What are Adjustment Disorders?

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Life can be challenging at any age, but for teenagers, it can feel especially overwhelming. Whether it’s juggling academic responsibilities, maintaining friendships, starting a first job, or trying to fit in, life can sometimes feel like too much to handle. For some teenagers, these challenges are too difficult to manage and could lead to the development of an adjustment disorder.

Learning about adjustment disorders is important because teenagers face new responsibilities, and social pressures, that can make life harder to cope with. Understanding adjustment disorder, its symptoms, and treatments is crucial because addressing it early can prevent more serious problems. In this post, we will define adjustment disorder, how it affects daily life, learn its symptoms, risk factors, how it affects the brain and available treatment options.

How do Adjustment Disorders Affect Your Life?

Adjustment disorders happen when a person experiences a stressful event in which their reactions to this event are more intense, last longer than expected, and interfere with daily life (Casey & Bailey, 2011). Teenagers already experience many changes such as navigating a breakup for the first time, struggling with academics, or dealing with the pressures of social media. For some teens, these changes may be too overwhelming. When reactions to these stressors are more severe than expected, it could be because of an adjustment disorder. Adjustment Disorder is actually pretty common, with studies showing that over 50% of psychiatrists diagnose it regularly (Zelviene & Kazlauskas, 2018). Therefore, it is important to be aware of this condition so that you are informed and know what to do if you feel this way.

What Counts as an Adjustment Disorder?

Adjustment Disorder occurs when emotions, or behaviours, change within three months of a stressful life event. The reaction must be more than what would normally be expected for that situation and must cause noticeable problems in important areas of life, such as at school, with friends, or with family. The symptoms can include feelings of sadness, anxiety, or excessive worry. Some people may also have behavioural changes, such as becoming more argumentative, acting impulsively, or having difficulty following rules. In many cases, people experience a combination of emotional and behavioural symptoms.

Although these reactions may look similar to symptoms of anxiety or depression, the key feature of Adjustment Disorder is that the symptoms are directly linked to a specific stressor, like a breakup or moving to a new city. The symptoms do not count as something like anxiety or depression, because adjustment disorders are caused by a stressful life change and typically resolve when the situation calms down, has been accepted, and the person learns ways to cope, which should take no more than 6 months (American Psychiatric Association, 2022).

Risk Factors

Adjustment disorders usually develop after a person experiences a stressful life event that becomes difficult to manage. However, not everyone who experiences change develops this condition. Certain factors can make some individuals more vulnerable to developing adjustment disorder (American Psychiatric Association, 2013; Bachem & Casey, 2018; Casey & Bailey, 2011; Casey & Doherty, 2012; O’Donnell et al., 2016).

Some of these factors are:

●       Major stressful life events can trigger adjustment disorder, Examples include losing a loved one, relationship breakups, money problems, illness, school pressure, or job stress.

●       Personality traits can increase risk. People who worry a lot, react strongly to emotions, or tend to think negatively may find it harder to deal with life changes.

●       Past stress or trauma can make someone more vulnerable. If a person has experienced difficult events before, their body and mind may become more sensitive to stress later in life.

●       Poor coping skills increase the risk. People who do not have strong ways to manage emotions, solve problems, or adapt to change may struggle more when stressful situations occur.

●       Lack of social support can make stress harder to handle. People without supportive friends, family, or community may feel more alone when dealing with difficult situations.

●       Existing mental health problems, such as anxiety or depression, can make it harder to deal with new stress and increase the risk of adjustment disorder.

●       Biological factors may also play a role. Differences in how the brain and body respond to stress may explain why some people develop stronger reactions to stressful events.

How Does it Affect the Brain?

Although stress may affect how we feel, it also affects how our brain functions. After encountering a significantly stressful event (such as a breakup, moving schools or family conflict), brain areas responsible for controlling emotions become harder to regulate. An important structure involved is called the amygdala. The amygdala acts as an alarm system for the brain. It detects threats and triggers our emotional responses like fear or anxiety. During overwhelming stress, the amygdala can become more reactive, especially during adolescence, when the brain is still developing (Tottenham & Galvan, 2016). In Adjustment Disorder, the alarm stays activated for longer than it should. This helps to understand why people with Adjustment Disorder feel constantly on edge or unable to control emotions, making everyday stressors feel much bigger than they actually are.

Image Credit: National Institute of Mental Health.

Another important area is the prefrontal cortex (PFC). This helps with decision making, self control and calming emotions. Stress tends to weaken the communication between both the amygdala and the prefrontal cortex, which makes it harder to regulate reactions made from emotions. When the prefrontal cortex is less effective at regulating emotional responses from the amygdala, individuals may experience a stronger reaction to stress (Myung et al., 2016). Understanding how the various parts of the brain interact helps to explain why stressful events tend to feel overwhelming. However, understanding how the brain works can also highlight that healthy coping strategies, along with support, can help the brain adapt and recover.

Treatment Options

Although Adjustment Disorder can feel overwhelming, it is highly treatable. Many people improve once they learn healthier ways to respond to stress. One of the most effective treatments is talk therapy, particularly Cognitive Behavioural Therapy (CBT). CBT helps teens recognize unhelpful thoughtful patterns, such as “I can’t handle this” and replace them with more balanced, realistic thoughts. It also teaches coping skills to manage intense emotions and problem-solving strategies for stressful situations (Casey & Doherty, 2012).

Support systems are also essential. Talking to a trusted adult, school counsellor, family member, or friend can reduce feelings of isolation. Feeling heard and supported helps calm the body’s stress response and makes challenges feel more manageable. In some situations, short-term medication may be considered if severe anxiety, or lack of sleep, are interfering with daily functioning. However, medication is typically not the first option and is often combined with therapy (American Psychiatric Association, 2013). Most importantly, Adjustment Disorder is often temporary. With the right support and coping strategies, many individuals begin to feel better within a few months.

Closing

Although Adjustment Disorder is common, it can significantly affect a teen’s life. It develops after a specific stressful event and is characterized by emotional, or behavioural, reactions that are more intense than expected and interfere with daily functioning (American Psychiatric Association, 2013). Although the distress can feel overwhelming, adjustment disorders are usually temporary. When the stressor is resolved, or coping skills improve, the problem resolves and the person can move on with their life (Casey & Bailey, 2011). Early treatment is key in preventing symptoms from developing into more serious mental health concerns.

Call-to-Action

If you or someone you know is struggling after a major life change, do not ignore the signs. Reach out to a trusted adult, school counsellor, healthcare provider, or mental health professional. Learning effective coping strategies and building strong support systems can make stressful situations feel more manageable and less overwhelming. We encourage you to continue learning about stress, coping strategies, and mental health so you can better understand yourself and others. If you feel comfortable, share your thoughts or experiences in the comments below. Your voice may help someone else feel understood and less alone.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Bachem, R., & Casey, P. (2018). Adjustment disorder: A diagnosis whose time has come. Neuropsychiatric Disease and Treatment, 14, 375–381. https://doi.org/10.2147/NDT.S121072

Casey, P., & Bailey, S. (2011). Adjustment disorders: The state of the art. World Psychiatry, 10(1), 11–18. https://doi.org/10.1002/j.2051-5545.2011.tb00003.x

Casey, P., & Doherty, A. (2012). Adjustment disorder: Implications for ICD-11 and DSM-5. Neuropsychiatric Disease and Treatment, 8, 543–550. https://doi.org/10.2147/NDT.S121072

Myung, W., Na, K.-S., Ham, B.-J., Oh, S.-J., Ahn, H.-W., & Jung, H. Y. (2016). Decreased medial frontal gyrus in patients with adjustment disorder. Journal of Affective Disorders, 191, 36–40. https://doi.org/10.1016/j.jad.2015.11.028

O’Donnell, M. L., Alkemade, N., & Creamer, M. (2016). Biological and neurobiological perspectives on stress-related disorders. Neuroscience & Biobehavioral Reviews, 68, 715–728. https://doi.org/10.1016/j.neubiorev.2016.07.030

Tottenham, N., & Galván, A. (2016). Stress and the adolescent brain: Amygdala–prefrontal cortex circuitry and ventral striatum as developmental targets. Neuroscience & Biobehavioral Reviews, 70, 217–227. https://doi.org/10.1016/j.neubiorev.2016.07.030

Zelviene, P., & Kazlauskas, E. (2018). Adjustment disorder: Current perspectives. Neuropsychiatric Disease and Treatment, 14, 375–381. https://doi.org/10.2147/NDT.S121072