Abstract
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.
Highlights
Adjustment disorder describes a maladaptive emotional and/or behavioural response to an identifiable psychosocial stressor, capturing those who experience difficulties adjusting after a stressful event at a level disproportionate to the severity or intensity of the stressor [1]
Unlike posttraumatic stress disorder (PTSD) or acute stress disorder (ASD), which have clear criteria for what constitutes a traumatic event, adjustment disorder criteria does not specify any requirements for what can be regarded as a stressor
The DSM-5 and ICD-11 diagnoses of adjustment disorder have many commonalities. Under both sets of criteria, a diagnosis of adjustment disorder must occur in the wake of an identifiable life stressor, and can only be diagnosed in the absence of another clinical diagnosis. Both systems recognise adjustment disorder as a transient condition, with DSM-5 stating that symptoms must not persist longer than six months after the stressor are resolved, and ICD-11 recognising that symptoms tend to resolve within six months unless the stressor persists for a longer duration
Summary
Adjustment disorder describes a maladaptive emotional and/or behavioural response to an identifiable psychosocial stressor, capturing those who experience difficulties adjusting after a stressful event at a level disproportionate to the severity or intensity of the stressor [1]. More recent studies using newer diagnostic tools have found prevalence rates of 2% in general population research [4]. At least one psychosocial stressor was noted in 93% of all patients, which included medical illness in 59% of patients In this setting, the diagnosis was used especially in patients with serious medical conditions, self-harm, injury and poisoning, and in cases presenting with a mixture of somatic and psychic symptoms. In an acutely ill medical inpatient unit, adjustment disorder was found to be the most common diagnosis (14%), more than double the rates of depressive and anxious disorders [13]. Despite research indicating significant prevalence rates that are often greater than depressive and anxiety disorders in some populations, adjustment disorder has historically attracted little empirical research. This paper aims to identify gaps in our current knowledge of adjustment disorder and present directions for future research
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