Psychiatry
AKT · Psychiatry/Anxiety & stress
Adjustment disorder
Overview
An emotional/behavioural reaction to an identifiable psychosocial stressor (divorce, diagnosis, job loss), out of proportion or impairing function, beginning within ~1 month and resolving within ~6 months of the stressor ending. Milder than depression/PTSD.
Recognise
- Clear, identifiable stressor within the preceding month
- Low mood, anxiety, worry, difficulty coping — but below the threshold for a depressive or anxiety disorder
- Functional impairment that resolves once the stressor/its consequences pass
Red flags
- Emerging major depression, suicidal ideation, or PTSD-level symptoms → reclassify and treat accordingly
Differentials & how to tell them apart
Depressionmeets full depressive criteria, often without a single clear stressor or persisting beyond it
Acute stress reactionwithin hours–days of a TRAUMATIC event, very short-lived
Post traumatic stress disorderfollows a life-threat event with re-experiencing/hyperarousal >1 month
Normal griefbereavement-specific, culturally expected
Investigations
Clinical; identify the stressor and timeline. Screen for depression (PHQ-9) to ensure it has not crossed the threshold.
Management
- 1Psychological support / problem-solving and addressing the stressor; watchful waiting.Gate: If symptoms meet the full threshold for depression or an anxiety disorder → treat as THAT disorder, not adjustment disorder
- 2Brief psychological therapy if persistent; review as the stressor resolves.
Usually none — psychological support is first-line; short-term symptomatic only if needed
Key points
Defined by the stressor and the timeline (onset <1 month, resolution <6 months). The exam contrast is "stressor + sub-threshold symptoms" vs full depression/PTSD.
Monitor & prognosis
Symptom course as the stressor resolves; escalate if it crosses a diagnostic threshold.
Usually self-limiting once the stressor passes.
Source: ICD-11; NICE (common mental health problems)