Adjustment Disorder Gains Respect in DSM-5
Adjustment Disorder Basics
The US National Library of Medicine lists a variety of stressful situations or circumstances that can potentially overwhelm a person’s normal coping mechanisms and lead to the onset of adjustment disorder. These situations and circumstances include going through a divorce or some other form of significant relationship disruption, the death of a close friend or relative, serious health problems that occur to the affected individual or a close friend or relative, money problems, exposure to a disaster, and moving to a new city or residence. Adjustment disorder may also appear in the aftermath of a series of relatively small problems that accumulate over time. Specific situations and circumstances that may lead to adjustment difficulties during adolescence or early adulthood include problems related to sexual orientation, school-related difficulties, and various forms of family conflict.
According to the now partially outdated guidelines established in the fourth edition of the Diagnostic and Statistical Manual, a person with a diagnosable case of adjustment disorder must have damaging behavioral or emotional responses to stress that arise within 90 days of an originating situation or circumstance. Things that signify a damaging stress response include emotions or actions that seem out of proportion to the source of stress and/or a substantial disruption of work-related, school-related or interpersonal aspects of everyday life. In addition, an affected individual must not have depression-like symptoms of bereavement (grief) or some other condition that better accounts for his or her unusual response to stress.
Apart from these criteria, there is a retrospective stipulation that states that a person with adjustment disorder typically recovers within half a year after the source of stress ceases to play an immediate role in his or her life. People who recover within this timeframe have acute or short-term adjustment disorder; people who don’t recover within this timeframe have chronic or long-term adjustment disorder. Doctors break down chronic forms of the condition into subtypes that vary according to the main symptom present. These subtypes go by the names “with anxiety,” “with depressed mood,” “with mixed anxiety and depressed mood,” “with disturbance of conduct,” “with mixed disturbance of emotions and conduct” and “unspecified.”
Although it’s not necessarily readily apparent from its wording on the page, adjustment disorder as described in the fourth edition of the DSM functioned as something of a catchall category. As a rule, mental health professionals would only consider diagnosing its presence in patients who did not meet all of the requirements needed to merit a diagnosis for some other more prominent mental health problem such as depression or post-traumatic stress disorder (PTSD). Because of its status in relation to these other problems, adjustment disorder didn’t really enjoy much respect as a concept or reality within the mental health community.
The fifth edition of the Diagnostic and Statistical Manual (known commonly as DSM 5) seeks to correct this perception by fully establishing adjustment disorder as a distinct, damaging condition that produces its own unique effects in people who don’t react well in the aftermath of extraordinary or everyday stress. By taking this stance, the American Psychiatric Association is essentially signaling to practicing mental health professionals that they should take the disorder more seriously and start to consider it as a meaningful, primary diagnosis for their patients rather than as a fallback diagnosis that they only use in cases that don’t meet the standards for other forms of mental illness.
Apart from this crucial change in emphasis, the overall definition of adjustment disorder remains basically the same between the fourth and fifth editions of the Diagnostic and Statistical Manual. Doctors can still do such things as identify acute and chronic cases of the disorder and specify which symptoms play a dominant role in chronically affected individuals.