Psych · General adult psychiatry — trauma and stressor-related disorders
Adjustment disorders
Also known as Adjustment disorder · Situational depression · Reactive depression (historical misuse) · Stress response syndrome · Transient situational disturbance (historical)
Exam-exhaustive fellowship reference on adjustment disorders — DSM-5-TR and ICD-11 criteria and timing; specifiers; differential vs MDD, PTSD/ASD, normal stress and prolonged grief; suicide-risk nuance; watchful waiting and brief psychological interventions (problem-solving, brief CBT); limited role of antidepressants; occupational and C-L pathways. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Suicidal ideation, planning, or recent self-harm — full risk assessment and safety plan; do not down-triage because the working label is adjustment disorder
- Full major depressive episode, PTSD/ASD, or manic symptoms — diagnose and treat the full syndrome; do not soft-label as adjustment disorder
- Ongoing domestic violence, homelessness, or workplace bullying — safeguarding and practical safety before psychotherapy booking alone
- Acute medical catastrophe framed only as 'stress' (PE, ACS, thyrotoxicosis, substance withdrawal) — medical resuscitation first
- Adolescent conduct change with impulsivity, substance use, or school collapse — high self-harm vigilance and family/school liaison
- Chronic daily benzodiazepines for life stress — dependence risk and blocked psychological work; exit strategy required
Meet the patient
A 45-year-old accountant is brought in by his wife. Six weeks ago he was made redundant in a ten-minute meeting, and he has replayed that meeting every night since. He is tearful, not sleeping, and has cancelled golf for a month — but he still enjoys his kids' football, has no suicidal thoughts, and brightens visibly when the conversation turns to what he might do next.[1][3][9]
The examiner's question: disorder or demoralisation — and if disorder, why not depression? Your answer lives on a clock and a count: the stressor link, the three-month window, and the full-episode screen.[1][5][17]
References18ShowHide
- [1]Bachem R, Casey P Adjustment disorder: A diagnosis whose time has come J Affect Disord, 2018.PMID 29107817
- [2]Casey P Adjustment disorder: new developments Curr Psychiatry Rep, 2014.PMID 24748555
- [3]Casey P Adjustment disorder: epidemiology, diagnosis and treatment CNS Drugs, 2009.PMID 19845414
- [4]Carta MG, Balestrieri M, Murru A, Hardoy MC Adjustment Disorder: epidemiology, diagnosis and treatment Clin Pract Epidemiol Ment Health, 2009.PMID 19558652
- [5]O'Donnell ML, Agathos JA, Metcalf O, Gibson K, et al. Adjustment Disorder: Current Developments and Future Directions Int J Environ Res Public Health, 2019.PMID 31315203
- [6]Domhardt M, Baumeister H Psychotherapy of adjustment disorders: Current state and future directions World J Biol Psychiatry, 2018.PMID 30204563
- [7]Cowansage KP, Milligan T, Morgan MA, et al. Treatments for adjustment disorder: A systematic review and meta-analysis of randomized controlled trials Psychiatry Res, 2025.PMID 41005147
- [8]Morgan MA, Kelber MS, Bellanti DM, et al. Outcomes and prognosis of adjustment disorder in adults: A systematic review J Psychiatr Res, 2022.PMID 36347110
- [9]Geer K Adjustment Disorder: Diagnosis and Treatment in Primary Care Prim Care, 2023.PMID 36822730
- [10]Strain JJ The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology Int J Environ Res Public Health, 2019.PMID 31766628
- [11]van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design Occup Environ Med, 2003.PMID 12771395
- [12]van der Klink JJ, van Dijk FJ Dutch practice guidelines for managing adjustment disorders in occupational and primary health care Scand J Work Environ Health, 2003.PMID 14712856
- [13]Pelkonen M, Marttunen M, Henriksson M, Lönnqvist J Suicidality in adjustment disorder--clinical characteristics of adolescent outpatients Eur Child Adolesc Psychiatry, 2005.PMID 15959663
- [14]Kryzhanovskaya L, Canterbury R Suicidal behavior in patients with adjustment disorders Crisis, 2001.PMID 11831599
- [15]Polyakova I, Knobler HY, Ambrumova A, Lerner V Characteristics of suicidal attempts in major depression versus adjustment reactions J Affect Disord, 1998.PMID 9476756
- [16]Maercker A, Brewin CR, Bryant RA, Cloitre M, et al. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11 World Psychiatry, 2013.PMID 24096776
- [17]Casey P, Doherty A Adjustment disorder: implications for ICD-11 and DSM-5 Br J Psychiatry, 2012.PMID 22859575
- [18]Fernández-Buendía S, Miguel C, Dumarkaite A, Kazlauskas E, et al. Technology-supported treatments for adjustment disorder: A systematic review and preliminary meta-analysis J Affect Disord, 2024.PMID 37992766