Adjustment Disorders: Diagnostic and Treatment Issues

The diagnostic category of adjustment disorder (AD) made its first appearance in DSM-III in 1968, replacing the previous “transient situational disturbance” of DSM-II, and shortly after was included in ICD-9. It has persisted into the current versions of both DSM-IV and ICD-10. The inclusion of AD recognizes that people can often develop symptoms or exhibit behaviors in response to stressful events that are in excess of normal reactions. Resolution with the minimum of intervention, apart from general supportive measures, is frequent, either when the stressor is removed, or as new levels of adaptation are reached. Management of anxiety or insomnia symptoms, or brief psychological treatments are sometimes used to shorten the duration or reduce the intensity of AD episodes. In patients with AD, both emotional and behavioral disturbances are present and include low mood, tearfulness, anxiety, self-harm, withdrawal, anger, and irritability.