Adjustment disorders

An adjustment disorder happens when a stressful event or change becomes too much to cope with, and your reaction is stronger than you'd expect. The stressor can be one event, such as losing a job; several in a row, such as money trouble followed by a breakup; or an ongoing situation, such as caring for a family member who is ill. Common triggers include:

• A death or loss
• A divorce, breakup or problems in a relationship
• Illness or health worries, your own or a loved one's
• Moving to a new home or city
• Money worries, or an unexpected disaster
• Big milestones, even good ones like becoming a parent

Common signs, in plain language

• Feeling sad, hopeless or tearful
• Feeling nervous, tense or worried
• Pulling away from people
• Struggling at work or with everyday responsibilities
• Acting on impulse or in ways that aren't like you
• Physical signs, such as trembling or a skipped heartbeat

Symptoms usually begin within 3 months of the stressor. These signs are a general guide, not a checklist for diagnosis.

Sometimes symptoms become severe, including thoughts of suicide. If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

Grief is a healthy, natural response to losing someone or something important, and it deserves respect, not a diagnosis. Everyone grieves in their own way. The most intense phase may last up to about 2 months, and milder feelings can last a year or longer.

Sometimes grief becomes more than expected, doesn't ease, or turns into depression. That's when an evaluation can help. Read more in our article on how grief affects mental health.

A careful evaluation looks at both the change in your life and how you're responding to it:

• What happened or changed, and when your symptoms started
• How strong your reaction feels, and how much it affects work, relationships and daily life
• Your sleep, mood, health and medications
• Whether something else explains the picture better, such as depression, an anxiety disorder or PTSD

Adjustment disorders can also happen alongside other conditions, so we look at the whole picture. This is part of a comprehensive psychiatric evaluation. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

The goal is to ease your symptoms and help you get back to how you were functioning before the change. Talk therapy is the usual main treatment, such as cognitive behavioral therapy (CBT), which helps you notice unhelpful thoughts and turn them into more helpful thoughts and actions. Support from family and friends, a steady daily routine and taking care of your health all help too.

Support in visits. Depending on your clinician, visits may draw on supportive, motivational interviewing, CBT-based, or DBT-based skills. We also talk through sleep habits and practical ways to cope with what's in front of you.

Medication, when it helps. Medication isn't the main treatment for an adjustment disorder, and the evidence for it is limited. It may help, alongside talk therapy, if you're anxious most of the time, not sleeping well, or very sad or depressed. If the picture turns out to be depression or an anxiety disorder, we treat that.

Therapy. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Regular follow-ups. We check in regularly. If symptoms aren't easing, or they're getting deeper, we look again at what's going on and adjust the plan.