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Review
Adjustment Disorder: Current Developments and
Future Directions
and
Winnie Lau
Meaghan L. O’Donnell
1,2,
*, James A. Agathos
1,2
1,2
, Olivia Metcalf
1,2
, Kari Gibson
1,2
1
Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC,
Melbourne 3053, Australia
2
Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
* Correspondence: mod@unimelb.edu.au

Received: 26 June 2019; Accepted: 10 July 2019; Published: 16 July 2019

Abstract: Despite its high prevalence in clinical and consultant liaison psychiatry populations,
adjustment disorder research has traditionally been hindered by its lack of clear diagnostic criteria.
However, with the greater diagnostic clarity provided in the Diagnostic and Statistical Manual of
Mental Disorders – fifth edition (DSM-5) and the International Statistical Classification of Diseases
and Related Health Problems, 11th edition (ICD-11), adjustment disorder has been increasingly
recognised as an area of research interest. This paper evaluates the commonalities and di erences
between the ICD-11 and DSM-5 concepts of adjustment disorder and reviews the current state of
knowledge regarding its symptom profile, course, assessment, and treatment. In doing so, it identifies
the gaps in our understanding of adjustment disorder and discusses future directions for research.
Keywords: adjustment disorder; review; diagnosis; symptoms; nosology; DSM-5; ICD-11; course;
trajectory; treatment
1. Introduction
Adjustment disorder describes a maladaptive emotional and/or behavioural response to an
identifiable psychosocial stressor, capturing those who experience di culties adjusting after a stressful
event at a level disproportionate to the severity or intensity of the stressor [1]. The symptoms are
characterised by stress responses that are out of step with socially or culturally expected reactions
to the stressor and/or which cause marked distress and impairment in daily functioning. Unlike
posttraumatic stress disorder (PTSD) or acute stress disorder (ASD), which have clear criteria for what
constitutes a traumatic event, adjustment disorder criteria does not specify any requirements for what
can be regarded as a stressor. Research has identified, however, that stressor events may include both
traumatic events, such as exposure to actual or threatened death, as well as non-traumatic stressful
events such as interpersonal conflict, death of a loved one, unemployment, financial di culties, or
illness of a loved one or oneself [2].
Prevalence estimates of adjustment disorder vary markedly due to various factors including
sampling process, population, and the diversity of measures used for assessment and diagnosis.
Population-based studies have found prevalence rates of less than 1%, which may be due to limitations
of the diagnostic tools used [3]. Conversely, more recent studies using newer diagnostic tools have
found prevalence rates of 2% in general population research [4]. Rates are much higher in specific
high-risk samples such as recently unemployed (27%; [5]) and bereaved individuals (18%; [6]).
Adjustment disorder is particularly prevalent in consultation liaison settings [7]. A multisite
study in consultation psychiatry services in the United States, Canada, and Australia found that
adjustment disorder was diagnosed in 12% of psychiatric consultations, with a further 11% identified
Int. J. Environ. Res. Public Health 2019, 16, 2537; doi:10.3390/ijerph16142537
www.mdpi.com/journal/ijerph

 
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