ICD-116B43	ADJUSTMENT DISORDER Adjustment disorder
ICD-10F43.2	Adjustment disorders
DSM-5-TRF43.2x	Adjustment Disorder

1. Definition and nosology

Adjustment disorder (ICD-11: 6B43 Adjustment Disorder; DSM-5-TR: F43.2x) — clinically significant emotional or behavioral symptoms that have developed in response to an identifiable stressor (acute or persistent, individual or collective). Symptoms do not meet full criteria for another mental disorder (MDD, GAD, etc.).

2. History

• DSM-III (1980) — “Adjustment Disorder” as an official diagnosis.
• ICD-11 — within the stress-related disorders group; general symptom profile ‘preoccupation’ (preoccupation with the stress factor) + adjustment difficulty.

3. Epidemiology

• Among the most frequent psychiatric diagnoses in primary care; in clinical populations 5–20%.
• Sex and age — universal; more intense at young age and during new stress periods.
• Comorbidity: MDD, anxiety, substance use, suicide risk (especially in short-term acute form).

4. Aetiology and pathogenesis

• Stress factor - a single event (divorce, job loss, illness diagnosis, grief) or multiple/persistent stressors.
• The role of personality and coping resources — the same stress elicits different responses in different people.
• Social support — protective factor.

5. Clinical features

• Preoccupation with the stress factor - recurrent thoughts, worry.
• Difficulty adapting to new situations.
• Emotional symptoms — depressed mood, anxiety, irritability.
• Behavioral symptoms — social withdrawal, decreased work/school performance, risky behavior.

DSM-5-TR subtypes

• With depressive mood (F43.21);
• With anxiety (F43.22);
• With mixed depressive mood and anxiety (F43.23);
• With conduct disorder (F43.24);
• Emotional and behavioral mixed (F43.25);
• Unspecified (F43.20).

6. Diagnosis

6.1 Unified diagnostic criteria

A. Identifiable stressor response — onset within 3 months (DSM-5-TR) / within 1 month (ICD-11).

B. Symptoms clinically significant — distress or functional impairment disproportionate to stress.

C. Does not meet criteria for another mental disorder (MDD, GAD, PTSD, complex PTSD, prolonged grief).

D. Not normal grief (sorrow).

E. Symptoms resolve within 6 months after the stress factor (or its consequences) has terminated (DSM-5-TR).

6.2 Source-specific clarifications

• DSM-5-TR — onset at 3 months; subtype specifiers.
• ICD-11 — onset 1 month; ‘preoccupation with the stressor’ main symptom; no subtypes, but additional anxiety qualifiers.

6.3 Diagnostic algorithm

1. Clinical interview — stressor, symptom onset, prior psychiatric history.
2. SCID-5, MINI.
3. Scale - PHQ-9, GAD-7 symptom severity.
4. MDD, GAD, PTSD, complex PTSD exclusion.
5. Suicide risk (C-SSRS) — acutely particularly high.

6.4 Differential diagnosis

7. Examination and assessment

• PHQ-9, GAD-7, C-SSRS.
• Documentation of the stress factor.

8. Treatment

1. First-line: short-term psychotherapy — supportive, problem-solving, CBT-based brief intervention (8–12 sessions).
2. Stress management, strengthening social support, development of coping strategies.
3. Pharmacotherapy — only in severe cases or comorbid; SSRIs short-term; benzodiazepines for acute anxiety for 1–2 weeks.
4. Monitor suicide risk.
5. Removal or modification of the stress factor (if possible).

Source-specific specifications

• NICE — no separate guideline for adjustment disorder; general anxiety and depression principles.
• WHO mhGAP — supportive approach in acute stress reactions, ‘watchful waiting’ in mild cases.
• Evidence base is limited — the residual nature of the diagnosis.

Treatment methods

1. Short-term problem-solving therapy (Problem-Solving Therapy) – Nezu (Nezu A.M.) — 4–8 sessions; concrete problem identification, evaluation of solution options, behavioral execution.
2. Supportive Psychotherapy — Validation, emotional expression, social support.
3. CBT in brief form — Cognitive restructuring + behavioral activation.
4. Stress management and relaxation — Breathing exercises, progressive muscle relaxation, mindfulness.

9. Prognosis

• In most cases remission within 6 months.
• Some persist or transition to MDD/PTSD — follow-up recommended.

10. Myths and misconceptions

Myth 1: “Adjustment disorder is not a real diagnosis, just ‘life difficulty’”

Evidence: Clinical diagnosis requires functional impairment or acute distress; suicidal risk must be assessed especially.

Myth 2: “When the stressor passes, the diagnosis automatically resolves, no treatment needed”

Evidence: Some cases persist or transition to MDD/PTSD; short-term intervention prevents treatment transition.

Myth 3: “Antidepressant is first-line for adjustment disorder”

Evidence: Psychotherapy is first-line; pharmacotherapy only in severe or comorbid cases.

Myth 4: “Suicide risk is low in adjustment disorder”

Evidence: Acute stress reactions are accompanied by a high impulsivity suicide risk; active assessment.

Myth 5: “The patient is weak or has a ‘weak character’”

Evidence: Reaction result of interaction between stress intensity and coping resources; weakness of character explanation stigmatizing and incorrect.

11. Sources

1. WHO. ICD-11. 6B43 Adjustment disorder. 2024.
2. APA. DSM-5-TR. 2022.
3. Maercker A. et al. ICD-11 stress-related disorders. World Psychiatry 2013;12(3):198–206.
4. Casey P. Adjustment disorder: epidemiology, diagnosis and treatment. CNS Drugs 2009;23(11):927–938.
5. Nezu A.M., Nezu C.M., D’Zurilla T.J. Problem-Solving Therapy: A Treatment Manual. New York: Springer, 2013.