Adjustment disorder

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Adjustment disorder
ICD-10	F43.2
ICD-9	309
DiseasesDB	33765
MedlinePlus	000932
MeSH	D000275

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Adjustment disorder refers to a psychological disturbance that develops in response to a stressor. Adjustment disorders are caused by specific sources of stress, such as severe personal crisis (divorce, death of loved one, recent abuse, recent job changes) or major unexpected negative events (tornado or fire destroys a person's home). The usual symptoms mimic depression, anxiety, or sleep disorder; however the disturbance disorder is short-term and can usually be treated with counseling or mild short-term medication. If the problem persists more than six months after removal of the stressor, the person may have a more permanent problem, such as a chronic mood or sleep disorder.

Differential Diagnosis

• Acute stress disorder
• Major depressive disorder
• Normative stress reactions
• Personality disorders
• Post traumatic stress disorder

Epidemiology and Demographics

Prevalence

Adjustment disorder is a common condition. The prevalence of adjustment disorder is:

• 5,000-20,000 per 100,000 (5-20%) in the outpatient mental health treatment setting.
• Up to 50,000 per 100,000 in the in-hospital psychiatric consultation setting of the overall population.

Risk Factors

• Stressors (divorce, death of loved one, recent abuse, recent job changes))
• Major unexpected negative events (tornado or fire destroys a person's home)

Natural History, Complications and Prognosis

Adjustment disorder is short-term and can usually be treated with counseling or mild short-term medication. If the problem persists more than six months after removal of the stressor, the person may have a more permanent problem, such as a chronic mood or sleep disorder.

Diagnosis

Diagnostic Criteria

DSM-V Diagnostic Criteria for Adjustment Disorder

“

A.The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). AND B.These symptoms or behaviors are clinically significant, as evidenced by one 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. AND 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. AND D.The symptoms do not represent normal bereavement. AND E.Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months. 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.

”

Diagnostic Criteria

The usual symptoms mimic depression, anxiety, or sleep disorder