:

  • Keep all appointments with your childs healthcare provider.

  • Talk with your childs healthcare provider about other providers who will be included in your childs care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your childs care team will depend on your childs needs and how serious the adjustment disorder is.

  • Work closely with school staff. Your child’s adjustment disorder may significantly interfere with his or her ability to learn. If this is the case, the Americans with Disabilities Act or Section 504 of the Civil Rights Act may allow the school to offer reasonable accommodations in the school setting.

  • Tell others about your childs adjustment disorder. Work with your childs healthcare provider and school to create a treatment plan.

  • Reach out for support from local community services. Being in touch with other parents who have a child with an adjustment disorder may be helpful.

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What Is An Adjustment Disorder

For more than 50 years, clinicians have been using the term adjustment disorder to describe individuals who are struggling to deal with a particular stressful situation or ongoing circumstance that causes distress.

Adjustment disorders are the most common diagnosed mental health issues and they may be diagnosed in children, adolescents, and adults. Most studies report about 1% of the population may have an adjustment disorder at any given time.

How Can I Take Care Of Myself

  • Get support. Talk with family and friends. Consider joining a support group in your area. Try to understand what made you start to feel this way. Understanding how stress has affected you is one of the most important things you can do for yourself.
  • Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
  • Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, try to quit. Avoid alcohol and drugs, because they can make your symptoms worse. Exercise according to your healthcare providerâs instructions.
  • Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
  • Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

Get emergency care if you or a loved one have serious thoughts of suicide or harming others.

For more information, contact:

  • National Institute of Mental Health 866-615-6464

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Distinguishing Adjustment Disorder With Mixed Anxiety And Depressed Moods From Anxiety And Depression

Because adjustment disorder symptoms are shared with symptoms of other mental health disorders, it can be challenging to determine an accurate diagnosis. In the case of adjustment disorder with depressed mood, a doctor or mental health professional will work with the person experiencing the symptoms to determine whether he/she is dealing with an anxiety disorder, depressive disorder, both, or adjustment disorder with mixed anxiety and depressed mood.

Perhaps the single most important factor in differentiating between adjustment disorders and other mental health disorders is the presence of one or more identifiable stressors in the persons life. Adjustment disorder happens when someone is having difficulty coping with or adjusting to one or more life stressors of any severity. In the case of adjustment disorder with anxiety and depression, the stressors lead to both symptoms of anxiety and symptoms of depression. Without identifiable stressors that cause the symptoms, a diagnosis of something other than adjustment disorder is appropriate.

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