Adjustment disorder
| Classification according to ICD-10 | |
|---|---|
| F43 | Reactions to severe stress and adjustment disorders |
| F43.2 | Adjustment disorders |
| ICD-10 online (WHO version 2019) | |
An adjustment disorder is a psychological response to one-time or ongoing identifiable psychosocial stressors that results in the development of clinically meaningful emotional or behavioral symptoms.
Symptoms
The symptoms can be very diverse and depend individually on the person and the event perceived as stressful.
The following symptoms are possible:
- Feeling of distress
- emotional impairment
- changed social behavior
- Problems with proximity / distance
- possibly social withdrawal
- Feelings of emptiness
- Brooding
- mental arrest (preoccupation)
- increased concern
- Joylessness
- Sadness
- fear
- depressed mood
- Shortness of breath
- etc.
The signs vary and include depressed mood , anxiety, or worry (or a mixture of these) without being too prominent to make the specific diagnoses possible. In addition, there can be a feeling of not being able to cope with the everyday circumstances, of not being able to plan or continue with them. Behavioral disorders can be an additional problem, especially among adolescents.
diagnosis
| Classification according to ICD-10 | |
|---|---|
| F43.2 | Adjustment disorder |
| F43.20 | ... short depressive reaction |
| F43.21 | … Prolonged depressive response |
| F43.22 | ... mixed fear and depressive reaction |
| F43.23 | ... with predominantly disturbance of other feelings |
| F43.24 | ... with predominant conduct disorder |
| F43.25 | ... with mixed disturbances of feelings and social behavior |
| F43.28 | ... with other specified predominant symptoms |
| ICD-10 online (WHO version 2019) | |
Diagnostic criteria for adjustment disorders F43.2 (ICD-10 research criteria):
A. Identifiable psychosocial distress, on a non-exceptional or catastrophic level; Symptoms start within a month.
B. Symptoms and behavioral disorders, as they occur in affective disorders (F3) (except delusions and hallucinations ), in disorders of chapter F4 ( neurotic , stress and somatoform disorders ) and in disorders of social behavior (F91). However, the criteria for a single incident are not met. Symptoms can vary in type and severity.
C. Symptoms do not last more than six months after the end of exercise or its aftermath, except for the prolonged depressive response (F43.21). An adjustment disorder can be diagnosed for up to six months.
In the ICD-10 adaptations of 2016, the previous general code F43.2 was divided into several more specific codes by adding a number.
Synonyms
Synonyms for adjustment disorder are hospitalism in children , abnormal grief response , culture shock .
causes
The adjustment disorders are reactions to stress. Such pressures can include ending a relationship, marital problems, job difficulties, or bullying. But so-called critical life events such as changing school, marriage, birth, death of a relative, unemployment , emigration and retirement can be a burden if you are unable to cope and lead to an adjustment disorder. This also applies to events such as flight, migration, accidents, robbery or operations. In children and adolescents, neglect (see hospitalism and deprivation ) can be the cause.
The individual predisposition or vulnerability plays an important role in the possible occurrence and form of the adjustment disorder.
frequency
As with all mental illnesses, the ascertained prevalence (frequency of illness) varies considerably depending on the population examined and the examination method . In the sample of children, adolescents and the elderly, it is 2–8%.
In a multicentre study in the general European population, applying the DSM-IV criteria for adjustment disorder with depressive symptoms, a point prevalence of 0.6% for women and 0.3% for men was determined. When the ICD-10 criteria were used, the rates were 0.3% lower for 18 to 65 year olds. In a Germany-wide representative study of 14 to 95 year olds, the adjustment disorder was found in 0.9% using new research criteria that will apply to the ICD-11 in the future.
Differential diagnosis
The ICD 10 specifies the non-existence of separation anxiety in childhood (F93.0) as an exclusion criterion.
There are several disorders that at first glance resemble an adjustment disorder, such as: B. attachment disorder , borderline , autism , Asperger's syndrome and schizoid personality disorder .
A distinction from other disorders is often only possible if the person affected is not in a home , hospital or institution , i.e. not in an environment that promotes hospitalism . If the person concerned is brought into a normal environment, the behavior often improves after a few months.
In contrast to the attachment disorder , the person concerned does not tend to violent or aggressive behavior and not to a “frozen” facial expression or to increased vigilance towards the environment.
The autism differs from the adjustment disorder mainly in that the autistic behavior even with good care persists excitation and enough. In addition, patients with adjustment disorder do not have the specific behavior of autistic people. In contrast to autistic people, people with an adjustment disorder also have no language deficits .
A differentiation from Asperger's syndrome is the performance of a neurological examination, which often produces suspicious results in people with Asperger's syndrome.
Consequences and complications
The subjective well-being of those affected is impaired; there are feelings of anxiety, depression, and / or worry. There may be difficulties coping with everyday life and its demands. Social behavior can be impaired, especially among young people, leading to loneliness and isolation . The consequences can be inability to work , difficulties in a relationship, or thoughts of suicide .
treatment
Adjustment disorders are treated psychotherapeutically , and in individual cases antidepressants are given as support.
Individual evidence
- ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Hogrefe, 2013, ISBN 978-0-89042-554-1 .
- ↑ Helmut Remschmidt, Martin H. Schmidt, Fritz Poustka (eds.): Multiaxial classification scheme for mental disorders of children and adolescents according to ICD-10 of the WHO. With a synoptic comparison of ICD-10 and DSM-IV. Huber, 2006.
- ↑ https://www.icd10data.com/ICD10CM/Codes/Changes/New_Codes/53?year=2016
- ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Hogrefe, 2013.
- ↑ JL Ayuso-Mateos, JL Vazques-Barquero, C. Dowrick et al. a .: The ODIN group: Depressive disorders in Europe: prevalence figures from the ODIN study. In: Brit J Psychiat. 179, 2001, pp. 308-316.
- ↑ A. Maercker, S. Forstmeier, L. Pielmaier u. a .: Adjustment disorders: Prevalence in a representative nationwide surcey study in German. In: Soc Psych Psychiat Epidem. 47, 2012, pp. 1745-1752.
- ↑ Helmut Remschmidt , Martin H. Schmidt , Fritz Poustka (eds.): Multiaxial classification scheme for mental disorders of children and adolescents according to ICD-10 of the WHO. With a synoptic comparison of ICD-10 and DSM-IV . Huber, 2006.
