Adjustment Disorder

One of the most common mental health diagnoses in general practice, though probably under-recognised as a distinct entity — it’s easy to either dismiss the presentation as “understandable” and not treat it, or to over-diagnose major depression/an anxiety disorder instead.

Diagnosis

The development of emotional or behavioural symptoms in response to an identifiable stressor (or stressors), occurring within 3 months of the stressor’s onset, where:

The distress is markedly out of proportion to the severity/intensity of the stressor (accounting for context and culture), and/or there is significant impairment in social, occupational, or other important functioning.
The disturbance does not meet criteria for another specific mental disorder (e.g. major depression, GAD) and is not simply an exacerbation of a pre-existing disorder.
Symptoms are not normal bereavement.
Once the stressor (or its consequences) has ended, symptoms don’t persist for more than a further 6 months.

Stressors can be single events (job loss, relationship breakdown, a new medical diagnosis) or ongoing (chronic illness, ongoing family conflict), and can be recurrent (e.g. seasonal business crises) — the diagnosis applies as long as it’s tied to an identifiable stressor and doesn’t meet fuller criteria for another disorder.

Subtypes (specifier, based on the predominant symptom pattern): with depressed mood; with anxiety; with mixed anxiety and depressed mood; with disturbance of conduct; with mixed disturbance of emotions and conduct; unspecified.

Differentiating from other diagnoses

Major depression / an anxiety disorder — diagnose these instead if full criteria are met, even if there’s an identifiable trigger; a stressor doesn’t preclude a “proper” depressive or anxiety episode.
Normal grief/bereavement — expected distress following a death is not, by itself, adjustment disorder (though prolonged grief that meets specific duration/severity criteria is now its own DSM-5-TR/ICD-11 diagnosis — see below).
PTSD/Acute stress disorder — require exposure to actual or threatened death, serious injury, or sexual violence, with the specific re-experiencing/avoidance/ arousal symptom clusters; a difficult life event that doesn’t meet this threshold (e.g. divorce, job loss) is adjustment disorder territory, not PTSD.

Management

Psychological therapy is first-line — brief, problem-focused approaches (problem-solving therapy, brief CBT, supportive counselling) tend to work well, given the time-limited, stressor-linked nature of the condition. Practical/social interventions addressing the stressor itself (where modifiable) are as important as formal psychotherapy.

Medication is not first-line and there’s limited evidence for antidepressants specifically in adjustment disorder — reserve pharmacotherapy for significant, persistent, or functionally disabling symptoms, or if the presentation evolves into a diagnosable depressive/anxiety disorder.

Most cases resolve within months, especially once the stressor resolves or the person adapts — but don’t assume it will always be self-limiting: reassess if symptoms are worsening, persisting well beyond the stressor, or if there’s any suicidal ideation, which should be assessed with the same rigour as in any other mental health presentation (see Suicide Risk Assessment).

Prolonged grief disorder

A related but distinct diagnosis (new to DSM-5-TR/ICD-11), for grief that persists well beyond expected cultural/social norms — ≥12 months in adults (≥6 months in children/adolescents) after a death, with intense yearning/preoccupation with the deceased plus significant functional impairment, distinct from normal grief which, while painful, doesn’t typically cause this degree of persistent impairment. Treatment is specialised grief-focused psychotherapy; routine antidepressants alone are not an established treatment for prolonged grief itself (though comorbid depression should still be treated). See also Illness/Loss/Death of Child/Partner/Family for the broader normal-grief and family-support framework.