Adjustment Disorder: A Comprehensive Exploration of Symptoms, Diagnosis, and Eligibility Criteria

Defined within the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) under Trauma- and Stressor-Related Disorders, Adjustment Disorder is a psychological condition. Its central aspect involves the manifestation of emotional or behavioral symptoms as a reaction to an identifiable stress-inducing factor. These stressors can vary in their magnitude, ranging from events like retirement to more distressing instances such as the loss of a loved one.

Stressors might encompass singular incidents like job loss or be composed of a combination of events such as divorce, custody battles, and financial challenges. Additionally, stressors can be either recurrent, as seen in seasonal business challenges, or persistent and continuous, such as an ongoing, debilitating illness.

According to its definition, the indications of adjustment disorder begin to emerge within three months of the commencement of the recognizable stressor(s) and persist no longer than half a year following the conclusion of the stressor or its repercussions. Should the stressor(s) or their consequences remain continuous, the adjustment disorder could transition into a persistent state. Only instances of adjustment disorder that endure as persistent are eligible for entitlement.

Criteria for Diagnosing Adjustment Disorder

The diagnostic criteria for adjustment disorder, originating from the DSM-5, can involve a specifier that characterizes the primary symptoms. Here’s an overview:

Criterion A: The onset of emotional or behavioral symptoms in response to identifiable stressors happening within three months of the initiation of said stressors.

Criterion B: These symptoms or behaviors are clinically significant and demonstrated by one or both of the following:

  1. Profound distress exceeding what would be anticipated considering the intensity of the stressor, considering external context and cultural factors that might influence the severity and presentation of symptoms.
  2. Substantial impairment in social, occupational, or other pivotal areas of functioning.

Criterion C: The stress-induced disturbance fails to fulfill the requirements for any other psychological disorder and is not simply an intensification of a preexisting psychological disorder.

Criterion D: The symptoms do not correspond to normal bereavement.

Criterion E: After the stressor or its consequences have ended, the symptoms do not persist for more than an additional half-year.

Diagnostic Guideline: A diagnosis given by a qualified medical professional (such as a family physician or psychiatrist) or a licensed psychologist is obligatory. The diagnosis is established based on clinical evaluation. Comprehensive supporting documentation is advisable.

Note: Eligibility should only be granted for a persistent condition. In the context of VAC (Veterans Affairs Canada), “persistent” refers to the indications and symptoms of the condition existing for a minimum of six months. These indications and symptoms are generally anticipated to endure despite medical attention, although they may fluctuate over the six-month period and beyond.

Considerations for Eligibility: On this page:

  1. Causes And/or Aggravation B. Medical Conditions That Should Be Included in Eligibility/Assessment C. Common Medical Conditions That Might Arise Wholly or Partly from Adjustment Disorder and/or Its Treatment
  2. Causes And/or Aggravation Distinguishing Causal or Aggravating Factors from Predisposing Factors Causal or aggravating factors have a direct impact on the initiation or exacerbation of the reported psychological condition. Predisposing factors do not induce a reported condition. Predisposing factors encompass experiences or exposures influencing an individual’s stress-coping abilities. These factors heighten an individual’s susceptibility to developing the reported condition. For instance, having a distant history of severe childhood abuse could serve as a predisposing factor in the emergence of a significant psychological condition in later life. Partial eligibility should only be taken into consideration for non-service-related causal or aggravating factors. Partial eligibility should not be taken into consideration for predisposing factors.

If there is uncertainty regarding whether a factor contributes as a causative or exacerbating element versus being a predisposing factor, it is strongly advised to seek consultation with a Medical Advisory.

Please note that the manifestation of symptoms related to an adjustment disorder typically occurs within three months of a clearly identifiable stressor(s). The formal diagnosis or documentation of these symptoms might not take place until after this initial three-month period has passed. Each individual case should be evaluated based on the medical evidence presented and its specific circumstances.

Keep in mind that the subsequent list of factors is not exhaustive. Besides those outlined in Section A, additional factors might be contended as causative or aggravating elements for an adjustment disorder. Other factors could be considered on an individual basis, depending on the quality of evidence provided for each case. It is highly recommended to consult with a Medical Advisory in such situations.

  1. Direct Exposure to Traumatic Events: Experiencing a traumatic event(s) directly within the three months prior to the clinical onset or worsening of an adjustment disorder.

Such traumatic events encompass, but are not limited to: a. Being exposed to military combat. b. Facing threats of physical assault or experiencing physical assault. c. Facing threats of sexual assault or experiencing sexual assault. d. Being kidnapped. e. Being held hostage. f. Being involved in a terrorist attack. g. Undergoing torture. h. Incarceration as a prisoner of war. i. Being affected by a natural or human-made disaster. j. Being in a serious motor vehicle accident. k. Accidentally causing harm or injury to someone. l. Experiencing a sudden and severe medical crisis.

  1. Witnessing Traumatic Events: Personally, witnessing traumatic event(s) as they unfold for other individual(s) within the three months prior to the clinical onset or aggravation of an adjustment disorder.

Examples of witnessed traumatic events include, but are not confined to: a. The threat of or actual serious injury to someone. b. Experiencing an unnatural death. c. Observing physical or sexual abuse of another person. d. A major medical catastrophe involving a close family member or dear friend.

  1. Learning About Traumatic Events: Discovering that a close family member or intimate friend underwent a violent or accidental traumatic event(s) within the three months before the clinical onset or aggravation of an adjustment disorder.

Such traumatic events incorporate, but are not restricted to: a. Physical assault. b. Sexual assault. c. A serious accident. d. Severe injuries.

  1. Repeated or Intense Exposure to Traumatic Details: Undergoing frequent or extreme exposure to distressing details of a traumatic event(s) within the three months before the clinical onset or aggravation of an adjustment disorder.

These exposures include, but are not confined to: a. Viewing and/or managing human remains. b. Participating in the handling of critically injured casualties. c. Repeated exposure to the specifics of abuse and/or atrocities inflicted on others. d. Dispatch operators exposed to violent or accidental traumatic event(s). Note: Factor 4 applies to exposure via electronic media, television, movies, and pictures only if such exposure is work-related.

  1. Residence or Employment in a Hostile or Life-Threatening Environment: Residing or working in an environment characterized by hostility or life-threatening circumstances for at least four weeks prior to the clinical onset or exacerbation of an adjustment disorder.

Situations or environments characterized by an inherent threat to personal safety and bodily well-being, encompassing but not limited to the following scenarios: a. Being exposed to the possibility of attacks involving artillery, missiles, rockets, mines, or explosive devices. b. Facing the risk of nuclear, biological, or chemical agent assaults. c. Engaging in combat activities or participating in combat patrols.

  1. Coping with the loss of an immediate family member or a close friend within the three months prior to the emergence or exacerbation of adjustment disorder.
  2. Confronting a distressing life incident within the three months preceding the onset or intensification of adjustment disorder.

Qualifying stressful life events encompass, among others: a. Dealing with social isolation and the inability to sustain relationships due to physical separation, language barriers, disability, or medical/psychiatric conditions. b. Navigating difficulties in long-term relationships, including the dissolution of close personal bonds, the need for couples or relationship therapy, separation, or divorce. c. Facing challenges in the work or school environment, such as persistent conflicts with colleagues, perceived lack of support, insufficient control over tasks, excessive workloads, or experiencing workplace or school-related bullying. d. Coping with serious legal problems, including detainment, ongoing legal entanglements, or court proceedings related to personal legal issues. e. Struggling with severe financial difficulties, such as job loss, prolonged unemployment, property foreclosure, or bankruptcy. f. Witnessing a significant decline in the health of an immediate family member or close friend. g. Assuming the role of a full-time caregiver for a family member or close friend with profound physical, mental, or developmental challenges.

  1. Battling a clinically noteworthy psychiatric condition within the three months preceding the onset or exacerbation of adjustment disorder.

A clinically significant psychiatric condition denotes a mental disorder as outlined in the DSM-5. 9. Confronting a life-threatening medical ailment or injury resulting in substantial physical or cognitive impairment within the three months preceding the onset or exacerbation of adjustment disorder.

  1. Suffering from chronic pain persisting for at least three months at the time of the emergence or exacerbation of adjustment disorder.
  2. Undergoing a miscarriage, fetal demise in utero, or stillbirth within the three months preceding the onset or exacerbation of adjustment disorder.
  3. Facing challenges in accessing appropriate clinical management for adjustment disorder.
  4. Medical Conditions to Be Included in Entitlement/Assessment NOTE: In cases where specific conditions are explicitly mentioned for a category, only those conditions are considered for entitlement and assessment of adjustment disorder. If no conditions are specified for a category, all conditions falling under that category are considered for entitlement and assessment of adjustment disorder. • Other Disorders Related to Trauma and Stress • Anxiety-related Disorders • Disorders Closely Associated with Obsessive-Compulsive Patterns • Mood Disorders Characterized by Depression • Conditions Related to Bipolar Disorders • Range of Disorders within the Schizophrenia Spectrum and Other Psychotic Disorders • Personality Disorders • Disorders Centered on Feeding and Eating Behaviors

Section A: Psychiatric Disorders

  1. Substance-Linked and Addictive Conditions
  2. Dissociation-Related Conditions
  3. Somatic Symptom and Associated Disorders a. Somatic Symptom Disorder b. Health Anxiety Disorder c. Conversion Disorder
  4. Pain Disorders/Chronic Pain Syndrome (DSM-IV-TR Axis I Diagnosis)
  5. Sleep-Wake Disturbances a. Insomnia Disorder b. Hypersomnolence Disorder
  6. Neurodevelopmental Issues a. Attention-Deficit/Hyperactivity Disorder
  7. Reduced Libido – if medical evidence indicates a connection between diminished libido and a psychiatric condition.

Section B: Entitlement for DSM-5 Conditions Not Covered in Section B of the Adjustment Disorder Entitlement Eligibility Guideline. Entitlement for conditions in Section B requires separate consideration and assessment.

Section C: Common Medical Conditions Potentially Linked to Adjustment Disorder and/or Its Treatment Medical conditions in this section may arise wholly or partly due to adjustment disorder, its treatment, or their combined effects. Entitlement for Section C conditions depends on a demonstrated consequential relationship, usually determined with input from Medical Advisory.

To assert that medication used for treating adjustment disorder led to the onset or exacerbation of a medical condition, the following conditions must be met:

  1. The individual was on the medication when the medical condition arose or worsened.
  2. The medication was prescribed for adjustment disorder treatment.
  3. The medication is either unlikely to be discontinued or is known to have lasting effects post-discontinuation.
  4. Current medical information supports the potential link between the medication and the medical condition.
  5. Note: While medications may belong to a specific class, individual effects should be considered, not group effects.

The Section C list is non-exhaustive. Conditions not listed may also be claimed to be linked to adjustment disorder and/or its treatment. Entitlement decisions for such cases depend on individual merits and provided medical evidence, often with consultation from Medical Advisory.

Section D: Medical Conditions Potentially Linked to Adjustment Disorder

  1. Sexual Dysfunction (e.g., Erectile Dysfunction)
  2. Irritable Bowel Syndrome
  3. Bruxism
  4. Xerostomia
  5. Periodic Limb Movement Disorder
  6. Restless Leg Syndrome
  7. Obstructive Sleep Apnea

Leave a Reply

Your email address will not be published. Required fields are marked *