Editorial

iMedPub Journals 2015
Acta Psychopathologica
http://www.imedpub.com ISSN 2469-6676 Vol. 1 No. 2:14

DOI: 10.4172/2469-6676.100014

Adjustment Disorders in DSM- Francesco Chirico
5: Implications for Occupational Institute: State Police Health Service
Health Surveillance Department, Ministry of Interior, Italy

Corresponding author: Chirico F

Abstract  medlavchirico@gmail.com
Work-related stress is experienced when the demands of the work environment
exceed the employees’ ability to cope with (or control) them. Recently, in DSM- Institute: State Police Health Service
5, disorders which are precipitated by specific stressful and potentially traumatic Department, Ministry of Interior, Italy.
events in the workplaces are included in a new diagnostic category, “Trauma
and Stress-related Disorders”, which includes both Adjustment Disorders (Ads) Tel: 3346904194
and PTSD. Adjustment disorder is a common diagnosis in psychiatric settings
and carries a significant rate of morbidity. Nevertheless, until now, despite its
relative frequency, adjustment disorder has been poorly covered in the literature; Citation: Chirico F. Adjustment Disorders in
this diagnostic category has been the subject of criticism. Occupational Health DSM-5: Implications for Occupational Health
Surveillance could reduce the misdiagnosis of AD and, simultaneously, improve Surveillance. Acta Psychopathol. 2015, 1:1.
the research on “work-related stress disorders”.
Keywords: Adjustment disorder; Work-related stress disorders; DSM-5;
Occupational health surveillance

Received: September 25, 2015; Accepted: October 05, 2015; Published: October 11,
2015

Adjustment disorders in DSM-5: impli- factors lead to clinically significant work- related stress disorders.
Interestingly, Cox and Griffiths reported that the literature which
cations for occupational health surveil- describes the translation from a normal psychological reaction
lance to events to psychological illness is not well formed, except in
the case of post-traumatic stress and related disorders [2].
Over the last decade a consistent increase in stress-related The term “work-related stress disorders” has been applied to
psychological consequences at the workplace has been seen. many overlapping stress-related concepts and diagnoses such
Stress isn’t a disease, but if it is intense and goes on for some as neurasthenia, AD and burnout. Unfortunately, there is no
time, it can lead to mental and physical ill-health. The Health and
consensus based on these concepts, terms, and diagnoses or on
Safety Executive in the UK defines work related stress as being
criteria that can be used in practice for employees with serious
‘the process that arises where work demands of various types
work-related problems or disorders [7]. For example, Burnout
and combinations exceed the person’s capacity and capability to
is not a psychiatric diagnosis but a concept of the occupational
cope’ [1]. According to EU-OSHA it is convenient to summarize
psychology concerning the impact of working conditions on the
the possible health and health-related effects of work-related
psyche of affected persons. Depression and burnout appear to
stress under two headings: psychological and social effects,
be interrelated. Research reported the overlap of job-related
and physiological and physical effects [2]. From, often cross-
sectional, studies it can be deducted that an association exists burnout and depressive disorders, i.e., major depressive disorder,
between work-related psychosocial risk factors and distress dysthymia, and minor depressive disorder and the need for their
symptoms. Reviews have examined the association of work- differential diagnosis has been highlighted in many reviews [8]. A
related psychosocial factors and depressive disorders [3] and group of Canadian psychiatrists has argued that burnout can be
all common mental disorders combined [4, 5]. Mental disorders considered a particular mental adjustment disorder as described
attributed to work-related stress include post-traumatic stress by DSM [9]. Moreover, according to Dutch guidelines on DSM-IV
disorder, burn-out, adjustment disorder (AD), depression and TR, adjustment disorders (Ads) were classified into the categories
anxiety [6]. However, it is not always clear whether such risk of distress, nervous breakdown, and burnout [7]. In Italy, the

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the SCID-5 can be used also in comprehensive reaching 50% [13]. alterations in mood. In DSM-5. policy makers. INAIL recognizes the Chronic Adjustment Disorder adjustment disorder. psychologists. which includes impaired functioning and in social.. unlike most conditions classified in DSM. 1 No. SCID by researchers.psychopathology. of psychiatric disorders among certain populations [13].imedpub. In a hospital psychiatric consultation IV Axis I Disorders (SCID-I). According to DSM 5. The The Structured Clinical Interview for DSM 5 (SCID-5) is a semi- percentage of individuals in outpatient mental health treatment structured interview guide for making DSM-5 diagnoses such as with a principal diagnosis of an adjustment disorder ranges from AD and has replaced the Structured Clinical Interview for DSM- approximately 5% to 20%. Casey has pointed out that AD is poorly employees exposed to specific health risks during the course of delineated in both DSM IV TR and ICD-10. According to Casey [24] there is Diagnostic criteria by DSM IV TR are vague and lead to many no guidance on the distinction from normal stress reactions.g. the DSM IV TR system has been replaced with than would normally be expected. the work-related problems seen in daily practice [7]. AD is a very common diagnosis in clinical forensic diagnostic evaluation. “adjustment disorder” is an accepted medical the external context and the cultural factors that might influence diagnosis and is consistent with experience in occupational health symptom severity and presentation and significant impairment is practice. in the healthcare system of the US [18]. The boundary between their work. there are still problems with the classification of Ads. or been the subject of criticism on three fronts. burnout or other outcomes such as job satisfaction. differently from DSM sickness absence. Some studies have found a discrepancy In occupational health practice. In Chronic Adjustment Disorder as professional illnesses referable DSM IV TR. Moreover. psychiatrists. 2015 Acta Psychopathologica ISSN 2469-6676 Vol. to more as a “justification” for diagnosis-based reimbursement operating severe and chronic psychopathology (including PTSD) [22. presenteeism and ill health retirement [14]. It’s a control measure that may be needed in some adjustment disorder and normal adaptive stress is not addressed situations where health risks cannot be eliminated or adequately and the differentiation from other psychiatric disorders such as controlled. the diagnostic data that practice. Friedman assert that there is having a specific symptom profile [16]. 23]. structured interview. occupational or academic functioning. but we still lack data about its rightful clinical entity. ADs are included in a new diagnostic category. Moreover. The second was that it heuristic value in grouping this set of disorders in a specific was a “wastebasket diagnosis” which was assigned to those who stress-related category as it enables clinicians to differentiate failed to meet the criteria for other disorders [17]. since its introduction the category of AD has magnitude of the distress (e. AD is an abnormal and excessive alone. 5 AD have been classified under the trauma and stress related depression. have been obtained using the SCID-5 interview can be utilized because it has found little place in the scientific literature. difficulties in terms of validity and reliability. having to situations of Mobbing and task-related Bullying [10-12]. disorders for the first time. practitioners. and that it does of these. and can result in significant a more simplified. was considered an overly rigid diagnostic instrument reaction to an identifiable life stressor. DSM-5. questionnaires could be useful between AD when diagnosed clinically as compared to using a in the first step medical examination (occupational physician). occupational or in other important areas of functioning. which includes both ADs and PTSD [13]. In DSM reported instruments such as questionnaires for reporting anxiety. diffuse on its diagnostic instability and that its main utility was to serve clinically elevated stress reactions indicative of AD.com . and the subtypes are not the most insightful critics of the DSM-IV. Wakefield [19]. The first was that conduct) exceeds what would normally be expected (which may it constituted an attempt to medicalize problems of living and vary in different cultures) or when the adverse event precipitates did not conform to the criteria for traditional disorders such as functional impairment [13]. although prevalence may vary widely as a function related Disorders”. J. and the general interview for DSM IV TR was rarely used for scientific research. structured diagnostic instruments (SCID). IV-TR. occupational physicians. seems most appropriate because it covers the Therefore. When health surveillance for work-related stress major depression and generalized anxiety is difficult since the is need. despite this positive step. disorders which are precipitated by specific AD occurs when an individual is unable to cope and develops stressful and potentially traumatic events in the workplaces behavioural or emotional symptoms. it is often the most common diagnosis. there are no specific out that it would allow the top third in the normal distribution of diagnostic criteria in terms of symptom numbers or combinations mood reactivity to be classified as disordered. According to diagnosis “adjustment disorder” should only be made when the Casey’s review [15]. to diagnosing AD. The third was between normal (non-pathological) distress. non-axial documentation approach in the impairment in social. such as the most frequently diagnosed psychiatric disorder context and presumptive longitudinal course rather symptoms caused by work-related stress. Therefore AD experts in work organization should operate in strict cooperation is common in medical and psychiatric settings but is frequently for diagnosing Chronic Adjustment Disorder in the workplace. criteria are underdeveloped and rudimentary [20]. one of it remains a subthreshold category. Recently. marked distress must take into account Nevertheless. for a diagnosis such as Moreover. Moreover. differently from “normative stress reactions”. Nevertheless. which relies heavily on clinical judgement. “Trauma and Stress- are common. of the population studied and the assessment methods used. In addiction. is replaced by major depression [20]. According to American Psychiatric setting. anxiety. from acute. Occupational not take into account the contextual factors that might cause health surveillance is the process of monitoring the health of this excess in distress. which. 2:14 Italian Workers Compensation Authority (INAIL) recognizes and prevalence for adjustment disorder. The reaction is more severe [24]. frequently Association. misdiagnosed [21]. when structured identifies the Post-Traumatic Stress Disorder (PTSD) and the interviews are used. points strongly underpinned by research. public that are interested in prevalence and incidence estimates By contrast. Clinical diagnosis has identified a higher but it is necessary a second step for the organizational analysis 2 This article is available from: www. been designed for use by lay interviewers. research on work-related stress very often used self. marked distress. This diagnosis.

0 License 3 . 1 No. clinical examination and SCID-5. simultaneously. occupational health improve the research on “work-related mental disorders”. 2015 Acta Psychopathologica ISSN 2469-6676 Vol. 2:14 (expert in work organization) and the third step psychiatric and diagnosis based on aetiology and outcome [24]. This procedure psychological examination [11. because AD is a longitudinal © Under License of Creative Commons Attribution 3. This latter phase needs both could reduce the misdiagnosis of AD and. surveillance can give an advantage. 12]. Moreover.

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