Adjustment Disorder: Supporting People After Stressful Events

Adjustment disorder is one of the most common reasons that people become distressed after something difficult happens in their lives, yet it is rarely discussed in care training. It describes an emotional or behavioural reaction to a stressful event that is stronger or longer-lasting than might be expected. In health and social care, staff meet this reaction often: after a bereavement, a new diagnosis, a move into a care home, a relationship breakdown or a loss of independence. This guide explains what adjustment disorder is, what it can look like and how staff can help. It draws on information from an NHS trust's mental health service and should be read alongside our guide to depression screening for older adults in care homes.

What is adjustment disorder?

An NHS trust's military mental health service describes adjustment disorder as an acute emotional or behavioural reaction to a recent stressor. The key features are an identifiable stressful event, symptoms that start within about three months of that event, and a reaction that usually lasts from days to several weeks. The page makes clear that stress reactions are normal and typically short-term. Because that page is undated and comes from a single trust, staff should treat this as an introduction rather than a clinical definition and look to local clinical guidance for detail.

What can trigger it?

The source describes triggers such as a stressful or traumatic event, and extreme distress after an event or being preoccupied with it. In practice the trigger varies enormously from person to person. Events that staff meet in care and support settings might include bereavement, a serious illness, a change of home or care provider, a family dispute or the loss of a job or role. What matters is not how big the event seems to others but what it means to the individual. The source itself highlights acknowledging the personal significance of the event.

Signs and symptoms

The same source lists symptoms that include:

• feeling overwhelmed or unable to cope
• trouble sleeping
• headache, stomach or chest pain, or palpitations
• acute anxiety or low mood
• drinking more alcohol

Note that several of these symptoms are physical. A person may complain of aches, sleeplessness or a racing heart rather than saying they are distressed. This is a reason for staff to ask how someone is feeling and not to assume that every physical symptom has a physical cause, while still making sure that new or severe symptoms are checked by a clinician. Where anxiety is prominent, our guide to generalised anxiety and panic disorder may help staff understand the overlap.

How it differs from depression and post-traumatic stress

Adjustment disorder is linked to a specific stressor and is usually shorter-lived. If low mood is severe or lasts longer than expected, or if the person has been through a life-threatening event and has flashbacks or nightmares, a clinician should assess whether something else, such as depression or post-traumatic stress, is going on. Care staff are not expected to make that distinction, but they are well placed to notice how long symptoms last and whether they are getting better or worse.

Supporting someone through it

The NHS trust source suggests practical steps that fit well with everyday care.

• Change the situation where possible. If the stressor can be reduced or removed, do so. Where it cannot, help the person find ways to cope.
• Build on strengths. Help the person recognise the steps they have already taken to cope.
• Keep connections strong. Support from family, friends and the community helps. Encourage contact where the person wants it.
• Return to usual activities. The source suggests returning to usual activities within a few weeks, at a pace the person can manage.
• Allow short-term rest. A short period away from usual duties or a short-term sick certificate may help, which for a colleague would be a matter for their GP.
• Encourage professional advice. Suggest that the person speaks to their GP if they are struggling.

When to seek further help

The source advises seeking professional support but does not set a threshold, so a sensible approach for staff is to ask for a GP review if symptoms are severe, getting worse or not easing after a few weeks. Also seek help sooner if the person drinks more heavily, stops eating or sleeping properly or cannot manage everyday tasks.

Always take any talk of suicide or self-harm seriously. Follow your organisation's procedures and see our guide to suicide and self-harm awareness for care staff. In an emergency, call 999.

Frequently asked questions

Is adjustment disorder a serious condition?

It can cause real distress and affect daily life, even though it is usually short-lived. People deserve the same respect and support as with any other mental health difficulty.

How long does it last?

The NHS trust source says it usually lasts from days to several weeks, but if it continues or worsens, a clinician should review the person.

Can staff diagnose it?

No. A diagnosis is made by a suitably qualified clinician. Staff can observe, record, support and escalate.

How can staff keep learning?

Use the health and social care learning available through Learnsignal CPD to build confidence in supporting people through difficult times.

This article is general information for care staff, based on information from an NHS trust mental health service, and does not replace the advice of a person's own clinicians. If you are worried about someone's health right now, contact their GP, NHS 111 or, in an emergency, call 999.