Adjustment Disorder: A Diagnostic Guide

A neuropsychologically informed approach to identifying and supporting stress-related

syndromes

What is Adjustment Disorder? 3. The disturbance does not meet

criteria for another mental disorder
Adjustment Disorder (AD) is a stress- and is not merely an exacerbation of
response syndrome. It describes the a preexisting condition.
emotional or behavioral symptoms that
4. The symptoms do not represent
arise in response to an identifiable
normal bereavement.
stressor — symptoms are clinically
significant but do not meet criteria for 5. Once the stressor (or its
consequences) has terminated, the
another disorder, such as Major
symptoms do not persist for more
Depressive Disorder or PTSD.
than an additional 6 months.
DSM-5 Diagnostic Criteria (309.x)

To diagnose Adjustment Disorder, all five of

Specifiers
the following must be met:
Adjustment Disorder can be specified by
1. Emotional or behavioral symptoms
predominant symptom type, coded as
in response to an identifiable
follows:
psychosocial stressor (e.g.,
relationship conflict, job loss, Specifier Description
medical illness, move), occurring
within 3 months of the onset of the With depressed Sadness, tearfulness,
stressor. mood hopelessness

2. Clinically significant distress that is: Nervousness, worry,

With anxiety jitteriness, fears of
Out of proportion to the severity
separation
or intensity of the stressor,
and/or With mixed
Features of both the
Causing marked impairment in anxiety and
above
social, occupational, or other depressed mood
areas of functioning. With disturbance Behavioral issues such
of conduct as aggression, rule-

© 2025 ANGELES NEUROPSYCHOLOGY GROUP, LLC. All rights reserved.

For educational and therapeutic use only.
Not a substitute for professional diagnosis or treatment.
Specifier Description Condition How It Differs

breaking, defiance Pervasive low mood, loss

Major
(often in youth) of interest, neurovegetative
Depressive
changes, no clear onset
With mixed Disorder
tied to a stressor
disturbance of Both emotional and
emotions and behavioral symptoms Generalized Excessive worry across
conduct Anxiety domains for ≥6 months,
Disorder no clear single trigger
Maladaptive responses
Unspecified not classifiable in the Exposure to trauma (life-
above types PTSD/Acute threatening or shocking),
Stress Disorder with re-experiencing and
hyperarousal
Clinical Neuropsychological Insights
Culturally expected grief,
Adjustment disorders are time-limited usually proportional and
Bereavement
stress-response syndromes, but repeated without functional
or chronic stressors can predispose to impairment
longer-term syndromes.
Chronic interpersonal or
Frontal-limbic dysregulation (especially Personality
identity instability,
amygdala and anterior cingulate cortex) Disorders
longstanding patterns
contributes to overreactivity to stress.

HPA axis hyperactivity may elevate

cortisol, contributing to fatigue, Clinical Pearls
irritability, sleep disturbance, and
Adjustment Disorder is a diagnosis of
cognitive fog.
exclusion. Rule out primary mood,
In children/teens, conduct or somatic trauma, or anxiety disorders first.
symptoms may be more prominent than
Think of it as the “bridge diagnosis”
verbalized distress.
when someone is not doing well but
doesn’t quite meet criteria for a major
disorder.
Differential Diagnosis: Key Distinctions
Use this diagnosis to justify support
services and brief interventions early —
before symptoms worsen.

© 2025 ANGELES NEUROPSYCHOLOGY GROUP, LLC. All rights reserved.

For educational and therapeutic use only.
Not a substitute for professional diagnosis or treatment.
 In medical and rehabilitation settings,
AD is common following new diagnoses,
hospitalization, or functional loss.

Consider using Rating Scales (e.g., GAD-

7, PHQ-9) to track symptom evolution
and clarify if escalation occurs.

Treatment Considerations

Psychotherapy is first-line (esp. CBT,

supportive therapy, brief dynamic work):
✔ Normalize stress reactions
✔ Reframe interpretations of the stressor
✔ Build coping skills
✔ Support adaptive problem-solving

Pharmacotherapy is generally not first-line

unless symptoms are severe or
comorbidities (e.g., insomnia, panic,
depressive features) are present.

Bottom Line

Adjustment Disorder is a valid, treatable

diagnosis.
It honors the real impact of life stressors
without pathologizing a person’s entire
identity. It’s time-limited, stress-linked, and
highly responsive to early, compassionate
intervention.

Adjustment symptoms are common, but

support makes all the difference.

© 2025 ANGELES NEUROPSYCHOLOGY GROUP, LLC. All rights reserved.

For educational and therapeutic use only.
Not a substitute for professional diagnosis or treatment.