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The volume of research involving adjustment disorder (AD) is limited. The scientific neglect of AD seems to result from the inadequate operationalisation of AD in DSM-IV and ICD-10. The aims of the present proposal are to discuss the shortcomings of AD conceptualisations and to present recommendations for the future.
This conceptual paper is based...
Contexts in source publication
Context 1
... question is now, not if this is a valid or clinically useful category, but whether the current criteria as constituted in DSM and ICD achieve the differentiation from normal reactions to stressful events on the one hand and from other axis 1 disorders on theaffe other? Adjustment disorders -Critique and recommendations 5 5 - Table 1 near here - This paper is an attempt to critique the current diagnostic criteria for AD with depressed mood and based on our iterative discussion to make recommendations for the DSM-V criteria. ...
Similar publications
Background: The volume of research involving adjustment
disorder (AD) is limited. The scientific neglect of AD seems
to result from the inadequate operationalisation of AD in
DSM-IV and ICD-10. The aims of the present proposal are to
discuss the shortcomings of AD conceptualisations and to
present recommendations for the future. Sampling and
Method...
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Citations
... This may explain the somewhat higher prevalence rates of 17% [7] and 19% [3] in studies in which all patients received a diagnostic interview. Another explanation may be the absence of clear criteria to diagnose AD, as strict diagnostic criteria for AD in the DSM-V are lacking [21]. As a consequence, the diagnosis of AD may be prone to a psychologist's individual interpretation of the criteria. ...
Purpose
To investigate the prevalence of adjustment disorder (AD) among cancer patients and the acceptance of psychological treatment, in relation to sociodemographic, clinical, and psychological factors.
Methods
Breast, prostate, and head and neck cancer patients of all stages and treatment modalities ( N = 200) participated in this observational study. Patients completed the Hospital Anxiety and Depression Scale, Checklist Individual Strength, Distress Thermometer and problem list. Patients with increased risk on AD based on these questionnaires were scheduled for a diagnostic interview. Patients diagnosed with AD were invited to participate in a randomized controlled trial on the cost-effectiveness of psychological treatment. Participation in this trial was used as a proxy of acceptance of psychological treatment. Logistic regression analyses were used to investigate associated factors.
Results
The overall prevalence of AD was estimated at 13.1%. Sensitivity analyses showed prevalence rates of AD of 11.5%, 15.0%, and 23.5%. Acceptance of psychological treatment was estimated at 65%. AD was associated both with being employed (OR = 3.3, CI = 1.3–8.4) and having a shorter time since diagnosis (OR = 0.3, CI = 0.1–0.8).
Conclusion
Taking sensitivity analysis into account, the prevalence of AD among cancer patients is estimated at 13 to 15%, and is related to being employed and having a shorter time since diagnosis. The majority of cancer patients with AD accept psychological treatment.
... Remarkably, there were some approved cases observed with morbidity changes. This is because adjustment disorder has the characteristics of a transitional mental disorder that can further develop into depressive disorder or anxiety disorder depending on the symptoms [11,12]. It is assumed that this is because the previously independent high-level diagnosis concept of adjustment disorder was recently included in the high-level diagnosis system related to trauma and stress-related disorders as a low-level concept in psychiatric diagnostic classification, providing the potential for inconsistent diagnoses between different specialists and diagnostic errors. ...
Background:
The number of claims of Industrial Accidents Compensation Insurance (IACI) for mental illness has increased. In particular, the approval rate was higher in cases with confirmed incident circumstances such as adjustment disorder, acute stress disorder, and post-traumatic stress disorder. With increased numbers of filed IACI applications and their approval rates, the need to evaluate various work-related incidents and stressors consistently is also increasing.
Method:
In January 2015-December 2017, among the cases of industrial accidents filed for mental illness and suicide by the Korea Workers' Compensation and Welfare Service, 76 filed or approved adjustment disorder cases were included. The cases of adjustment disorder were applied in this study to the "Criteria for Recognition of Mental Disorders by Psychological Loads" established in Japan in 2011 and investigated if cases were approved/rejected consistently. Additionally, features with the greatest influence on approval/rejection were examined quantitatively.
Results:
The number of applications more than doubled from 2015 to 2017, with the approval rate rising from 66.7% to 90.6%. Among the major categories, applications of adjustment disorder related to "interpersonal relationships" were the largest number of applications. Applications related to "sexual harassment", "interpersonal relationships", and "accidents and experiences including fires" showed relatively higher approval rate. The approval rate was the lowest in the case of "change in the amount and quality of work".
Conclusions:
Approved cases tend to have special precedents and strong intensity. The main reasons for the rejection were that there were no special precedents and that the intensity of the case was weak. These 2 were the most important factors in determining approval/rejection.
... Das vorliegende Kapitel bietet hierfür die methodischen Grundlagen zur dimensionalen Erfassung psychischer Belastungen und kategorialen Diagnostik psychischer Störungen in der somatischen Rehabilitation, einschließlich einer Darstellung der Besonderheiten bei der Psychodiagnostik somatisch erkrankter Rehabilitanden und der Beschreibung einer praxiserprobten psychodiagnostischen Routine. (Baumeister et al. 2009;Baumeister und Morar 2008). Um dem entgegenzuwirken, erscheint es insbesondere von Bedeutung, psychische Belastungen zu entstigmatisieren und als zumindest temporär zum menschlichen Leben dazugehörend anzuerkennen. ...
Menschen mit körperlichen Erkrankungen weisen häufig psychische Belastungen auf, die zu einem substantiellen Anteil auch die Kriterien einer psychischen Störung erfüllen. Liegen komorbid psychische Belastungen und psychische Störungen vor, ist dies mit einer negativen Behandlungs- und Erkrankungsprognose assoziiert. Entsprechend bedeutsam ist eine fundierte Psychodiagnostik in der somatischen Rehabilitation, die die Erkennungsraten psychischer Belastungen und psychischer Störungen weiter verbessert. Das vorliegende Kapitel bietet hierfür die methodischen Grundlagen zur dimensionalen Erfassung psychischer Belastungen und kategorialen Diagnostik psychischer Störungen in der somatischen Rehabilitation, einschließlich einer Darstellung der Besonderheiten bei der Psychodiagnostik somatisch erkrankter Rehabilitanden und der Beschreibung einer praxiserprobten psychodiagnostischen Routine.
... Box 1 lists a few clinical considerations that will assist in making this judgement. A particularly useful distinguishing feature between those who are distressed and those who are more broadly affected is likely to be functional impairment (Baumeister 2009). Both the ICD-10 and the new ICD-11 (World Health Organization 2018) criteria require functional impairment. ...
The differentiation of pathological stress responses from responses that are appropriate and adaptive is a challenge with little to guide the clinician. This refreshment considers adjustment disorder and possible approaches to distinguishing those who have the disorder from those who are responding ‘normally’ to stressful events.
... Structured interviews for AD are poorly developed: Mostly where AD is included, the diagnosis is only made if the threshold for another disorder is not met. This approach ignores context and has attracted criticism from researchers of stress-related disorders [21,22]. Therefore, although we used SCAN, a structured interview, for the purposes of this study, we used clinical diagnosis as the diagnostic gold standard. ...
... Structured diagnostic tools such as SCAN use symptoms alone in arriving at a diagnosis without considering context, whereas context is key in arriving at a clinical diagnosis. As a result, there is a body of opinion that clinical diagnosis is the gold standard method for the diagnosis of AD [21,22], as clinical diagnosis, unlike structured interviews, considers both symptoms and their context [22,[25][26][27]. Therefore, the use of clinical diagnosis may be regarded as either a strength or a limitation. ...
... Structured diagnostic tools such as SCAN use symptoms alone in arriving at a diagnosis without considering context, whereas context is key in arriving at a clinical diagnosis. As a result, there is a body of opinion that clinical diagnosis is the gold standard method for the diagnosis of AD [21,22], as clinical diagnosis, unlike structured interviews, considers both symptoms and their context [22,[25][26][27]. Therefore, the use of clinical diagnosis may be regarded as either a strength or a limitation. ...
Depression is common in the perinatal period, with prevalence rates of 14.4%, but prevalence rates of adjustment disorder in this period have not been established. We aimed to examine the characteristics of women attending a perinatal psychiatry service diagnosed with adjustment disorder (AD) or depressive episodes (DE). The data were collected as part of a multicentre case-control study of 370 patients, 45 of whom were recruited from perinatal psychiatry service at a maternity hospital. We recruited 45 patients with AD or DE diagnosed in the perinatal period and compared them to a matched sample of 109 non-perinatal women. Almost half, 22 (48.9%) perinatal women had a diagnosis of AD and 23 (51.1%) had a diagnosis of DE. Of the perinatal participants, those with AD had more stressful life events, and suicidal ideation and behaviours were three times more common (31.8%) in AD than in DE (8.7%). There were no significant differences in levels of suicidality between the perinatal and the non-perinatal groups. In our cohort, AD is associated with symptoms of depression including suicidal ideation during the perinatal period. Further study is required to examine the relationship between stressors and suicidality in this population.
... This may be related to the inherent difficulties in diagnosing AD when relying on structured interviews, many of which only include AD in an appendix, only to be used if the threshold for another disorder cannot be met. This approach, ignoring context, has been criticised by many researchers in the area of stress-related disorders [5,35]. The majority of the studies included have used clinical diagnosis, and as a result have utilised the clinician's clinical judgment about the role of context and stressors in the patients' presentations. ...
Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and behaviours, and AD. In this paper, we aimed to explore this relationship, by establishing the incidence of AD in patients who present with self-harm and suicidal ideation, and the rates of self-harm among patients with a diagnosis of AD. Methods: We conducted a review of the literature of well-established databases using specific key words then synthesised the results into a descriptive narrative as well as representing it in table form. Results: Sample sizes and study methods varied significantly across the review. A majority of studies were retrospective chart-based reviews, and only three used structured diagnostic instruments. A high prevalence of AD (ranging from 9.8 to 100%) was found, with self-poisoning representing the most common form of suicide attempt in the majority of studies. Interpersonal difficulties were the main precipitant in studies which examined this. Conclusions: This study suggests there is a strong association between AD and suicidal behaviours. Given the paucity of research in the area, there is a need to build the evidence base for effective treatment strategies.
... The adjustment disorder concept has attracted significant criticism due to issues related to its diagnostic vagueness. Research has struggled to neatly establish the extent to which adjustment disorder differs from other psychiatric disorders, or from normal adaptive stress responses [18]. ...
Despite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder research has traditionally been hindered by its lack of clear diagnostic criteria. However, with the greater diagnostic clarity provided in the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11), adjustment disorder has been increasingly recognised as an area of research interest. This paper evaluates the commonalities and differences between the ICD-11 and DSM-5 concepts of adjustment disorder and reviews the current state of knowledge regarding its symptom profile, course, assessment, and treatment. In doing so, it identifies the gaps in our understanding of adjustment disorder and discusses future directions for research.
... Unlike those conditions where a list of required symptoms is provided, the classification systems ICD-10 and DSM-5 do not provide a list of potential symptoms. It is well recognized that many of the biological symptoms of depression are commonly seen in AD [4,5], and certain symptoms such as suicidal ideation are equally common in both conditions [6]. Sleep is one of these symptoms, and to date there has been little research specifically examining the role of sleep in AD, whether as a symptom or indeed as a precipitant of other symptoms such as suicidal ideation. ...
Background: In this paper, we aimed to examine the patterns of sleep disturbance in adjustment disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre case-control study of 370 patients: 185 patients with AD and 185 patients with a diagnosis of DE, recruited from the liaison psychiatry services of three Dublin hospitals. We examined the participants’ sleep pathology using the sleep disturbance items on the Schedule for Clinical Assessment in Neuropsychiatry, and the Inventory of Depressive Symptoms—Clinician-rated-30. Results: Patients with a diagnosis of AD were less likely to report disturbed sleep than those with a diagnosis of DE (p = 0.002). On multivariate analysis, sleep disturbance was significantly associated with greater severity of certain depressive symptoms: decreased appetite (p < 0.001) and psychomotor agitation (p = 0.009). Decreased appetite, younger age and single marital status were significantly associated with sleep disturbance in male patients, and decreased appetite and psychomotor agitation were significantly associated with sleep disturbance in female participants. Conclusions: This is the largest study to date which has examined sleep disturbance in adjustment disorder. Disturbance of sleep is a significant symptom in AD and may represent a potential target for treatment. With further research, patterns of sleep disturbance may be useful in differentiating AD from DE.
... As a result of the fuzzy criteria, the heterogenous clinical presentations, and the lack of research, appropriate treatment options for patients with AjD are scarce. To some extent, it is even unclear whether these patients are in need for active treatment, such as psycho-or pharmacotherapy, or less invasive interventions, such as monitoring or psychoeducation (Baumeister, Maercker, & Casey, 2009). ...
Adjustment disorder (AjD) describe exaggerated responses to psychosocial stressors. For ICD-11, the proposed core symptoms are preoccupation, failure to adapt, and significant impairment in functioning, which represents a major shift in the description of the disorder. The present cumulative dissertation collects systematic evidence for the validity of the new AjD definition in a sample who experienced involuntary job loss. A large-scale longitudinal study assessed individuals who recently lost their jobs up to nine months after their last day at work and again six months later. The first paper established a measurement model for the main outcome, the Adjustment Disorder – New Module 20. The confirmatory factor analysis revealed that the items are best represented within a bifactor model with five correlated group factors plus one general factor. The dominant source of covariation was accounted for by the general factor representing all AjD items, suggesting unidimensionality of the construct. The second paper developed an aetiological model of AjD based on the socio-interpersonal framework model for stress- response syndromes. Several interpersonal variables were associated with more AjD symptoms. The inclusion of contextual factors can extend our knowledge of pathological reactions to stressful life events. The third paper identified three groups of individuals who differed in symptom severity over time by application of a latent class latent change model. One group evidenced high symptom severity at both assessments. Belonging this group was associated with several demographic and psychological characteristics. Selective prevention strategies that target high-risk individuals with specific stress-management skills training could be developed. The synopsis of this cumulative dissertation provides a review of adjustment disorder as disorder specifically associated with stress in ICD-11. All three papers are integrated into an overall discussion about the validity of the ICD-11 definition of adjustment disorder, the context of involuntary job loss, and the treatment implications. Anpassungsstörungen (ASt) beschreiben eine maladaptive Reaktion auf psychosozialen Stress. Für die ICD-11 wurden neu die Kernsymptome Präokkpationen, Fehlanpassung und funktionelle Beeinträchtigung vorgeschlagen. Die vorliegende kumulative Dissertation sammelt systematisch Evidenz für die Validität der neuen ASt Diagnose in einer Stichprobe von ungewollt entlassenen Personen. Eine längsschnittliche Studie untersuchte Personen bis zu neun Monate nach ihrem letzten Arbeitstag und ein zweites Mal sechs Monate später. Das erste Paper bestimmte das Messmodell für das zentrale Ergebnismass, der Adjustment Disorder – New Module 20. Die konfirmatorische Faktorenanalyse zeigte, dass die Items am besten in einem Bifaktor-Modell repräsentiert wurden, das aus fünf korrelierten Gruppenfaktoren sowie einem generellen Faktor bestand. Die Kovariation zwischen den Items wurden am besten durch den generellen Faktor erklärt, was für die Eindimensionalität des Konstrukts spricht. Das zweite Paper entwickelte ein ätiologisches Modell für ASt basierend auf dem Sozio-Interpersonellen Modell für Stressfolgestörungen. Mehrere interpersonelle Variablen waren mit stärkeren ASt-Symptomen assoziiert. Der Einbezug kontextueller Faktoren kann unser Verständnis von pathologischen Reaktionen in Bezug auf kritische Lebensereignisse erweitern. Das dritte Paper hat anhand eines Latent Class Latent Change Modells drei Gruppen von Individuen identifiziert, die sich durch die Symptomschwere zu beiden Messzeitpunkten unterschieden. Zugehörigkeit zu der Gruppe mit hoher Symptomatik war mit verschiedenen demographischen und psychologischen Variablen assoziiert. Diese Personen könnten durch selektive Prävention angesprochen und ihre spezifischen Stressmanagement-Fertigkeiten trainiert werden. Die Synopsis der kumulativen Dissertation umfasst einen Überblick über ASt als Stressfolgestörung in ICD-11. Alle drei Paper werden in eine Diskussion über die Validität des ICD-11 Ansatzes, den Kontext Arbeitsplatzverlust, und Behandlungsimplikationen eingebettet.
... Stressors are decisive life changes that occur following a stressful critical event (e.g. separations, emigration, chronic or severe acute illness, unemployment, conflicts in the workplace) (Baumeister et al., 2009). According to the ICD-11, PTSD is a disorder that develops following exposure to an extremely threatening or horrific event or series of events (Maercker et al., 2013), therefore it is not expected to find previous stressful event (which is not extremely threatening or horrific) to be a predictor for PTSD. ...
The minority of people who have experienced a traumatic event and were diagnosed as either suffering from PTSD or from Adjustment disorder, may suggest that victims of a traumatic event vary in risk factors for the disorders. The current research aimed at examining the association between reports of Adjustment disorder and PTSD symptoms (In accordance with the proposed revisions of the ICD-11) and several vulnerability variables: previous traumatic event, previous stressful event and physical proximity to the terror attack. Using an online survey, 379 adult participants were recruited, and filled out Adjustment disorder, PTSD symptomatology scales, as well as a previous exposure, magnitude of exposure and death anxiety scales. Findings revealed that previous experience of traumatic events was a significant predictor associated with both PTSD and Adjustment disorder symptoms. Previous experience of stressful events was a significant predictor associated with Adjustment disorder alone. Physical proximity to the site of the attack was a significant predictor associated with PTSD symptoms but not Adjustment disorder symptoms. The importance of previous traumatic events, previous stressful events and physical proximity to the terror attack as factors which are associated with Adjustment disorder and PTSD symptomatology is discussed.
