Adjustment Disorder in Japan: How to Navigate Work, Stress, and Your Rights
Recently, someone asked me about adjustment disorder at work — a condition more common than many people realize.
During my years as Head of HR, I encountered many cases of mental health challenges, including adjustment disorder. I also accompanied some employees to sessions with psychiatrists to plan for a successful return to work.
If you're a foreigner working or living in Japan and feeling mentally exhausted, emotionally unstable, or simply “off,” please know that you're not alone.
This blog is here to help you recognize what may be happening, understand how to consult with a psychiatrist, know your rights, and learn how to communicate effectively with your employer — all based on real-world experience.
🔹 This Blog Covers:
Feeling Overwhelmed After Moving to Japan? It Might Be More Than Homesickness
Other Typical Mental Health Issues at Work in Japan
How to Consult with a Psychiatrist in Japan
How to Communicate with Your Boss and Company
Available Benefits: EAP, Medical Leave, and Legal Protection
Reinstatement – Step by Step
Wrap-Up
1. Feeling Overwhelmed After Moving to Japan? It Might Be More Than Homesickness
Many foreigners assume that emotional instability is just culture shock or temporary homesickness. But when these feelings persist or intensify, it may indicate something deeper.
According to the WHO’s ICD-10 diagnostic guidelines, Adjustment Disorder is:
“A state of subjective distress and emotional disturbance, usually interfering with social functioning and performance, and arising in the period of adaptation to a significant life change or to the consequences of a stressful life event.”
In simple terms, it’s your emotional system struggling to catch up with a major change — like relocating to a new country, starting a new job, or losing familiar social support.
As one psychiatrist once told me: “About 90% of mental health issues can be managed with well-established, textbook-based approaches. Reaching out to a professional early greatly improves the chances of recovery.”
🔹 Common symptoms include:
Persistent sadness or irritability
Anxiety, numbness, or emotional overwhelm
Trouble sleeping or concentrating
Withdrawing from work or social life
Headaches, stomachaches, or fatigue
🔹 In Japan, these symptoms may be intensified by:
Stress from the workplace — managers, colleagues, workload
Limited mental health conversations
Isolation due to language or cultural gaps
🔹 Adjustment Disorder vs. Depression:
One key distinction is that adjustment disorder symptoms are directly tied to a stressor and tend to ease when you are removed from it.
For example:
You may experience headaches or low mood before going to work, but still enjoy weekends or social outings.
In contrast, clinical depression often involves a constant low mood regardless of setting, and a persistent loss of pleasure in previously enjoyable activities.
2. Other Typical Mental Health Issues at Work in Japan
Adjustment Disorder can be an early sign. Ignoring it may lead to deeper issues such as:
Depression (うつ病 / utsu-byo): Often undiagnosed due to stigma
Anxiety Disorders: Including panic attacks and social anxiety
Burnout (過労 / karo): Caused by chronic overwork and lack of autonomy
Workplace Trauma: From harassment or abusive leadership
🔹 Mental Health Screening at Hiring: Some employers now conduct stress-resilience and personality assessments during recruitment. These aim to gauge how well candidates cope with pressure — not for diagnosis.
🔹 To prevent mental health issues, detect them early, and improve the workplace environment, companies in Japan are legally required to conduct stress checks.
These assessments, administered online or by doctors or public health nurses, help employers monitor the mental well-being of their employees.
3. How to Consult with a Psychiatrist in Japan
Many hesitate to seek psychiatric care, but early consultation can make a huge difference.
🔹 What’s the Difference Between Psychiatry and Psychosomatic Medicine in Japan?
In Japan, you’ll often see two types of mental health services: Psychiatry (精神科) and Psychosomatic Medicine (心療内科). The difference can be confusing, even for locals.
Psychiatry focuses on mental health conditions such as adjustment disorder, depression, anxiety, panic disorder, bipolar disorder, and schizophrenia. If your main concerns are emotional or psychological, a psychiatrist is typically the right choice.
Psychosomatic Medicine is designed for people experiencing physical symptoms caused or worsened by stress — like headaches, stomach pain, insomnia, or fatigue — especially when no clear cause is found through general medical exams. These clinics treat both mind and body.
In reality, many psychiatrists in Japan are licensed to treat both, and some clinics may list both names. So don’t worry too much about choosing “the perfect label”
What matters is finding a provider who understands your needs, ideally one who speaks your language or offers interpreter support.
Personal note: Psychosomatic Medicine may have been coined, in part, to offer a softer-sounding alternative to Psychiatry, which can still carry social stigma in Japan.
🔹 Steps to See a Psychiatrist:
Ask your primary care doctor, if you have one, or look for a referral to a mental health clinic (精神科 seishinka or 心療内科 shinryōnaika).
Search for English-speaking providers
See the related blog: How to Get Medical Care in Japan as a Foreigner (Real Tips + Free Hospital List)
TELL Japan – Tokyo English Lifeline
24-hour support and English-speaking counseling services.
Book early. Appointments can take 2–4 weeks, especially for first-time visits.
Good to know: Most services are covered under Japan’s national health insurance or company’s health insurance, with only a 30% co-pay.
🔹For Expats: What to Expect from Psychiatry in Japan
In Japan, psychiatry often functions more like internal medicine: short, focused visits—typically 7 to 8 minutes—followed by prescriptions.
First-time consultations may take longer (sometimes up to an hour), but don’t expect deep, extended dialogue. Psychiatrists typically see 5–6 patients per hour and treat a range of conditions including depression, anxiety, adjustment disorders, insomnia, addiction, bipolar disorder, schizophrenia, developmental disorders (発達障害), autism, and more.
While Japan’s system is structured and efficient, expats expecting in-depth talk therapy in a comfortable, living-room-like setting may need to adjust their expectations.
Forget the U.S.-style “hour on the couch” approach. When my former expat boss in Tokyo went looking for a “shrink,” he was confused and disappointed by how different the system was. Japan’s mental healthcare is fast, structured, and practical—not centered around talk therapy.
This difference in care style is partly due to how Japan's medical system works. All services are governed by a national points system set by the Ministry of Health (厚生労働省). Doctors are reimbursed based on this system, which makes U.S.-style long-form therapy sessions difficult to provide—even if they want to.
If you're used to “talking it out,” you’ll need to adjust expectations. Bring any past diagnoses and treatment records, and try to find a psychiatrist who speaks English.
Online Consultations
Online consultations with psychiatrists have recently become more available and convenient.
According to Japanese medical regulations, first-time online appointments are allowed if no prescriptions—especially for psychoactive medication (向精神薬)—are needed.
If a prescription is required, an initial in-person visit is mandatory to verify identity and ensure safe treatment. Be sure to confirm the detail with your psychiatrist’s office.
Team-Based Support
In Japan, it’s also common for psychiatrists to provide team-based care when needed—working alongside nurses, psychologists, social workers, and other professionals. Many clinics and hospitals offer group programs such as art therapy, drawing sessions, or “re-work” (reintegration) programs to support patients returning to work.
4. How to Communicate with Your Boss and Company
Communicating mental health concerns at work can be challenging — especially when the source of stress is your job itself.
But there are professional and protective ways to manage the situation. You don’t have to deal with this by yourself.
🔹 If You’re Able to Work Full-Time :
It’s still best to inform your manager and/or HR as soon as your doctor issues a medical certificate. The earlier you communicate, the more options you’ll have for support and adjustment.
Trying to “act normal” while suppressing symptoms can increase the mental and physical strain — and may actually worsen your condition.
Duty of Care
Employers in Japan have a legal duty of care to protect the health and safety of their employees. This includes taking appropriate steps when someone is diagnosed with adjustment disorder, such as offering reasonable accommodations and preventing further harm.
If You Feel Unfairly Evaluated
If your employer treats you unfairly or lowers your performance evaluation solely due to your medical condition, that’s a serious concern.
In Japan, companies with poor labor practices are often referred to as “black companies.” If your workplace is unsupportive or discriminatory, it may be worth considering a change in environment.
That said, employers may have legitimate concerns if your condition leads to frequent absences or uncertainty that impacts business continuity — even if most colleagues and managers are genuinely supportive.
To help manage the situation, see the ✅ Tip: How to Effectively Communicate with Your Manager/HR down below.
🔹 If You Need a Job Transfer or Reduced Hours:
If your stress is linked to your manager, specific duties, work volume, don’t skip the option of requesting a change in duties or work arrangement — this can be a crucial part of preventing further mental health deterioration.
Consult with your doctor and HR about the possibility of:
A transfer to a different team or supervisor
A short-time work arrangement (時短勤務), if applicable
Modified duties that reduce emotional or physical strain
These changes often require a doctor's recommendation and HR coordination, but many companies are open to such adjustments — especially when it helps prevent medical leave or resignation.
🔹 If You Need Medical Leave:
If your doctor advises Medical leave:
Submit the doctor’s note to your manager and HR as soon as possible.
Work with your HR to coordinate:
a. Whether the leave is paid or unpaid
b. A brief handover of your current work
c. Your emergency contact information during the leave
d. Reinstatement procedures — in most cases, you’ll need a medical certificate confirming you’re ready to return
✅ Tip: How to Effectively Communicate with Your Manager/HR
Understand your condition and clearly identify the key points you want to share.
Choose an appropriate time and private setting for the conversation.
Practice open communication and honestly express your situation and needs. (e.g., you can work full-time but are unable to do overtime))
Suggest how your responsibilities can be managed during your absence or transition period —> for example, by discussing temporary staffing options, arranging support from other departments, or temporarily shifting responsibilities. HR can assist with these adjustments.
Clearly explain what support or adjustments you’re seeking.
Be open to your manager’s feedback and suggestions, and aim for ongoing dialogue. -> If your work environment or manager is the root cause of your stress, you may understandably hesitate to maintain communication.
However, completely cutting off contact can make returning to work even more difficult.
Try to keep in touch with someone at work — whether it’s your manager or HR — even on a monthly basis.
Workplaces can change quickly, and staying informed can ease your reintegration later on. When I was in HR, I often shared team updates, including new hires or resignations, with employees on leave — but always with their consent.
5. Available Benefits: EAP, Medical Leave, and Legal Protection
You may be eligible for the following support systems:
✅ EAP (Employee Assistance Program):
Some companies offer free, confidential counseling through external partners. Check your HR or company benefits portal.
✅ Medical Leave:
· Many companies allow paid and/or unpaid medical leave with a doctor’s note.
· If you meet certain eligibility requirements, your company health insurance provides an injury and illness allowance (傷病手当金), which typically covers about two-thirds of your regular salary during your medical leave. Ask HR for more details.
Note: This benefit is not available under Japan’s National Health Insurance.
✅ Job Protection:
Can you be fired for mental health reasons in Japan?
The short answer is: not easily.
Employers are required to allow medical leave as outlined in company policy, and they must consider reasonable accommodations such as lighter duties or a job transfer if you're medically able to work.
Even if you’re unable to return to your original role, you cannot be dismissed unless all leave options are exhausted and no suitable position is available.
If your condition was caused or worsened by the workplace, termination may even be considered unlawful.
Know your rights. Mental health is medical — not a personal matter.
6. Reinstatement – Step by Step
Returning to work after mental leave can be challenging — both emotionally and logistically. Timing, process, and expectations must be carefully managed to ensure your recovery continues.
Fortunately, many psychiatrists’ clinics in Japan offer a “Return to Work Support Program” (リワークプログラム), and some companies have formal reintegration procedures in place.
These can include counseling, gradual work re-entry, or coordination between your medical provider and HR.
Work closely with your network — including your psychiatrist, para-medical staff (e.g., counselors or social workers), HR, and your manager — to develop a plan that balances your recovery with realistic work expectations.
You might think, “I don’t want to make a big deal out of this.”. Don’t worry — just use whatever resources are available to you!
🔹 Reinstatement Process:
Obtain a medical certificate (診断書) confirming you are fit to return to work.
Meet with HR/your manager to discuss your reinstatement plan. Depending on company policy and your condition, they may offer:
a. A trial period with reduced hours and prorated pay (時短勤務)
b. A phased return (e.g., 2 or 3 days a week before resuming full-time)
c. Immediate full-time reinstatement
Review your job description: Make sure your tasks align with your current capacity. Don't hesitate to request adjustments if needed.
Establish regular check-ins with your manager or HR — especially during the first few weeks after returning.
Clarify expectations: What are your responsibilities, what flexibility do you have, and what support can you expect?
✅ Additional Tips:
You may be required to see a company-appointed doctor (産業医) to confirm your fitness to return.
This doctor is familiar with your workplace environment and job responsibilities, so their evaluation may differ from your personal psychiatrist’s.
If your manager, team dynamics, or specific job duties were significant sources of stress, consider exploring internal transfer opportunities before returning.
If you feel that returning to the same role could trigger your symptoms again, it may be wise to explore external opportunities as part of your recovery plan.
✅How Colleagues and HR Can Support Someone with Adjustment Disorder
Most managers, HR staff, and colleagues want to support team members who are struggling — but many simply don’t know how. If you’re open to it, offering gentle guidance on how to engage with you can make a big difference.
Key workplace support strategies:
Respect personal space: Over-involvement, though well-meaning, can backfire. Avoid excessive checking-in or probing. Let the individual open up on their own timeline.
Listen empathetically and without judgment: If the person shares their struggles, focus on listening rather than “fixing.” Avoid interrupting or minimizing their feelings. Use validating phrases like “That sounds tough” or “Thank you for sharing.”
Don’t rush or pressure: Avoid comments like “So when are you coming back?” or “You seemed fine last week.” These can unintentionally worsen anxiety or guilt. Instead, trust their recovery timeline and support them patiently.
Avoid overloading the person with tasks upon return: Give them time to regain confidence and capacity. Collaborate on manageable goals.
Promote a culture of psychological safety: Recovery is not linear, and occasional setbacks are normal. Foster an environment where it's okay to ask for help or step back temporarily.
Creating a supportive workplace isn’t about having all the answers — it’s about being present, respectful, and committed to learning.
Relax !!
🧾 Real Story 1: Returning Too Early
A foreign sales associate diagnosed with adjustment disorder took paid leave, then returned early due to fear of losing his job.
Post-reinstatement, his attendance was unstable — frequent absences and half-days. I joined him at a psychiatrist visit, discussing possible reduced hours or more leave.
But he insisted on full-time work. The result was what we call 五月雨出勤 (samidare shukkin) — frequent unpredictable absences — which hurt the team. Eventually, he resigned.
Reflection:
· Take time to recover. In the long term, this leads to a more successful return to work.
· Many people with adjustment disorder are highly responsible, perfectionistic, and eager to meet expectations — sometimes to their own detriment.
· Awareness of on/off time and setting boundaries are key.
🧾 Real Story 2: Company Rules in Action
Rules of employment stated: "If an employee is unable to return to work after the leave of absence period has ended, they will be treated as having resigned."
An operations manager struggled under a new boss and clashed with leadership after a series of mistakes.
Eventually, he submitted a doctor’s note diagnosing adjustment disorder and requested a three-month leave of absence. The root cause: a strained relationship with his manager.
Based on company policy:
He received a total of 6 months of paid leave and 1 year of unpaid leave, based on his tenure.
He continued renewing his leave until all available time was exhausted — at which point he was automatically treated as resigned under the company’s rules. The company had reminded him of this policy throughout the process, so he was fully aware of the outcome.
Important Note: Even while on unpaid leave, he remained enrolled in the company’s health insurance and continued to receive the injury and illness allowance (傷病手当金).
However, as long as you are still considered an employee, you are required to continue paying into Japan’s mandatory social insurance system.
7. Wrap-Up
Adjustment disorder is real, common, and manageable — especially in Japan’s structured and high-pressure work culture.
The most important step is prevention. Living in a foreign country is already a major life change. Be kind to yourself, and make sure you get enough rest.
As I’ve mentioned in my blogs — when I was going through a tough time alone in the U.S., I used to go to Sam’s Club every Friday just to buy shrimp. That small treat helped me stay grounded.
Then do not ignore the signs. See a doctor sooner rather than later. And if you need to take a leave of absence, take it.
In the end, no one else walks in your shoes. You know your limits, your needs, and what truly matters to you. Seeking help, taking time to rest, or stepping away from work temporarily is not weakness — it’s courage !
