Adjustment disorder
Adjustment disorder is a psychological response to an identifiable stressor or group of stressors that cause(s) significant emotional or behavioral symptoms that do not meet criteria for anxiety disorder, PTSD, or acute stress disorder. The condition is different from anxiety disorder
Anxiety disorder
Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are...

, which lacks the presence of a stressor, or post-traumatic stress disorder
Post-traumatic stress disorder
Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...

 and acute stress disorder, which usually are associated with a more intense stressor. There are nine different types of adjustment disorders listed in the DSM-III-R. In DSM-IV, adjustment disorder was reduced to six types, classified by their clinical features. Adjustment disorder may also be acute or chronic, depending on whether it lasts more or less than six months. Diagnosis of adjustment disorder is quite common; there is an estimated incidence of 5-21% among psychiatric consultation services for adults. Adult women are diagnosed twice as often as are adult men, but among children and adolescents, girls and boys are equally likely to receive this diagnosis. Adjustment disorder was introduced into the psychiatric classification systems almost 30 years ago, but the concept was recognized for many years before that . When considering biopsychosocial disorders, an athlete’s overtrained state can be due to an Adjustment Disorder.

Signs and symptoms

Suicidal behavior is prominent among people with AD of all ages and up to one fifth of adolescent suicide victims may have an adjustment disorder. Bronish and Hecht (1989) found that 70% of a series of patients with AD attempted suicide immediately before their index admission and they remitted faster than a comparison group with major depression. Asnis et al. (1993) found that AD patients report persistent ideation or suicide attempts less frequently than those diagnosed with major depression.. Henriksson et al. (2005) states statistically that the stressors are of one half related to parental issues and one third in peer issues .

Risk factors

Various factors have been found to be more associated with a diagnosis of AD than other Axis I disorders, including:

  • younger age

  • more identified psychosocial and environmental problems

  • increased suicidal behaviour, more likely to be rated as improved by the time of discharge from mental healthcare

  • less frequent previous psychiatric history

  • shorter length of treatment

  • Those exposed to repeated trauma are at greater risk, even if that trauma is in the distant past. Age can be a factor due to young children having fewer coping resources; however, children are also less likely to assess the consequences of a potential stressor.

    A stressor is generally an event of a serious, unusual nature that an individual or group of individuals experience. The stressors that cause adjustment disorders may be grossly traumatic or relatively minor, like loss of a girlfriend/boyfriend, a poor report card, or moving to a new neighborhood. It is thought that the more chronic or recurrent the stressor, the more likely it is to produce a disorder. The objective nature of the stressor, however, is of secondary importance. Stressors' most crucial link to their pathogenic potential is their perception by the patient as stressful.The presence of a causal stressor is essential before a diagnosis of adjustment disorder can be made p.279.


    The diagnostic criteria in the DSM-IV
    Diagnostic and Statistical Manual of Mental Disorders
    The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

    1. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s).

    2. These symptoms or behaviors are clinically significant as evidenced by either of the following:

      1. marked distress that is in excess of what would be expected from exposure to the stressor

      2. significant impairment in social or occupational (academic) functioning

    3. The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

    4. The symptoms do not represent Bereavement.

    5. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional six months.

    Specify if:
  • Acute: if the disturbance lasts < 6 months

  • Chronic: if the disturbance lasts ≥ 6 months

  • Treatment

    Often, the recommended treatment for adjustment disorder is psychotherapy. The goal of psychotherapy is symptom relief and behavior change. Anxiety may be presented as "a signal from the body" that something in the patient's life needs to change. Treatment allows the patient to put his or her distress or rage into words rather than into destructive actions. Counseling, psychotherapy, crisis intervention, family therapy, and group treatment are often used to encourage the verbalization of fears, anxiety, rage, helplessness, and hopelessness. Sometimes small doses of antidepressants and anxiolytics are also used. In patients with severe life stresses and a significant anxious component, benzodiazepines
    A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...

    are used, although non-addictive alternatives have been recommended for patients with current or past heavy alcohol use, because of the greater risk of dependence. Tianeptine, alprazolam, and mianserin were found to be equally effective in patients with AD with anxiety.


    Like many of the items in the DSM, adjustment disorder receives criticism from a minority of the professional community as well as those in semi-related professions outside the health-care field. First, there has been criticism of its classification. It has been criticized for its lack of specificity of symptoms, behavioral parameters, and close links with environmental factors. Relatively little research has been done on this condition.

    Adjustment disorder has been classified as being so "vague and to be useless," but it has been retained in the DSM-IV because of the belief that it serves a useful clinical purpose for clinicians seeking a temporary, mild, non-stigmatizing label, particularly for patients who need a diagnosis for insurance coverage of therapy.

    There has been little systematic research regarding the best way to manage individuals with an adjustment disorder. Because natural recovery is the norm, it has been argued that there is no need to intervene unless levels of risk or distress are high. However, for some individuals treatment may be beneficial. AD sufferers with depressive and/or anxiety symptoms may benefit from treatments usually used for depressive and/or anxiety disorders. One study found that AD sufferers received similar interventions to those with other psychiatric diagnoses, including psychological therapy and medication. Another study found that AD responded better than major depression to antidepressants.Given the absence of a meaningful evidence base for the treatment of AD per se, watchful waiting should be considered initially, but if symptoms are not improving or causing the sufferer marked distress then treatment should be directed at the predominating symptoms.

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