Adjustment disorder is the term used by the American Psychiatric Association to describe a slow, dysfunctional adaptation to the mental/emotional stress triggered by exposure to traumatic situations or non-traumatic situations. Currently, doctors have no easy way to distinguish this dysfunctional adaptation from more serious stress-related conditions. In a study published in 2014 in the International Journal of Methods in Psychiatric Research, a team of Dutch researchers assessed the potential usefulness of a newly developed screening tool called the Diagnostic Interview Adjustment Disorder (DIAD) in helping doctors identify affected individuals.
Adjustment disorders belong to a larger group of mental health issues known as “trauma- and stressor-related disorders.” Other members of this group include post-traumatic stress disorder (PTSD) and acute stress disorder (ASD). In a certain sense, an adjustment disorder can be viewed as an intermediate stage between the typical psychological/emotional adaptations that take place after trauma exposure and the highly dysfunctional reactions associated with PTSD and ASD. There are six identified subtypes of the condition: adjustment disorder centered on a depressed mood, adjustment disorder centered on an anxious mood, adjustment disorder with combined indications of depression and anxiety, adjustment disorder centered on the presence of conduct problems, adjustment disorder with combined indications of mood problems and conduct problems, and a generalized poor adaptation to stress or trauma that does not fit the definition of any other adjustment disorder subtype.
The symptoms of any adjustment disorder subtype must appear within a quarter of a year following the event or situation identified as the underlying cause of problems. In addition, affected individuals must have stress reactions that seem outsized in proportion to the originating event or situation, or alternately must experience some sort of significant life impairment as a result of their stress reactions. Affected individuals must not meet the terms used to diagnose PTSD, ASD or other trauma- or stress-related conditions; symptoms of an adjustment disorder must also fade within half a year of the end of the originating trauma exposure.
In addition to differentiating adjustment disorders from PTSD and ASD, doctors must be careful not to confuse the symptoms of adjustment problems with the symptoms of depressive illness, psychosis-related illness or any of the 10 mental health conditions known collectively as personality disorders. Currently, there is no clear-cut way for doctors to make this differentiation. Instead, they use a general mental status examination to characterize each individual’s overall emotional/psychological health and ability to do such things as think and speak coherently, make rational judgments and provide insights on his or her state of general well-being.
Effectiveness of a New Screening Tool
In the study published in the International Journal of Methods in Psychiatric Research, researchers from the University of Groningen, VU University Amsterdam and two other Dutch institutions used a combination of expert opinions and interviews with potentially affected individuals to assess the effectiveness of the Diagnostic Interview Adjustment Disorder as a screening tool for identifying people with adjustment disorders. The DIAD uses the official American Psychiatric Association definition for adjustment disorders as the basis for a detailed interview of people who experience emotion and conduct problems in the aftermath of trauma exposure. A total of 11 experts were asked to evaluate the screening tool. In addition, the researchers used the screening tool to evaluate 323 people with symptoms that might qualify them for an adjustment disorder diagnosis. They used two other mental health screening procedures—the Kessler Psychological Distress Scale and the World Health Organization Disability Assessment Schedule—to roughly gauge the validity of the results obtained with the DIAD.
Overall, the experts consulted by the researchers deemed the Diagnostic Interview Adjustment Disorder to be “moderate to good” as a screening tool for identifying people with an adjustment disorder. All told, 7.4 percent of the interview participants had DIAD results that would qualify them for an adjustment disorder diagnosis. The researchers concluded that this rate of illness identification matches well with the more generalized, non-adjustment disorder-specific results obtained with the Kessler Psychological Distress Scale and the World Health Organization Disability Assessment Schedule.
On the whole, the study’s authors believe that their findings provide preliminary support for the potential usefulness of the Diagnostic Interview Adjustment Disorder as a screening tool for detecting the presence of adjustment disorders. However, they note the need for additional research to verify and widen the scope of their findings.