Adjustment disorder (AD) is a psychiatric condition characterized by emotional and behavioral responses to identifiable psychosocial stressors, resulting in significant impairment in functioning (1). According to the American Psychiatric Association (2013) and the ICD-11 criteria, AD develops in response to a specific stressor and can negatively impact an individual’s functioning (1, 2). AD is also referred to as an “adjustment syndrome” and is associated with severe emotional distress (3). AD shares certain similarities with post-traumatic stress disorder (PTSD); while PTSD is typically linked to life-threatening events, AD can arise from more common stressors. Although AD and PTSD may appear similar due to their association with external stressors, they differ substantially in terms of diagnostic criteria and symptomatology. PTSD typically involves exposure to life-threatening or highly traumatic events and is marked by intrusive thoughts, flashbacks, and persistent avoidance of trauma-related stimuli. In contrast, AD results from non-traumatic but significant psychosocial stressors and is characterized by emotional or behavioral symptoms that are disproportionate to the stressor, yet insufficient to meet criteria for other specific mental disorders. Although AD is frequently diagnosed by clinicians, it has been studied less extensively compared to other psychiatric disorders (4). The stressors that lead to AD can vary between individuals (5). Paykel et al. (3) classified life events as “desirable/undesirable” (e.g., career advancement/illness) and “entry/escape” (e.g., marriage/loss of a loved one) (3). Similarly, mandatory and structured stressful life events, such as a compulsory military service, may have adverse psychological effects on individuals.

Military service constitutes a unique context for AD due to its distinct psychosocial stressors. These may include forced relocation, interpersonal conflicts with superiors, disruption of daily routines, chronic sleep disturbances, intense physical training demands, limited personal autonomy, reduced access to social support, and difficulties adapting to strict institutional hierarchies and environments. Notably, the clinical sample in our study comprised individuals who developed symptoms of AD in response to military-related stressors that, while not formally classified as traumatic, involved significant and sustained psychological strain. Therefore, our findings regarding schemas, coping strategies, and functional impairments should be interpreted within this specific institutional and psychosocial context. The response to stressors depends on individual factors, including age, gender, health status, and comorbid psychiatric conditions, as well as contextual factors, such as educational level, social support, religious beliefs, and economic conditions (6).

In this context, stress can be defined as an individual’s inherent response to a stimulus, pressure originating from an external source, or a dynamic process involving both internal and external factors (7, 8). Coping strategies play a critical role in maintaining psychological well-being and are associated with dynamic, cognitive, and behavioral efforts by the individual (9). Research on the clinical course of AD primarily focuses on two key areas: consultation-liaison psychiatry and military mental health. Within the realm of consultation-liaison psychiatry, AD may arise in association with chronic illnesses or highly stressful conditions and can predispose individuals to other psychiatric disorders (10). Military personnel represent a distinct at-risk group for AD due to their continuous exposure to stress. A study conducted in the United States found that AD was implicated in one-third of newly diagnosed mental health disorders among military personnel and that early diagnosis could influence the duration of a military career (11). The progression of AD, including whether the disorder becomes chronic or evolves into more severe psychiatric conditions, is a critical research area in both military and civilian populations due to its impact on functional impairment (11, 12).

Early maladaptive schemas (EMS) are stable cognitive-emotional frameworks, developed during childhood and adolescence, that profoundly affect individuals’ interpretations and responses to stress (13). While extensive research has focused on EMS in relation to chronic psychopathologies, particularly personality disorders and persistent mood/anxiety conditions (14), their role in acute stress-related disorders, such as AD, remains less explored. Investigating EMS in AD represents a novel and significant contribution to the literature, as it offers insights into schema-driven vulnerabilities that shape coping mechanisms and contribute to functional impairments, potentially improving therapeutic outcomes through targeted schema-based interventions. EMS may represent a key mechanism in the development of AD. According to Young et al. (13), EMS are persistent cognitive and emotional patterns that develop through early life experiences and influence how individuals perceive, interpret, and regulate their environment. EMS are therefore critical factors that can shape the stress-coping mechanisms of an individual and are likely to play a significant role in stress-related psychiatric disorders such as AD (15). To the best of our knowledge, studies directly examining the relationship between AD and EMS are limited.

Individuals may develop various strategies to manage the activation or potential activation of EMS. According to Young’s conceptualization, three primary coping mechanisms are utilized as a response to EMS: surrender, avoidance, and overcompensation (16). Surrender entails the acceptance of the schema as true and behaving accordingly. Avoidance refers to cognitive or behavioral strategies aimed at preventing the activation of the schema, such as emotional detachment or distraction. Overcompensation, on the other hand, is characterized by an attempt to counteract the schema by adopting exaggeratedly opposite beliefs and behaviors. It is important to note that these coping mechanisms primarily serve to manage internal emotional and cognitive experiences rather than external circumstances. Additionally, these responses are often automatic, occurring without conscious awareness (16). Understanding these coping patterns is therefore essential to evaluate the persistence of maladaptive schemas and their role in psychological distress.

Given the limited number of studies directly addressing the relationship between AD and EMS, the present study seeks to determine whether EMS represent a risk factor in the development and persistence of AD symptoms.

Based on the existing literature and clinical observations, this study hypothesizes that individuals diagnosed with Adjustment Disorder would report higher levels of maladaptive schemas—particularly Failure, Enmeshment/Dependence, Pessimism, Entitlement/Insufficient Self-Control, and Social Isolation/Mistrust—along with increased use of avoidance-based coping strategies and impaired functionality, compared to healthy controls. The rationale behind focusing on schemas, coping, and functionality in individuals with AD is to identify underlying cognitive-emotional vulnerabilities (schemas) that shape maladaptive coping responses. While the primary analyses are hypothesis-driven, secondary exploratory analyses were also conducted to examine additional associations that could further clarify the clinical picture of AD.

The current study is among the very few that have examined the relationship between AD, EMS, and coping mechanisms in individuals who were committed to work at a new institution. The key finding of the current study is that individuals with AD show significantly higher scores in the maladaptive schemas of social isolation/mistrust, enmeshment/dependence, and entitlement/insufficient self-control compared to healthy controls. These schemas are strongly linked to avoidance-based coping strategies and worse functional outcomes. To our knowledge, the current study is the first to explore these specific schema patterns in individuals with AD. Given the limited research in this area, our findings can contribute to a deeper understanding of functional impairment and maladaptive coping mechanisms in this patient population.

EMS have been widely investigated across a broad spectrum of psychiatric disorders, consistently demonstrating elevated levels in clinical populations. Numerous studies have established strong associations between EMS and conditions such as major depressive disorder (24), borderline personality disorder (25), obsessive-compulsive disorder (26), PTSD (27), and eating disorders (28). For instance, individuals with borderline personality disorders tend to score high across nearly all EMS domains, particularly abandonment, emotional deprivation, and mistrust/abuse, while individuals with depression exhibit heightened defectiveness/shame, failure, and social isolation schemas (29). Similarly, patients with PTSD display elevated levels of emotional inhibition, vulnerability to harm, and mistrust/abuse schemas, while patients with obsessive-compulsive disorder often display perfectionism/unrelenting standards and emotional inhibition (30). Despite the extensive research on EMS across various psychiatric conditions, AD remains significantly understudied in this context. To address this gap, our study provides novel insights into EMS patterns in individuals with AD, revealing significantly higher scores compared to healthy controls. The most pronounced effects were observed in the schemas related to social isolation/mistrust, enmeshment/dependence, and entitlement/insufficient self-control. These findings suggest that much like other psychiatric disorders, AD may also be characterized by maladaptive cognitive and emotional patterns, further underscoring the importance of schema-focused interventions in this patient population (31). Similar schema-based mechanisms have also been documented in other clinical populations. For example, Parlak et al. (32) found that individuals with alcohol use disorder who scored high in maladaptive schema domains such as disconnection, impaired autonomy, and insufficient self-control were more likely to rely on avoidance-based coping styles and experience higher craving intensity. These findings further support the transdiagnostic relevance of EMS and the clinical importance of addressing maladaptive coping early in treatment planning (32).

Maladaptive schemas are believed to develop in response to negative parental attitudes and early traumatic experiences (32, 33). The enmeshment and dependence schema, in particular, is characterized by a lack of self-sufficiency, difficulties in making independent decisions, and a persistent reliance on others. The heightened presence of this schema in individuals with AD may reflect underlying dependent personality traits, reduced autonomy, and difficulties in emotional regulation. Barber and Harmon (34) demonstrated that overcontrolling or intrusive parental attitudes can reinforce feelings of dependence and inadequacy, potentially shaping cognitive frameworks that contribute to AD (34). In the current study, individuals with AD exhibited a decreased tendency to engage in active problem-solving strategies such as planning and seeking external support, preferring to rely more heavily on avoidance-based coping mechanisms, including emotional-behavioral and biochemical avoidance. This preference for avoidance may serve as a short-term attempt to reduce distress but is likely to reinforce maladaptive patterns, further entrenching emotional and functional impairment. The prominence of enmeshment/dependence and low self-efficacy schemas suggests that these cognitive structures not only shape emotional responses but also directly influence coping styles, potentially exacerbating AD symptoms over time and limiting adaptive stress management.

One of the most compelling insights from our study is the identification of a direct relationship between maladaptive schemas and dysfunctional coping behaviors in AD. In particular, we found that the entitlement/impaired self-control schema exhibited the strongest positive correlation with biochemical avoidance, suggesting that well beyond being merely elevated, EMS may actively shape avoidance-based coping strategies. Sakulsriprasert et al. (33) reported that the impaired limits schema domain is closely linked to difficulties in impulse regulation, which can contribute to dysfunctional behavior patterns (33). Our findings extend this perspective by demonstrating that the entitlement/impaired self-control EMS was not only prevalent in AD but also played a significant role in reinforcing biochemical avoidance, a maladaptive strategy aimed at temporary distress relief. This highlights a potential mechanism through which maladaptive schemas contribute to the clinical manifestations of AD. While elevated EMS have been observed across various psychiatric disorders, their role in influencing avoidance-based coping strategies may be particularly crucial in understanding the functional impairment seen in AD.

The impact of AD on daily functioning is a critical yet often overlooked aspect in published studies. In our study, individuals with AD exhibited significantly lower functionality, underscoring the profound disruptions this condition imposes on various domains of life. Notably, functional impairment was strongly correlated with pessimism and incompetence schemas, suggesting that deep-seated maladaptive cognitive patterns may contribute to the persistence of functional difficulties. These findings align with data from Catalina-Romero et al. (5), which indicated that AD is not merely a transient response to stressors but a condition that can lead to long-term impairment in psychosocial and occupational domains (5). Furthermore, our study highlights that individuals with AD predominantly rely on avoidance-based coping strategies, which may exacerbate functional impairment. Unlike previous studies, which have primarily focused on the association between AD and other psychological conditions, our findings offer a more nuanced understanding of how EMS can shape maladaptive coping mechanisms in AD, providing new insights into its cognitive and emotional underpinnings.

EMS can play a crucial role in shaping stress coping styles, particularly in individuals diagnosed with AD. However, the application of this schema-driven coping model specifically to AD has not been previously examined, highlighting the novelty of the current study. Given that avoidance strategies are associated with worse psychosocial functioning and increased vulnerability to substance use as a coping mechanism, our findings underscore the clinical relevance of addressing EMS while designing therapeutic interventions for AD.

Cudo et al. (35) reported that the relationship between EMS and problematic video gaming was not mediated by depression and anxiety. This suggests that certain EMS may be directly associated with symptoms of AD, rather than via the intermediary mechanisms of mood disturbances. Moreover, the significantly higher prevalence of tobacco, alcohol, and substance use in the AD group aligns with prior research indicating that such individuals often rely on avoidance-based coping strategies. McCarthy et al. (7) highlighted that substance use is commonly employed as a mechanism to mitigate stress, further reinforcing the maladaptive patterns observed in this population. This underscores the importance of addressing substance use within the therapeutic framework of AD, particularly in interventions targeting avoidance-based coping mechanisms. Furthermore, our study shows that individuals with AD tend to be younger and have lower educational attainment compared to healthy controls, a pattern that has been consistently reported in the literature. Catalina-Romero et al. (5) demonstrated that AD patients frequently come from socioeconomically disadvantaged backgrounds. These findings reinforce the notion that AD is shaped not only by cognitive and emotional factors but also by broader social determinants, necessitating a more comprehensive and integrative approach in both research and clinical practice.

Collectively, our findings provide new insights into the interplay between maladaptive schemas, avoidance-based coping strategies, and key demographic variables in AD. While our study contributes to a growing body of evidence on schema-related mechanisms in AD, further longitudinal research is needed to clarify the causal pathways and to explore potential interventions that can promote adaptive coping strategies in this patient population.

Several limitations should be acknowledged. First, the inclusion of participants solely from a male-only institution limits the generalizability to broader populations; future research should involve mixed-gender samples. Second, although structured clinical interviews were used, undetected subclinical psychiatric symptoms in the control group cannot be completely excluded. Third, the cross-sectional design precludes establishing causal relationships, and longitudinal studies are warranted. Lastly, reliance on self-report measures may introduce various forms of bias, including recall bias, social desirability bias, and subjective interpretation of questionnaire items. This suggests the need for clinician-rated or objective assessments in future research to enhance validity and reduce measurement error.

The current study highlights the significant role of EMS in shaping stress coping strategies and functional outcomes in individuals diagnosed with AD. While EMS have been extensively studied in other psychopathological conditions, their specific impact on AD remains underexplored. Our study provides, for the first time, evidence that maladaptive schemas are associated with a decreased tendency to engage in adaptive coping mechanisms and an increased reliance on avoidance-based strategies, which in turn can negatively affect overall functioning. These findings emphasize the importance of integrating schema-focused therapeutic approaches, such as schema therapy and cognitive restructuring, into treatment protocols for AD. Additionally, future research should consider longitudinal studies or randomized controlled trials to further investigate the effectiveness of schema-focused interventions in improving coping strategies and functionality in AD.