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The Spectrum of Adjustment Disorders: Too Broad to be Clinically Helpful

Published online by Cambridge University Press:  07 November 2014

Federica Semprini ,
Giovanni Andrea Fava  and
Nicoletta Sonino
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Abstract

The clinical value of the current Diagnostic and Statistical Manual of Mental Disorders diagnosis of adjustment disorder is controversial. The aim of this article is to review the literature on adjustment disorder and to present suggestions for the improvement of this diagnostic category in future classification systems. The literature utilized for this review was retrieved by MEDLINE (1967 until May 2009) and was supplemented by a manual search of the literature. The analysis of the literature indicates that the diagnosis of adjustment disorder is not characterized by consistent clinical description and prognosis, adequate differentiation from other disorders, or specific psychometric and neurobiologic features. The spectrum of affective disturbances entailed by the diagnosis of adjustment disorder appears to be too broad. A major problem seems to lie in the fact that it is an exclusion diagnosis that overlaps with subthreshold manifestations of mood and anxiety disorders. More precise characterizations of stress-related disturbances are available.

Type
Review Article
Information
CNS Spectrums , Volume 15 , Issue 6 , June 2010 , pp. 382 - 388
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

1. Blacker, CV, Clare, AW. The prevalence and treatment of depression in general practice. Psychopharmacology. 1988;95(suppl):S14–S17.CrossRefGoogle ScholarPubMed
2. Greenberg, WM, Rosenfeld, DN, Ortega, EA. Adjustment disorder as an admissions diagnosis. Am J Psychiatry. 1995;152(3):459–461.Google Scholar
3. Despland, JN, Monod, L, Ferrero, F. Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV. Compr Psychiatry. 1995;36(6):454–460.CrossRefGoogle ScholarPubMed
4. Strain, JJ, Smith, GC, Hammer, JS, et al. Adjustment disorder: a multi-side study of its utilization in the consultation-liaison psychiatry setting. Gen Hosp Psychiatry. 1998;20(3):139–149.CrossRefGoogle Scholar
5. Silverstone, PH. Prevalence of psychiatric disorders in medical inpatients. J Nerv Ment Dis. 1996;184(1):43–51.CrossRefGoogle ScholarPubMed
6. Casey, P. Adjustment disorder, epidemiology, diagnosis and treatment. CNS Drugs. 2009:23(11):927–938.CrossRefGoogle Scholar
7. Andreasen, NC, Wasek, P. Adjustment disorders in adolescents and adults. Arch Gen Psychiatry. 1980;37(10):1166–1170.CrossRefGoogle ScholarPubMed
8. Fabrega, H, Mezzich, JE, Mezzich, AC. Adjustment disorder as a marginal or transitional illness category in DSM-III. Arch Gen Psychiatry. 1987:44(6):567–572.CrossRefGoogle ScholarPubMed
9. Fabrega, H, Mezzich, J. Adjustment disorder and psychiatric practice: cultural and historical aspects. Psychiatry. 1987;50(1):31–49.CrossRefGoogle ScholarPubMed
10. Casey, P. Diagnosing adjustment disorder with depressive features. Expert Rev Neurother. 2008;8(8):1203–1208.CrossRefGoogle ScholarPubMed
11. Jager, M, Frasch, K, Becker, T. Adjustment disorder-nosological state and treatment options. Psychiatr Prax. 2008;35(5):219–225.Google ScholarPubMed
12. Baumeister, H, Kufner, K. It is time to adjust the adjustment disorder category. Curr Opin Psychiatry. 2009;22(4):409–412.CrossRefGoogle ScholarPubMed
13. Laughame, J, van der Watt, G, Janca, A. It is too early for adjusting the adjustment disorder category. Curt Opin Psychiatry. 2009;22(1):50–54.Google Scholar
14. Baumeister, H, Maercker, A, Casey, P. Adjustment disorder with depressed mood: a critique of its DSM-IV and ICD-10 conceptualisations and recommendations for the future. Psychopathology 2009;42(3):139–147.CrossRefGoogle ScholarPubMed
15. Robins, E, Guze, SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatty. 1970:126(7):983–987.CrossRefGoogle Scholar
16. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association: 1994.Google Scholar
17. Foster, P, Oxman, T. A descriptive study of adjustment disorder diagnosis in general hospital patients. Irish J Psychol Med. 1994;11:153–157.CrossRefGoogle Scholar
18. Grassi, L, Mangelli, L, Fava, GA, et al. Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V. J Affect Disord. 2007;101(1–3):251–254.CrossRefGoogle ScholarPubMed
19. Oxman, TE, Barrett, JE, Freeman, DH, et al. Frequency and correlates of adjustment disorder related to cardiac surgery in older patients. Psychosomatics. 1994;35(6):557–568.CrossRefGoogle ScholarPubMed
20. Myers, JK, Weissman, MM, Tischler, GL, et al. Six-month prevalence of psychiatric disorders in three communities 1980 to 1982. Arch Gen Psychiatry. 1984;41(10):959–967.CrossRefGoogle ScholarPubMed
21. Kessler, RC, McGonagle, KA, Zhao, S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: result from national comorbidity survey. Arch Gen Psychiatry. 1994;51(1):8–19.CrossRefGoogle Scholar
22. Jenkins, R, Lewis, G, Bebbington, P, et al. The national psychiatric morbidity surveys of Great Britain: initial finding from the household survey. Psychol Med. 1997;27(4):775–789.CrossRefGoogle Scholar
23. Dowrick, C, Casey, P, Dalgard, O, et al. Outcome of Depression International Network (ODIN). Background, methods and field trials. ODIN Group. Br J Psychiatry. 1998;172:359–363.CrossRefGoogle ScholarPubMed
24. Casey, P, Maracy, M, Kelly, BD, et al. Can adjustment disorder and depressive episode be distinguished? Result from ODIN. J Affect Disord. 2006;92(2–3):291–297.CrossRefGoogle Scholar
25. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1987.Google Scholar
26. International Classification of Disease and Related Health Problems. 9th rev. Geneva, Switzerland: World Health Organization; 1978.Google Scholar
27. The ICD-10 Classification of Mental and Behaviour Disorders: Clinical Description and Diagnostic Guidelines. Geneva, Switzerland: World Health Organization; 1992.Google Scholar
28. Rutter, M. Stress, coping and development: some issues and some questions. J Child Psychol Psychiatry. 1981;22(4):323–356.CrossRefGoogle ScholarPubMed
29. Kovacs, M, Gatsonis, C, Pollock, M, et al. A controlled prospective study of DSM-III adjustment disorder in childhood. Short-term prognosis and long-term predictive validity. Arch Gen Psychiatry. 1994;51(7):535–541.CrossRefGoogle ScholarPubMed
30. Popkin, MK, Callies, AL, Colon, EA, et al. Adjustment disorders in medically ill inpatients referred for consultation in a university hospital. Psychosomatics. 1990:31(4):410–414.CrossRefGoogle ScholarPubMed
31. Fabrega, H, Mezzich, JE, Mezzich, AC, et al. Descriptive validity of DSM-III depressions. J Nerv Ment Dis. 1986;174(10):573–584.CrossRefGoogle ScholarPubMed
32. Snyder, S, Strain, JJ, Wolf, D. Differentiating major depression from adjustment disorder with depressed mood in the medical setting. Gen Hosp Psychiatry. 1990;12(3):159–165.CrossRefGoogle ScholarPubMed
33. Lott, A, Borgeat, F, Carron, R. Adjustment disorder: a minor diagnosis? A comparative study with the diagnosis of major depressive disorder. Schweiz Archiv Neurol Psychiatr. 2003;154:96–105.Google Scholar
34. Pelkonen, M, Marttunen, M, Henriksson, M, et al. Adolescent adjustment disorder: precipitant stressors and distress symptoms of 89 outpatients. Eur Psychiatry. 2007;22(5):288–295.CrossRefGoogle ScholarPubMed
35. Newcorn, JH, Strain, J. Adjustment disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1992:31(2):318–326.CrossRefGoogle ScholarPubMed
36. Andreasen, NC, Hoenk, PR. The predictive value of adjustment disorders: a follow-up study. Am J Psychiatry. 1982;139(5):584–590.Google ScholarPubMed
37. Jones, R, Yates, WR, Williams, S, et al. Outcome for adjustment disorder with depressed mood: comparison with other moods. J Affect Disorder. 1999:55(1):55–61.CrossRefGoogle Scholar
38. Jones, R, Yates, WR, Zhou, M. Readmission rates for adjustment disorders: comparison with other mood disorders. J Affect Disord. 2002;71(1–3):199–203.CrossRefGoogle ScholarPubMed
39. Looney, JG, Gunderson, EK. Transient situational disturbances: course and outcome. Am J Psychiatry. 1978;135(6):660–663.Google ScholarPubMed
40. Bronisch, T. Adjustment reactions: a long term prospective and retrospective follow-up of former patients in a crisis intervention ward. Acta Psychiatr Scand. 1991;84(1):86–93.CrossRefGoogle Scholar
41. Kumano, H, Ida, I, Oshima, A, et al. Brain metabolic changes associated with predispotion to onset of major depressive disorder and adjustment disorder in cancer patients - a preliminary PET study. J Psychiatr Res. 2007;41:(7):591–599.CrossRefGoogle ScholarPubMed
42. Bronisch, T, Hecht, H. Validity of adjustment disorder, comparison with major depression. J Affect Disord. 1989;17(3):229–236.CrossRefGoogle ScholarPubMed
43. Spalletta, G, Troisi, A, Saracco, M, et al. Symptom profile, axis II comorbidity and suicidal behavior in young males with DSM-III-R depressive illness. J Affect Disord. 1996;39(2):141–148.CrossRefGoogle Scholar
44. Enns, MW, Cox, BJ. Personality dimensions and depression: review and commentary. Can J Psychiatry. 1997;42(3):274–284.CrossRefGoogle ScholarPubMed
45. Alnaes, R, Torgensen, S. The relationship between DSM-III symptom disorders (axis I) and personality disorders (axis II) in an outpatient population. Acta Psychiatr Scand. 1988;78(4):485–492.CrossRefGoogle Scholar
46. Casey, PR, Tyrer, P. Personality disorder and psychiatric illness in general practice. Br J Psychiatry. 1990;156:261–265.CrossRefGoogle ScholarPubMed
47. Polyakova, I, Knobler, HY, Ambrumova, A, et al. Characteristics of suicidal attempts in major depression versus adjustment reactions. J Affect Disord. 1998;47(1-3):159–167.CrossRefGoogle ScholarPubMed
48. Lönnqvist, JK, Henriksson, MM, Isometsä, ET, et al. Mental disorders and suicide prevention. Psychiatry Clin Neurosci. 1995;49(suppl 1):S111–S116.CrossRefGoogle ScholarPubMed
49. Shaffer, D, Craft, L. Methods of adolescent suicide prevention. J Clin Psychiatry. 1999;60(suppl 2):70–74.Google ScholarPubMed
50. Bhatia, MS, Aggarwal, NK, Aggarwal, BB. Psychosocial profile of suicide ideators, attemptersand completers in India. Int J Soc Psychiatry. 2000;46(3):155–163.CrossRefGoogle ScholarPubMed
51. Wai, BH, Hong, C, Heok, KE. Suicidal behaviour among young people in Singapore. Gen Hosp Psychiatry. 1999;21(2):128–133.Google Scholar
52. Skopek, MA, Perkins, R. Deliberate exposure to motor vehicle exhaust gas: the psychosocial profile of attempted suicide. Aust N Z J Psychiatry. 1998:32(6):830–838.CrossRefGoogle ScholarPubMed
53. Pelkonen, M, Marttunen, M, Henriksson, M, et al. Suicidality in adjustment disorder-clinical characteristics of adolescent outpatients. Eur Child Adolesc Psychiatry. 2005;14(3):174–180.CrossRefGoogle ScholarPubMed
54. Mitrev, I. A study of deliberate self-poisoning in patients with adjustment disorders. Folia Med (Plovdiv). 1996;38(3–4):11–16.Google ScholarPubMed
55. Cavanagh, J, Owens, D, Johnstone, E. Suicide and undetermined death in south east Scotland. A case-control study using the psychological autopsy method. Psychol Med. 1999;29(5):1141–1149.CrossRefGoogle Scholar
56. Schaffer, D, Gould, MS, Fisher, P, et al. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry. 1996;53(4):339–348.CrossRefGoogle Scholar
57. Henriksson, MM, Aro, HM, Martunnen, MJ, et al. Mental disorders and comorbidity in suicide. Am J Psychiatry. 1993;150(6):935–940.Google ScholarPubMed
58. Marttunen, MJ, Aro, HM, Henriksson, MM, et al. Mental disorders in adolescent suicide. DSM-III-R axes I and II diagnoses in suicides among 13 to 19-years-olds in Finland. Arch Gen Psychiatry. 1991;48(9):834–839.CrossRefGoogle Scholar
59. Rich, CL, Scherman, M, Fower, RC. San Diego suicide study: the adolescents. Adolescence. 1990;25(100):855–865.Google Scholar
60. Kryzhanovskaya, L, Canterbury, R. Suicidal behavior in patients with adjustment disorders. Crisis. 2001;22(3):125–131.CrossRefGoogle ScholarPubMed
61. Runeson, BS, Beskow, J, Waern, M. The suicidal process in suicides among young people. Acta Psychiatr Scand. 1996;93(1):35–42.CrossRefGoogle ScholarPubMed
62. Portzky, G, Audenaert, K, van Heeringen, K. Adjustment disorder and the course of the suicidal process in adolescents. J Affect Disord. 2005;87(2–3):265–270.CrossRefGoogle ScholarPubMed
63. Magni, G, Palazzolo, O, Bianchin, G. The course of depression in elderly outpatients. Can J Psychiatry. 1988;33(1):21–24.CrossRefGoogle ScholarPubMed
64. Rothenhausler, HB, Grieser, B, Nollert, G, et al. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry. 2005;27(1):18–28.CrossRefGoogle ScholarPubMed
65. Akechi, T, Okuyama, T, Sugawara, Y, et al. Major depression, adjustment disorders, and posttraumatic stress disorder in terminally ill cancer patients: associated and predictive factors. J Clin Oncol. 2004;22(10):1957–1965.CrossRefGoogle ScholarPubMed
66. Torgensen, S. Genetic factors in moderately severe and mild affective disorders. Arch Gen Psychiatry. 1986;43(3):222–226.CrossRefGoogle Scholar
67. Maercker, A, Einsle, F, Kollner, V. Adjustment disorders as stress response syndromes: a new diagnostic concept and its exploration in a medical sample. Psychopathology. 2007;40(3):135–146.CrossRefGoogle Scholar
68. Bley, S, Einsle, F, Maercker, A, et al. Evaluation of a new concept for diagnosing adjustment disorders in a psychosomatic setting. Psychother Psychosom Med Psychol. 2008;58(12):446–453.CrossRefGoogle Scholar
69. Dobricki, M, Komproe, IH, de Jong, JT, et al. Adjustment disorders after severe life-events in four postconflict settings. Soc Psychiatry Psychiatr Epidemiol. 2010;45(1):39–46.CrossRefGoogle ScholarPubMed
70. Maercker, A, Forstmeier, S, Enzler, A, et al. Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: findings from a community survey. Compr Psychiatry. 2008;49(2):113–120.CrossRefGoogle ScholarPubMed
71. Strain, JJ, Diefenbacher, A. The adjustment disorders: the conundrums of the diagnoses. Compr Psychiatry. 2008;49(2):121–130.CrossRefGoogle ScholarPubMed
72. Hennessy, JW, Levine, S. Stress arousal, and the pituitary-adrenal system: a psychoendocrine hypothesis. In: Sprague, JM, Epstein, AN, eds. Progress in Psychobiology and Physiological Psychology. New York, NY: Academic Press; 1979:133–178.Google Scholar
73. Lupien, SJ, de Leon, M, de Santi, S, et al. Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Nat Neurosci. 1998;1(1):69–73.CrossRefGoogle ScholarPubMed
74. Malarkey, WB, Glaser, R, Kiecott-Glaser, JK, et al. Behavior: the endocrine-immune interface and health outcomes. Adv Psychosom Med. 2001;22:104–115.CrossRefGoogle ScholarPubMed
75. Kirschbaum, C, Hellhammer, DH. Salivary Cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology. 1994;19(4):313–333.CrossRefGoogle ScholarPubMed
76. Sudakov, KV, Yumatov, EA, Tarakanov, OP. The integral criterion of emotional stress. Int J Stress Manage. 1996;3(1):37–46.CrossRefGoogle Scholar
77. Veen, G, Giltay, EJ, Derijk, RH, et al. Salivary Cortisol, serum lipids, and adiposity in patients with depressive and anxiety disorders. Metabolism. 2009;58(6):821–827.CrossRefGoogle ScholarPubMed
78. Seeman, TE, McEwan, BS, Singer, BH, et al. Increase in urinary Cortisol excretion and memory declines: MacArthur studies of successful aging. J Clin Endocrinol Metab. 1997;82(8):2458–2465.Google ScholarPubMed
79. First, MB, Zimmermann, M. Including laboratory tests in DSM-V diagnostic criteria. Am J Psychiatry. 2006;163(12):2041–2042.CrossRefGoogle ScholarPubMed
80. McEwen, BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev. 2007;87(3):873–904.CrossRefGoogle ScholarPubMed
81. Fava, GA, Guidi, J, Semprini, F, et al. Clinical assessment of allostatic load andclinimetric criteria. Psychother Psychosom. In press.Google Scholar
82. Maj, M. Are we able to differentiate between true mental disorders and homeostatic reactions to adverse life events. Psychother Psychosom. 2007;76(5):257–259.CrossRefGoogle ScholarPubMed
83. Fava, GA, Wise, TN. Issues for DSM-V: psychological factors affecting either identified or feared medical conditions: a solution for somatoform disorders. Am J Psychiatry. 2007;164(7):1002–1003.CrossRefGoogle ScholarPubMed
84. de Figuereido, JM. Demoralization and psychotherapy. A tribute to Jerome D. Frank, MD, PhD (1909-2005). Psychother Psychosom. 2007;76(3):129–133.CrossRefGoogle Scholar
85. Cockram, CA, Doras, G, de Figueiredo, JM. Diagnosis and measurement of subjective incompetence: the clinical hallmark of demoralization. Psychother Psychosom. 2009;78(6):342–345.CrossRefGoogle ScholarPubMed
86. Ferrari, S, Galeazzi, GM, Mackinnon, A, et al. Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses. Psychother Psychosom. 2008;77(5):306–314.CrossRefGoogle ScholarPubMed
87. Fava, GA, Sonino, N. Psychosomatic assessment. Psychother Psychosom. 2009;78:333–341.CrossRefGoogle ScholarPubMed
88 Sonino, N, Peruzzi, P. A psychoneuroendocrinology service. Psychother Psychosom. 2009;78(6):346–351.CrossRefGoogle ScholarPubMed
89. Howland, RH, Schettler, PJ, Rapaport, MH, et al. Clinical features and functioning of patients with minor depression. Psychother Psychosom. 2008;77(6):384–389.CrossRefGoogle ScholarPubMed