Psychiatric Care for Life Transitions and Adjustment

Life transitions such as a move, a new job, a breakup or divorce, a new diagnosis, or a change of school can bring stress that outlasts the event itself. When anxiety, low mood, irritability, or trouble sleeping persists and gets in the way of daily life, this may be an adjustment disorder. In children and teens, it can show up as changes in behavior or schoolwork.

How our physicians help

Our physicians take time to understand the change, what it means to you, and what else is going on, including depression or anxiety that the transition may have uncovered. Care is often brief and focused, centered on psychotherapy, with medication considered only when symptoms call for it. For children and teens, we work closely with parents and, with permission, with schools.

Signs in adults

Stress after a big change can creep in slowly, so it is easy to miss.

• You keep replaying the decision or the loss.
• You cry more easily, snap at people you love, or feel numb.
• You have dropped the friends or habits that used to steady you.
• You are drinking more, or using other substances, to get through the evening.

Signs in children and teens

Children and teens may not link a change to how they feel, so watch what they do.

• Younger children may have stomachaches or headaches on school mornings, with no clear medical cause.
• They may go back to earlier habits, such as needing help at bedtime or wetting the bed.
• Teens may drop sports, clubs, or friends they used to enjoy.
• Some teens take new risks, such as skipping class or trying alcohol or drugs.

How we tell adjustment disorder from other conditions

Timing is a key clue. Adjustment disorder usually begins within about three months of the change, so we map when symptoms started and whether you have felt this way before.

Major depression, anxiety disorders, and bipolar disorder can all surface during a stressful stretch. A frightening or violent event raises the question of post-traumatic stress disorder (PTSD). After a death, grief has its own course. A new job or a first year of college can reveal attention problems, such as ADHD, that old routines kept hidden. We also ask about sleep, alcohol and other substances, and medical causes such as thyroid problems.

Therapy, medication, and what each can do

Psychotherapy is the main treatment. Problem-solving therapy breaks a messy situation into steps you can act on. Cognitive behavioral therapy (CBT) helps you test the thoughts that keep stress going. Interpersonal therapy focuses on relationships and on stepping into a new role, such as new parent, retiree, or newly single person. Children and teens often do best when parents take part.

No medication is approved specifically for adjustment disorder, and many people never need one. An antidepressant may help if depression or an anxiety disorder is also present, but it needs several weeks to take effect and can cause side effects. A sleep or anxiety medicine may be used briefly, though some can cause drowsiness or dependence.

Treatment cannot undo a loss. It can help you find your footing while life settles, and many people improve as they adapt.

When to call, and how family can help

It is time to call if several weeks have passed and things are not easing, or if you are missing work or school.

If someone you love is struggling, ask what the change means to them before you offer solutions. With children, keep meals and bedtimes steady, give honest, simple facts about what comes next, and keep adult disputes out of their view.

If anyone in your family is thinking about suicide or self-harm, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

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