Introduction

The concept of adjustment disorder (or a group of adjustment disorders) has a long history, though what is actually meant by the term has changed over time. Originally, as ‘adjustment reaction’, it was one of a very few disorder categories included in major psychiatric classification schemes specifically for use in children and adolescents. In DSM-I, for instance, adjustment reaction and childhood schizophrenia were the only two categories of childhood psychiatric disorder. The intention was to indicate that some instances of disordered behaviour or emotions arose specifically because of an identified stressor rather than, say, a process of mental illness. The source of stress was originally thought of as including both external events (such as bereavement) or an internal developmental process, which might require significant adaptation of mental functioning (such as maturational changes during adolescence). There was an implicit idea that adjustment to adversity or intra-psychic conflict could be either adaptive or maladaptive. If it was maladaptive, then personal dysfunction was to be seen as a psychiatric condition.

Historically, the most widespread way of understanding a psychological response to adversity or conflict was initially through psychoanalytic theory and a concept of trauma or intrapsychic conflict secondary to external events or developmental challenges. Subsequently, the development of a model of social influences led to a rather different way of thinking which emphasized processes rather more than events.