Considering adjustment disorders as stress response syndromes for DSM-5

Abstract

Adjustment Disorder (AD) is included in this special issue because AD shares with posttraumatic stress disorder (PTSD), and acute stress disorder (ASD) the etiology of a stressful event that has precipitated a clinically significant alteration in cognitions, emotions, and/or behavior.The AD diagnostic criteria are shown in Table 1.Initially conceived as transitory diagnoses that should not exceed 6 months in duration in DSM-III [1] the AD criteria were expanded in DSM-IV to include a chronic form when the stressor persists for more than 6 months.Unlike PTSD, which requires that symptoms must present more than a month after exposure to a traumatic event, AD may be diagnosed immediately after an individual has a distressing experience.Furthermore, because AD may be diagnosed after any distressing event that causes significant distress or functional impairment, the crucial requirement in ASD and PTSD for a traumatic stressor as the precipitating event does not apply to AD. Nontraumatic stressors may also precede AD.This has both diagnostic advantages and clinical utility, as discussed below.In this brief article, we will consider AD as a stress response syndrome, in agreement with Maercker et al. [2] We will not address the question of AD within the larger context of mood, conduct, and other anxiety disorders.We will discuss the current lack of a standardized assessment instrument for AD and suggest that this may be one reason why there has been so little empirical research on AD.We will review current DSM-IV as well as the proposed DSM-5 diagnostic criteria for AD and the rationale for these suggested revisions, especially with respect to the newly proposed ASD/PTSD subtype.Finally, we will present a theoretical context for AD as a stress response syndrome and suggest an agenda for future research.

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