What Is Adjustment Disorder And How Does It Differ From Post-Traumatic Stress Disorder (PTSD)?

Reactions to trauma vary greatly from one person to the next — as does what a person personally experiences as traumatic. While post-traumatic stress disorder has got to be the most well-known trauma-related diagnosis, some people who lived through events that were traumatic to them will instead be diagnosed with adjustment disorder. 

What do you need to know about the differences between the two?

A look at the diagnostic requirements for PTSD and acute stress disorder

Post-traumatic stress disorder can be diagnosed in people who meet the diagnostic criteria laid out in the diagnostic and statistical manual of mental disorders (DSM-5) at least a month after a traumatic event.

The first diagnostic criterion explains what kinds of events are considered traumatic — exposure to actual or threatened death, serious injury, or sexual violence. Someone may be a direct victim, or witness one or more of these catastrophic events happen to someone else. In some cases, people may also be diagnosed with PTSD after learning that a loved one went through a trauma, or after repeatedly being confronted with the gory details of others' trauma, for instance as a law enforcement officer, medic, or firefighter. 

With those qualifiers out the way, the range of PTSD symptoms recognized in the DSM-5 are:

• Reexperiencing the trauma through intrusive memories, flashbacks, nightmares, or distress after being reminded of the trauma in some way. People diagnosed with PTSD will relive their trauma in at least one of these ways. 
• Avoiding reminders of the trauma to the best of your ability — these reminders can be out in the world, in your mind, or both. 
• Experiencing negative thinking patterns — being unable to remember important details of the trauma, negative and distrustful thoughts about the world and the people in it, experiencing excessive self-blame, feeling detached from others, having angry, frightful, or sad thoughts, being unable to experience positive emotions, and losing interest in activities that previously mattered to you. At least two of these symptoms are necessary for a diagnosis of PTSD. 
• Having reactive responses as a result of the trauma — angry outbursts, reckless or harmful behavior, hypervigilance (being "on guard"), a highly active startle response, trouble focusing, and trouble sleeping. Again, two symptoms are required. 

In the first three days to a month after a traumatic event, people who experience a significant number of PTSD symptoms may be diagnosed with acute stress disorder. While a portion of those people will go on to develop post-traumatic stress disorder, many will not. 

Who might be diagnosed with adjustment disorder instead?

Adjustment disorder, which also appears in the DSM-5 chapter on trauma-related disorders, may be diagnosed in people who are having marked emotional difficulty that starts within three months after experiencing an identifiable "stressor". This stressor can be much broader than the set of circumstances the DSM-5 considers "traumatic", and can include the loss of a loved one (not necessarily under traumatic circumstances), a romantic breakup, job loss, or anything else exceptionally life-changing for the person who experienced it. 

Adjustment disorder is a diagnosis with a very short set of diagnostic criteria:

• Distress clinically considered disproportionate to the severity of the stressor. 
• This distress causes significant difficulties in daily functioning. 
• The distress isn't the result of another mental disorder, or the worsening of a preexisting mental disorder. 
• The symptoms don't fall under "normal bereavement". 
• Once the stressor ceases to exist, the symptoms stop within six months. (This might mean you cope better within six months of losing a loved one, or after a breakup — one-time events. It may mean within six months after finding a new job or six months after a loved one's chemotherapy came to an end — some stressors go on much longer, after all.)

Adjustment disorder additionally comes with some possible specifiers, and can be diagnosed with depressed mood, anxiety, mixed anxiety and depression, disturbed conduct, disturbed emotions and conduct, and unspecified. 

In the context of wondering how adjustment disorder differs from PTSD and other trauma-related diagnoses, you need to know that:

• Some people who were exposed to events the DSM-5 agrees are traumatic may be diagnosed with adjustment disorder rather than acute stress disorder or PTSD, if the symptoms fit better. In practice, this means the many people who have "sub-threshold" PTSD symptoms or acute stress disorder symptoms after a trauma; meaning some symptoms, but not enough to meet the diagnostic criteria. 
• People who were exposed to stressors that were traumatic to them but not recognized as such in the DSM-5 may also be diagnosed with adjustment disorder. These people have, for all intents and purposes, PTSD, but the nature of their stressor is not recognized as traumatic. 
• The stressor that causes adjustment disorder can be of any severity, as long as it is distressing to the person going through it. Examples from the DSM-5 include living in a crime-ridden neighborhood, a long and disabling illness, the death of a loved one, a natural disaster, a romantic breakup, and even adolescents leaving home or having an unfulfilling romantic relationship. 

We have to recognize that the nature of adjustment disorder is somewhat subjective — the professional diagnosing it has to deem the reactions to the stressor to be beyond the cultural norm.