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An adjustment disorder occurs when an individual is unable
to adjust to or cope with a particular stressor, like a major
life event. Since people with this disorder normally have
symptoms that depressed people do, such as general loss of
interest, feelings of hopelessness and crying, this disorder
is also sometimes known as situational depression.
Unlike major depression however, the disorder is caused by
an outside stressor and generally resolves once the individual
is able to adapt to the situation. One hypothesis for
adjustment disorder is that it may represent a sub-threshold
The condition is different from anxiety disorder, which lacks
the presence of a stressor, or post-traumatic stress disorder
and acute stress disorder, which usually are associated with
a more intense stressor.
Its common characteristics include mild depressive symptoms,
anxiety symptoms, and traumatic stress symptoms or a combination
of the three.
There are nine different types of adjustment disorders listed
in the DSM-III-R.
According to the DSM-IV-TR, there are six types of adjustment
disorders, which are characterized by the following predominant
symptoms: depressed mood, anxiety, mixed depression and anxiety,
disturbance of conduct, mixed disturbance of emotions and conduct,
However, the criteria for these symptoms are not specified in
Adjustment disorder may also be acute or chronic, depending on
whether it lasts more or less than six months.
According to the DSM-IV-TR, if the adjustment disorder lasts less
than 6 months, then it may be considered acute.
If it lasts more than 6 months, it may be considered chronic.
However, the symptoms cannot last longer than six months after the
stressor(s), or its consequences, have terminated.
Diagnosis of adjustment disorder is quite common; there is an
estimated incidence of 5–21% among psychiatric consultation services
Adult women are diagnosed twice as often as are adult men, but
among children and adolescents, girls and boys are equally likely to
receive this diagnosis.
Adjustment disorder was introduced into the psychiatric classification
systems almost 30 years ago, but the concept was recognized for many
years before that. When considering biopsychosocial disorders, an
athlete’s over trained state can be due to an adjustment disorder.
Various factors have been found to be more associated with a diagnosis
of AD than other Axis I disorders, including.
1- younger age
2- more identified psychosocial and environmental problems
3- increased suicidal behaviour, more likely to be rated as
improved by the time of discharge from mental healthcare
4-less frequent previous psychiatric history
5- shorter length of treatment
Those exposed to repeated trauma are at greater risk, even if that
trauma is in the distant past.
Age can be a factor due to young children having fewer coping resources;
however, children are also less likely to assess the consequences of a
A stressor is generally an event of a serious, unusual nature that an
individual or group of individuals experience. The stressors that cause
adjustment disorders may be grossly traumatic or relatively minor, like
loss of a girlfriend/boyfriend, a poor report card, or moving to a new
It is thought that the more chronic or recurrent the stressor, the more
likely it is to produce a disorder. The objective nature of the stressor,
however, is of secondary importance.
Stressors’ most crucial link to their pathogenic potential is their
perception by the patient as stressful. The presence of a causal stressor
is essential before a diagnosis of adjustment disorder.
There are certain stressors that are more common in different age groups:
1- Marital conflict
2- Financial conflict Adolescence and childhood:
3- Family conflict/parental separation
4- School problems/changing schools
5- Sexuality issues
6- Death/illness in the family
Razi Ghaemmagham Farahani