Adjustment Disorder

Description

Adjustment disorder (AD)

• Development of emotional/behavioral symptoms due to an identifiable stressor(s) and occurring within 3 months of onset of stressor(s) (1)
• Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) overview:
  • Various types
    • With depressed mood—feelings of depression, tearfulness, or feelings of hopelessness
    • With anxiety—nervousness, worry, or jitteriness, or, in children, fears of separation from major attachment figures
    • With mixed anxiety and depressed mood—a combination of depression and anxiety
    • With disturbance of conduct—there is violation of the rights of others, major age-appropriate societal norms, and rules
    • With mixed disturbance of emotions and conduct
    • Unspecified includes maladaptive reactions that are not classified as one of the other subtypes.

Epidemiology

Incidence

• Varies among population
• High incidence during times of disaster and in patients with chronic illnesses
• Common diagnosis in clinical setting

Prevalence

• Varies among population
• 11–18% among primary care (2)
• 10–35% in consultation liaison psychiatry (2)

Etiology and Pathophysiology

• Individual vulnerability and risk play a greater role in AD than in other psychiatric disorders (3).
• Factors that lead to development of AD in children and adolescents are similar to those found in adults and are adjusted for stage of life.

Risk Factors

• Women > men (3)
• Younger age
• High rate of stressors
• Other mental health problems
• Unstable family environment, divorce
• Military service
• Natural disasters

General Prevention

• Good coping mechanisms to stressors
• Establishing support

Commonly Associated Conditions

• Personality disorders previously linked to AD (Few studies show a true correlation.)
• Suicide attempts and completed suicide
• Substance abuse