Adjustment disorder is emotional or behavioral distress that starts within 3 months of a clear stressor, such as a breakup, job loss or illness, and is stronger than expected or disrupts daily life. It usually settles within 6 months once the stressor ends or the person adapts.
Key symptoms
- Low mood, tearfulness or hopelessness after a stressful event
- Worry, nervousness or feeling overwhelmed
- Trouble sleeping or concentrating
- Pulling away from friends, work or school problems
- Acting out or reckless behavior, mostly in teens
What you find on exam
- Mental status exam: mood, affect, thought content
- Ask directly about suicidal thoughts and plans
- Look for alcohol or drug use as coping
- Check that criteria for major depression, PTSD or another disorder are not met
Tests
- Diagnosis is clinical, linked in time to a stressor
- PHQ-9 and GAD-7 to measure symptoms
- Suicide risk screening, such as the Columbia scale
- Labs only if a medical cause is suspected, such as thyroid tests
Treatment basics
- Supportive brief psychotherapy and problem solving
- Cognitive behavioral therapy and stress management skills
- Help with the stressor: social work, work or school supports
- Short-term medicine for sleep or anxiety only if needed
- Follow up to watch for progression to depression
Red flags
- Suicidal thoughts, plan or recent self-harm
- Heavy alcohol or drug use
- Symptoms lasting beyond 6 months or worsening into major depression
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.