MENTAL HEALTH Stress & Anxiety • Obsessive-compulsive disorder • Post-traumatic stress disorder (PTSD) • Phobias • Panic attacks • Generalized anxiety disorder • Adjustment disorders • Social anxiety disorder (social phobia) • Oppositional defiant disorder (ODD)

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Layoffs, breakups, accidents — any number of life events can take the wind out of your sails. Most of the time your coping techniques, such as talking about your problems with loved ones and getting extra rest, may help you feel better within a few months. But if you've recently experienced a stressful event and your usual self-care steps aren't working, you may have a mental health condition called an adjustment disorder.

You may feel sad, worried or even reckless — the specific symptoms matter less than the fact that you started experiencing them within three months of a stressful event. If you have an adjustment disorder, the distress you're feeling is probably taking a toll on your performance at work, in school or in your social relationships.

Job loss, divorce and new medical diagnoses are all common triggers of adjustment disorders. But happy events like marriage and pregnancy also can be the cause. In some cases, you may not recognize that the triggering event was significant. But if you haven't felt like yourself since, it was important — and it's worth talking with your doctor about the possibility of an adjustment disorder. Untreated adjustment disorders can turn into more serious mental health problems. Available treatments may help you feel better soon.

If you begin to feel distressed or out of control within three months of a stressful event, you may have an adjustment disorder. The specific signs and symptoms of an adjustment disorder may vary greatly from one affected person to the next, but they typically fit into one of six adjustment disorder subtypes. These include:

• Adjustment disorder with depressed mood. If your symptoms primarily include feeling depressed, tearful and hopeless, and you don't take pleasure in the things you used to enjoy, you may have this type of adjustment disorder.
• Adjustment disorder with anxiety. The primary symptoms of this type of adjustment disorder include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones.
• Adjustment disorder with mixed anxiety and depressed mood. People with this condition have symptoms that fit both of these types of adjustment disorder.
• Adjustment disorder with disturbance of conduct. Behavioral problems, including violence and impulsive behavior, are characteristic of this type of adjustment disorder. Children and adolescents who are affected by this condition may skip school, vandalize property and get into fights.
• Adjustment disorder with mixed disturbance of emotions and conduct. People with this type of adjustment disorder experience symptoms of depression and anxiety as well as behavioral problems.
• Adjustment disorder unspecified. You may be diagnosed with this type of adjustment disorder if you experience emotional or behavioral problems soon after a difficult event, but your symptoms don't fit the other subtypes.

Researchers have suggested a distinct, seventh subtype called adjustment disorder with embittered mood. This proposed type of adjustment disorder is characterized by strong feelings of injustice and thoughts of revenge after a negative life experience. Obsessive thoughts about the negative event, a sense of helplessness and self-blame also are typical of this as-yet unofficial type of adjustment disorder.

Your doctor will determine which type of adjustment disorder best fits your symptoms, and may also distinguish between acute and chronic forms of the condition:

• Acute adjustment disorders. These last less than six months. Most adjustment disorders resolve in this time frame.
• Chronic adjustment disorders. These persist beyond six months. If your symptoms last this long, your doctor may change your diagnosis to a more serious mental health disorder such as major depression or generalized anxiety disorder.

Adjustment disorders are caused by identifiable events or changes in your life. Common stressors that lead to an adjustment disorder include:

• The end of a marriage or other significant relationship
• Job loss
• Financial or legal problems
• A new medical diagnosis

Life events that are commonly viewed as positive also can cause an adjustment disorder. Getting married, having a baby or going away to college all can trigger adjustment problems. In some cases, ongoing problems — such as living in a crime-ridden neighborhood — can reach a breaking point and cause an adjustment disorder.

For children and adolescents, the events that most commonly lead to adjustment disorders include:

• Marital problems or divorce between parents
• Family illness
• Death of a loved one
• Moving
• Problems in their peer relationships

Doctors aren't certain why one person is more likely than another to develop an adjustment disorder. Your inborn temperament appears to play a role. The strength of your support system also seems to make a difference. You may be more likely to develop an adjustment disorder when stressful events happen during a time when you're not well supported emotionally.

Studies also suggest that you're at increased risk of an adjustment disorder if you experienced stress in early childhood. Overprotective or abusive parenting, family disruptions and frequent moves early in life may establish a lasting sense of being unable to control life events — and increase the likelihood that later difficulties will cause anxiety.

People of all ages are affected by adjustment disorders. Among children and adolescents, boys and girls are equally at risk. But among adults, women appear to be at greater risk than are men.

Other risk factors include:

• Recent changes, difficulties or losses at work or in your family life
• A history of mental health problems, including eating disorders, anxiety, depression and bipolar disorder
• Prior exposure to war without having developed post-traumatic stress disorder (PTSD)
• Disadvantaged life circumstances

A diagnosis of a new medical illness also increases your risk of an adjustment disorder. Some studies have found that some people with cancer have an adjustment disorder, and the condition may be even more common among those with advanced or terminal cancer.

Although adjustment disorders may sound less worrisome than other mental health problems, such as depression, they are associated with equally serious risks. People with adjustment disorders are at increased risk of substance abuse problems, suicide and violence against others. If you or a loved one is having suicidal thoughts or seriously considering hurting someone, you need to seek help urgently. Emergency room staff can help in these situations. If you suspect your child is suicidal, you should also get help immediately.

Also seek immediate care if you have severe chest pain or trouble breathing, symptoms that can appear with severe anxiety.

Talk to your doctor if you have lasting feelings of sadness, worry or anger, or if you can't seem to stop acting in an impulsive manner. Effective treatments are available that can prevent adjustment disorders from turning into depression and other chronic mental health problems.

There is no clear-cut list of adjustment disorder symptoms, or of the stressors that are significant enough to trigger an adjustment disorder. The type and intensity of symptoms you experience may be very different from those of another person with an adjustment disorder. To diagnose the condition, your doctor needs to understand whether the distress you're feeling following a recent difficult event is abnormal for you when compared with your previous reactions to similar life events.

Your doctor will ask detailed questions so that he or she can differentiate between symptoms of an adjustment disorder and another serious mental health disorder, such as major depression, generalized anxiety disorder or post-traumatic stress disorder. You may also have another mental health disorder in addition to an adjustment disorder.

If your symptoms are severe or disabling, or have lasted longer than six months, your doctor may refer you to a psychiatrist for diagnosis and treatment.

Most people with adjustment disorders recover within six months and aren't at increased risk of long-term complications. People who have another mental health disorder, a substance abuse problem or a chronic adjustment disorder are at greatest risk of developing long-term mental health problems, which may include:

• Major depression
• Alcohol and drug addiction
• Suicidal thoughts and behavior

Adolescents and children with adjustment disorders are more likely than adults to develop these complications, and are also at increased risk of:

• Bipolar disorder
• Antisocial personality disorder
• Schizophrenia

However, doctors don't know whether adjustment disorders predispose children and adolescents to these problems. It's possible that youths affected by adjustment disorders are more likely to already have another, undiagnosed mental health disorder.

The primary treatment for adjustment disorders is psychotherapy, also called counseling or talk therapy. In addition to offering emotional support, your therapist will try to help you understand why the event that triggered your symptoms affected you so profoundly and will help you develop more effective coping mechanisms. Your doctor may recommend individual, family or group therapy sessions, depending on your circumstances. Counseling for adjustment disorders is usually short-term and aimed at resolving your symptoms.

Your doctor also may recommend a short course of medications to help manage some of the symptoms associated with adjustment disorders. To relieve depression and anxiety, he or she may prescribe a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil) or the related antidepressant venlafaxine (Effexor). If anxiety is your primary symptom, your doctor may prescribe an anti-anxiety medication such as alprazolam (Xanax) or clonazepam (Klonopin).

If your child is having difficulty adjusting after a stressful event or major life change, encourage your child to talk about his or her feelings whenever your child feels ready. Offer support and understanding, and reassure your child that his or her reaction is normal. Let other adults who spend time with your child know about the symptoms that he or she is experiencing and stay in close communication with these other adults about your child's progress.

It may reassure your child to have the chance to exert some control over his or her life. You can help by letting your child make simple decisions, such as what to eat for dinner or what movie to watch.

These same guidelines can help adults who have an adjustment disorder. If you are having trouble coping with a difficult event, talk with family and friends about your feelings, and take steps to manage your mental and physical health. Exercise regularly, follow a healthy diet, and limit your use of caffeine and alcohol.

Support groups can offer an effective place to work through your feelings with the help of others in similar situations. Most communities offer support groups for people who are adjusting to divorce, job loss, bereavement, new parenthood, new medical diagnoses and other major life changes. Ask your doctor or clergy member to help you find one that's right for you.

In addition to psychotherapy and medication, complementary therapies such as biofeedback, progressive muscle relaxation, massage therapy and yoga can help manage some of the symptoms of adjustment disorders, including stress, anxiety and depression:

• Biofeedback. In biofeedback, you learn to use your mind to control your body. Through practice, you can learn to control your heart rate, skin temperature, blood pressure and muscle tension, along with many other body functions.
• Progressive muscle relaxation. Progressive muscle relaxation, a technique in which people consciously tense and then relax muscles, can reduce anxiety and tension.
• Massage therapy. Massage involves the kneading, stroking and manipulation of your body's soft tissues — your skin, muscles and tendons. It's used to relieve muscle tension and stress and promote relaxation.
• Yoga. This 5,000-year-old practice incorporates breathing, movement and posture to achieve a union of mind, body and spirit. It involves completing a series of postures, during which you pay special attention to your breathing — exhaling during certain movements and inhaling with others. Yoga may help you to relax and manage stress.