Adjustment Disorder

Primer

Adjustment Disorder (sometimes called situational depression) is an excessive and abnormal reaction to a life stressor.[1] The reaction is more severe than normally expected and results in significant social, occupational, or academic impairment.

DSM-5 Diagnostic Criteria

Criterion A

The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

Criterion B

These symptoms or behaviours are clinically significant, as evidenced by 1 or both of the following:

  1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
  2. Significant impairment in social, occupational, or other important areas of functioning.
Criterion C

The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.

Criterion D

The symptoms do not represent normal bereavement.

Criterion E

Once the stress or or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

Specifiers

Specifiers

Specify whether:

  • With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
  • With anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant.
  • With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
  • With disturbance of conduct: Disturbance of conduct is predominant.
  • With mixed disturbance of emotions and conduct: Both emotional symptoms (e.g. - depression, anxiety) and a disturbance of conduct are predominant.
  • Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.

Scales

Pathophysiology

Investigations

Treatment

Psychotherapy such as cognitive behavioural therapy and brief supportive therapy has been investigated in adjustment disorder.[2][3]

Differential Diagnosis

Resources

For Patients

For Providers

Articles
Research

References

1) Casey, P., & Bailey, S. (2011). Adjustment disorders: the state of the art. World Psychiatry, 10(1), 11.
2) O'Donnell, M. L., Metcalf, O., Watson, L., Phelps, A., & Varker, T. (2018). A systematic review of psychological and pharmacological treatments for adjustment disorder in adults. Journal of traumatic stress, 31(3), 321-331.
3) Carta, M. G., Balestrieri, M., Murru, A., & Hardoy, M. C. (2009). Adjustment Disorder: epidemiology, diagnosis and treatment. Clinical Practice and Epidemiology in Mental Health, 5(1), 1-15.