Adjustment Disorders

  • Author: Julia Frank, MD; Chief Editor: David Bienenfeld, MD  more...
Updated: Dec 11, 2014

Practice Essentials

Adjustment disorder is a stress-related, short-term, nonpsychotic disturbance. The discomfort, distress, turmoil, and anguish to the patient are significant, and the consequences (eg, suicidal potential) are extremely important.

Signs and symptoms

As the term adjustment disorder implies, symptoms develop when the person is responding to a particular event or situation, for example a loss, a problem in a close relationship, an unwanted move, a disappointment, or a failure. Typical symptoms include the following:

  • Low mood
  • Sadness
  • Worry
  • Anxiety
  • Insomnia
  • Poor concentration
  • Other typical manifestations - Loss of self esteem, hopelessness, feeling trapped, having no good options, and feeling isolated or cut off from others

Children and adolescents with adjustment disorder commonly exhibit the following:

  • Depressed/irritable mood
  • Sleep disturbances
  • Poor performance in school

No specific physical findings correlate with adjustment disorder, but people may consult a healthcare provider for poor sleep, aches and pains, indigestion, fatigue, and other typical symptoms.

Use of the Impact Thermometer in combination with the Distress Thermometer can help identify patients with adjustment disorder; however, the inability of these measures to distinguish between adjustment disorder and other depressive disorders limits their diagnostic utility.

See Presentation for more detail.


The specific DSM-5 diagnostic criteria for adjustment disorder are as follows[1] :

  • Emotional or behavioral symptoms develop in response to an identifiable stressor or stressors within 3 months of the onset of the stressor(s) plus either or both of (1) marked distress that is out of proportion to the severity or intensity of the stressor, even when external context and cultural factors that might influence symptom severity and presentation are taken into account and/or (2) significant impairment in social, occupational, or other areas of functioningThe stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
  • The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
  • The symptoms do not represent normal bereavement
  • After the termination of the stressor (or its consequences), the symptoms persist for no longer than an additional 6 months

The following 6 specifiers are used to identify subtypes of adjustment disorder:

  • With depressed mood
  • With anxious mood
  • With mixed anxiety and depressed mood
  • With disturbance of conduct
  • With mixed disturbance of emotions and conduct
  • Unspecified

As in all psychiatric diagnoses, a complete evaluation and mental status examination must be conducted.

See Workup for more detail.


Selection of treatments for adjustment disorder is a clinical decision. At present, no official consensus identifies an optimal therapy. Both psychological therapy and pharmacotherapy may be considered.

Because adjustment disorder tends to be time-limited, brief rather than long-term psychotherapy is generally preferred. Goals should include the following:

  • To analyze the stressors affecting the patient and determine whether they can be eliminated or minimized (problem solving)
  • To clarify and interpret the meaning of the stressor for the patient
  • To reframe the meaning of the stressor
  • To illuminate the concerns and conflicts the patient experiences
  • To identify a means of reducing the stressor
  • To maximize the patient’s coping skills (emotional self-regulation, avoidance of maladaptive coping, especially substance misuse)
  • To help patients gain perspective on the stressor, establish relationships, mobilize support, and manage themselves and the stressor

Approaches that may be helpful include the following:

  • Psychotherapy
  • Crisis intervention
  • Family and group therapies
  • Support groups specific to the stressor
  • Cognitive-behavioral therapy (CBT)
  • Interpersonal psychotherapy

Pharmacotherapy may help, particularly with the task of improving coping by moderating symptoms such as insomnia, anxiety, or dysphoria. Agents that have been used include the following:

  • Benzodiazepines (eg, lorazepam and clorazepate)
  • A nonbenzodiazepine anxiolytic, etifoxine, has been used in one clinical study in France [2]
  • SSRI or SNRI (sertaline, venlafaxine)
  • Plant extracts (eg, kava-kava and valerian)

Further studies are required to investigate the effectiveness of these agents and additional novel agents in treating adjustment disorder.

See Treatment and Medication for more detail.



Adjustment disorder is a stress-related, short-term, nonpsychotic disturbance. Persons with this condition are impaired in some element of their general functioning because of their emotional or behavioral response to an identifiable stressful event or change in the person’s life. In the pediatric population, such events could be parental separation or divorce, a new birth in the family, or loss of an attachment figure or object (eg, a pet). In adults, typical stressors include disruptions in relationships, loss of a job or job-related difficulties, bankruptcy, undesired changes (eg, moves for a spouse’s career), or diagnosis or worsening of a serious health condition.

The disorder usually begins within 3 months of the stressful event and should subside when the stressor resolves or the person has adapted to the change, usually within 6 months. Although adjustment disorder is by definition self limited, the associated discomfort, distress, turmoil, and anguish are significant, and the consequences, including the possibility of suicide, are extremely important.

Diagnostic criteria (DSM-5)

The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5),[1] lists adjustment disorders in the category of trauma- and stress-related disorders, a group of conditions for which one of the explicit criteria is exposure to a traumatic or stressful event. The specific DSM-5 diagnostic criteria for adjustment disorder are as follows:

  • Emotional or behavioral symptoms develop in response to an identifiable stressor or stressors within 3 months of the onset of the stressor(s)
  • The symptoms or behaviors are clinically significant, as evidenced by one or both of the following: (1) marked distress that is out of proportion to the severity or intensity of the stressor, even when external context and cultural factors that might influence symptom severity and presentation are taken into account; and (2) significant impairment in social, occupational, or other areas of functioning
  • The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
  • The symptoms do not represent normal bereavement
  • After the termination of the stressor (or its consequences), the symptoms persist for no longer than an additional 6 months

The following 6 specifiers are used to identify subtypes of adjustment disorder:[1]

  • With depressed mood - Symptoms of depression (low mood, loss of motivation, reduced enjoyment) dominate the clinical picture
  • With anxious mood - Symptoms of anxiety (worry, overestimation of negative possibilities, helplessness or feeling overwhelmed) dominate the clinical picture
  • With mixed anxiety and depressed mood - Predominant symptoms reflect a combination of depression and anxiety
  • With disturbance of conduct - Behaviors that break societal norms or violate the rights of others dominate the clinical picture (eg, binge eating, drinking or drug use, outbursts of anger, efforts to punish or seek revenge on others)
  • With mixed disturbance of emotions and conduct - Predominant symptoms consist of a combination of emotional symptoms (eg, depression or anxiety) and conduct disturbances
  • Unspecified - Maladaptive reactions occurring in response to stress that do not fall into the other subtypes of adjustment disorders

DSM-5 also lists a separate category, other specified trauma- and stressor-related disorder, which is used when the clinician chooses to communicate the specific reason why the presentation does not meet the criteria for any specific trauma- and stressor-related disorder. Presentations that can be assigned to this category include the following:

  • Adjustmentlike disorders with delayed onset of symptoms (>3 months after the stressor)
  • Adjustmentlike disorders of prolonged duration (>6 months) without prolonged duration of the stressor
  • Persistent complex bereavement disorder


The pathology of adjustment disorders is not clear. Human life involves constant adaptation to change. Distress and disorder occur when the need to adapt exceeds the person’s capacity to maintain psychological or physiological equilibrium. Adaptation at the physical level involves the activity of monoamine neurotransmitters, hormones, and other neuromodulators. These factors regulate many elements of behavior, including sleep, impulsivity or behavioral constriction, autonomic functions like heart rate and blood pressure, digestion, movement and sensitivity to pain. Any of these functions may be disrupted by an uncontrolled or excessive stress response.

In a study evaluating the relation of blood serotonin concentrations to underlying psychiatric disorders, Rao et al observed that patients with adjustment disorders had a significantly higher maximal binding capacity of the platelet serotonin-2A receptor.[3] These findings were consistent with those in other psychiatric patients who were suicidal and suggested that a reduction in the availability of serotonin and an upregulation of the serotonin-2A receptors in psychiatric patients were associated with a loss of control over suicidal impulses.

Di Rosa et al conducted a study that analyzed serum levels of protein carbonyl groups and nitrosylated proteins, which are biologic markers of oxidative stress.[4] These biomarkers were higher in 19 individuals who experienced psychological abuse and suffered from workplace mobbing−associated adjustment disorders, in comparison to 38 healthy subjects; this finding suggested a direct role of oxidative stress in adjustment disorders.



In humans, the meaning of an event or circumstance often mediates the degree to which an individual views it as a stress. Factors that contribute to the meaning of a stressor and, thus, to adjustment disorder, include the patient’s genetic endowment, preexisting personality, past personal history, stage of development, psychological qualities (cognitive capacities, typical coping patterns,), and overall constitution. The form and presentation of the stressor also contribute to the individual’s reaction. What may be perceived as a minor irritant by one person could be the stressor that challenges both the resources and coping skills of another person.

The factors that contribute to the development of adjustment disorder in children and adolescents are similar to those found in adults, adjusted for stage of development. In 1996, Tomb identified the following 4 factors that may contribute to the development of adjustment disorders in children[5] :

  • Nature of the stressor
  • Vulnerabilities of the child
  • Intrinsic factors - Age; sex; intellectual, emotional, and ego development; coping skills; temperament; and past experiences
  • Extrinsic factors - Parents and support systems; expectations, understanding, skills, maturity, and support available from the child’s larger environment

The most important factor in the development of adjustment disorder in a child is his or her degree of vulnerability, which depends on the characteristics of both the child and the child’s environment.

Psychosocial factors related to comorbidity

A study of 686 patients with confirmed diagnoses of adjustment disorder reported that people who were significantly more likely to have a comorbid diagnosis were married, employed full time, and not living alone.[6] The most frequent confirmed diagnoses associated with adjustment disorder were personality disorders, organic mental disorders, and psychoactive substance abuse disorders; the least frequent were schizophrenia and mood disorders.

A separate cross-sectional, case-control designed studydetermined associations between personal and psychosocial factors.[7] A vast majority of patients with adjustment disorders defined themselves as “insecurely attached” and tended to “keep a larger interpersonal distance from self-images, family members, and significant others,” in addition to having “low self-esteem, self-efficacy, and poor social support from family, friends, and significant others.”

Additionally, Kienlen et al found that nonpsychotic “stalkers” tended to meet diagnostic criteria for either major depression or adjustment disorder in addition to personality disorders.[8]

Social factors related to suicidality

Polyakova et al, in a study comparing the characteristics of the suicide attempts of 69 patients experiencing major depression with those of 86 patients with adjustment disorders, found no significant differences in suicide methods between the 2 groups but did find several social and demographic differences.[9]

The suicidal patients with adjustment disorders had less education and lower social status than the patients with major depression; in addition, they were more likely to be unmarried.[9] More than half of the patients who attempted suicide in the group with adjustment disorders reported unstable parental families, being orphaned at an early age, and emotional deprivation during childhood. Less than 35% of the patients with major depression reported such experiences.

In a study by Pelkonen et al that included 89 patients who received a diagnosis of adjustment disorder, those who made suicide attempts, voiced suicidal threats, or disclosed suicidal ideation (as compared with those who had the same diagnosis but no suicidal tendencies) were characterized by previous psychiatric treatment, poor psychosocial functioning at treatment entry, suicide as a stressor, dysphoric mood, and psychomotor restlessness.[10]



United States statistics

The reported frequency of adjustment disorder varies widely, depending on the population studied and the assessment methods used. A number of studies have reported rates around 12% across a variety of populations. In clinical patient populations, rates as high as 23% have been recorded.[6, 11, 12, 13, 14] Depressed mood was the most common subtype assigned (11.6%), followed by anxious mood, mixed anxiety and depressed mood, and disturbance of conduct.[6]

In a survey of mental health−related hospitalizations in the US Armed Forces between 2000 and 2012, 49,790 of 192,317 hospitalizations of active duty personnel (38%) were related to adjustment disorder.[15]

According to DSM-5, a principal diagnosis of adjustment disorder is made in approximately 5-20% of individuals undergoing outpatient mental health treatment. In the setting of a hospital psychiatric consultation service, adjustment disorder is often the most common diagnosis, with frequencies as high as 50%.[1]

Age-, sex-, and race-related demographics

Although longitudinal data are limited, studies suggest that adults with adjustment disorders have a good long-term prognosis, whereas adolescents may eventually develop major psychiatric conditions. Most studies report no significant differences in prevalence among age groups.[16, 17] Rates of adjustment disorder do not clearly vary by race or sex in current studies.[16] A study by Jones et al found that female patients were significantly more likely to be diagnosed with major depression or dysthymia than with an adjustment disorder.[18]



As many as 70% of patients with adjustment disorder in adult medical settings of general hospitals receive comorbid psychiatric diagnoses, such as personality disorders, anxiety disorders, affective disorders, and psychoactive substance abuse disorders. In a study of refugees in Ethiopia, Algeria, Gaza, and Cambodia, Dobrisk et al identified posttraumatic stress disorder (PTSD) as a comorbid condition in about 53-70% of adjustment disorder cases.[19] While these individuals had experienced a high number of traumatic life events, the high comorbidity between adjustment disorder and PTSD indicates that the 2 conditions constitute a continuum of a stress-responses.[19]

In addition, adjustment disorder has been reported in as many as one third of patients with cancer.[20] Although this number may be something of an overestimation, a meta-analysis of 94 interview-based studies by Mitchell et al found that the prevalence of adjustment disorder was approximately 15.4% in palliative-care settings and approximately 19.4% in oncologic and hematologic settings.[21]

The literature suggests that the incidence of adjustment disorder increases in other major illnesses as a consequence of the upsetting nature of a life-changing diagnosis or event.[22, 23] For instance, one study demonstrated that 61.5% of burn victims referred for psychiatric consultation suffered from adjustment disorder.[24]

No clear correlation exists between adjustment disorder and mortality; however, research findings suggest that patients with adjustment disorder are at increased risk for morbidity and mortality.

Gradus et al examined all of the 9612 suicides recorded in Denmark from 1994 to 2006.[25] For each case, as many as 30 controls were matched on the basis of gender, date of birth, and calendar time. Conditional logistic regression analyses revealed that those diagnosed with adjustment disorder had a 12-fold higher rate of suicide than those without such a diagnosis.

Mitrev et al found that suicide risk was higher in patients with chronic adjustment disorder and in individuals with previous suicide attempts.[26] Patients aged 15-19 years demonstrated the highest suicide risk. The suicide risk for women increased with age.

In a study comparing the characteristics of the suicide attempts of 69 patients experiencing major depression with those of 86 patients who had adjustment disorders, Polyakova et al found that the interval from the first symptoms to the suicide attempt was shorter in the group with adjustment disorder than in the group with major depression.[9] Furthermore, suicide attempts of people with adjustment disorder frequently were not planned.

Runeson et al evaluated 58 consecutive suicides among individuals aged 15-29 years through psychologic autopsy and study of the suicidal process, finding that the median interval from the first suicidal communication to the suicide was less than 1 month for persons with adjustment disorder.[27] Portzky et al also confirmed that the suicidal process in adjustment disorder was significantly shorter and evolved more rapidly without any previous indications of emotional or behavioral problems.[28]

These studies underscore the importance of assessing suicidal risk in patients diagnosed with adjustment disorder and for considering adjustment to a stressor as an important contributor to any expression of suicidal thought or suicidal behavior. Psychiatric assessment of patients with adjustment disorder should include careful monitoring of both symptoms and potential for suicide and harm to significant others.

Patients with adjustment disorder engage in deliberate self-harm at a rate that surpasses those seen in most other disorders. An emergency department (ED) study of individuals who engaged in deliberate self-harm determined that a clinical diagnosis of adjustment disorder was made in 31.8% of those interviewed.[29, 30]

In a study by Vlachos et al examining 548 patients referred for deliberate self-harm, self-poisoning accounted for most of the deliberate self-harm behaviors, and adjustment disorder or acute reaction to stress was the most common psychiatric diagnosis. A study by Mitrev et al found that in cases of deliberate self-poisoning among persons with adjustment disorder, suicidal thoughts persisted in only 11% of patients.[26]

Individuals with adjustment disorder may also be at increased risk for substance abuse disorders. However, some evidence suggests that the instability associated with the misuse of drugs and alcohol confounds the diagnoses of adjustment disorder. Addictions and their consequences are often the cause rather than the result of stress. One study revealed that 59% of individuals diagnosed primarily with adjustment disorder were relabeled on discharge with a primary diagnosis of substance abuse.[31]


Patient Education

Efforts should be made to help patients and their families comprehend that adjustment disorder occurs when a psychological stressor challenges an individual’s capacity for coping. The stressor can be anything that is important to the patient.

Every individual reacts differently to a situation, depending on the importance and intensity of the event, the personality and temperament of the person reacting, and the person’s age and well-being. Thus, adjustment disorder may result from a single event, or it may result from a string of events that deplete individual resources. The patient should be encouraged to acknowledge the personal significance of the stressful event(s).

Patients and families should be reassured that the emotional and physical effects of stressful events are natural, often self-limited reactions. Stress-related symptoms usually last only days or weeks. Patients can generally expect to return to previous levels of functioning, even if their initial symptoms were severe. Patients should be encouraged to identify relatives, friends, and community resources that can provide support during the acute period.

The following Web sites provide useful resources for patient education:

For other patient education resources, see the Depression Center, as well as Depression, Post-traumatic Stress Disorder (PTSD), and Suicidal Thoughts.

Contributor Information and Disclosures

Julia Frank, MD Professor, Director of Psychiatry Clerkship, Director of Medical Student Education in Psychiatry, Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences

Disclosure: Nothing to disclose.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.


Tami D Benton, MD Clinical Director, Child and Adolescent Psychiatry, Psychiatrist-in-Chief, Executive Director, Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia

Tami D Benton, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013. 286-9.

  2. Nguyen N, Fakra E, Pradel V, Jouve E, Alquier C, Le Guern ME, et al. Efficacy of etifoxine compared to lorazepam monotherapy in the treatment of patients with adjustment disorders with anxiety: a double-blind controlled study in general practice. Hum Psychopharmacol. 2006 Apr. 21(3):139-49. [Medline].

  3. Rao ML, Hawellek B, Papassotiropoulos A, Deister A, Frahnert C. Upregulation of the platelet Serotonin2A receptor and low blood serotonin in suicidal psychiatric patients. Neuropsychobiology. 1998. 38(2):84-9. [Medline].

  4. Di Rosa AE, Gangemi S, Cristani M, Fenga C, Saitta S, Abenavoli E, et al. Serum levels of carbonylated and nitrosylated proteins in mobbing victims with workplace adjustment disorders. Biol Psychol. 2009 Dec. 82(3):308-11. [Medline].

  5. Tomb DA. Child psychiatry emergencies. Lewis M. Child and Adolescent Psychiatry: A Comprehensive Textbook. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996. 929-934.

  6. Strain JJ, Smith GC, Hammer JS, McKenzie DP, Blumenfield M, Muskin P, et al. Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting. Gen Hosp Psychiatry. 1998 May. 20(3):139-49. [Medline].

  7. Ponizovsky AM, Levov K, Schultz Y, Radomislensky I. Attachment insecurity and psychological resources associated with adjustment disorders. Am J Orthopsychiatry. 2011 Apr. 81(2):265-76. [Medline].

  8. Kienlen KK, Birmingham DL, Solberg KB, O'Regan JT, Meloy JR. A comparative study of psychotic and nonpsychotic stalking. J Am Acad Psychiatry Law. 1997. 25(3):317-34. [Medline].

  9. Polyakova I, Knobler HY, Ambrumova A, Lerner V. Characteristics of suicidal attempts in major depression versus adjustment reactions. J Affect Disord. 1998 Jan. 47(1-3):159-67. [Medline].

  10. Pelkonen M, Marttunen M, Henriksson M, Lönnqvist J. Suicidality in adjustment disorder--clinical characteristics of adolescent outpatients. Eur Child Adolesc Psychiatry. 2005 May. 14(3):174-80. [Medline].

  11. Uwakwe R. Psychiatric morbidity in elderly patients admitted to non-psychiatric wards in a general/teaching hospital in Nigeria. Int J Geriatr Psychiatry. 2000 Apr. 15(4):346-54. [Medline].

  12. Grassi L, Mangelli L, Fava GA, Grandi S, Ottolini F, Porcelli P, et al. Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V. J Affect Disord. 2007 Aug. 101(1-3):251-4. [Medline].

  13. Despland JN, Monod L, Ferrero F. Clinical relevance of adjustment disorder in DSM-III-4 and DSM-IV. Compr Psychiatry. 1995 Nov-Dec. 36(6):454-60. [Medline].

  14. Wai BH, Hong C, Heok KE. Suicidal behavior among young people in Singapore. Gen Hosp Psychiatry. 1999 Mar-Apr. 21(2):128-33. [Medline].

  15. Summary of mental disorder hospitalizations, active and reserve components, U.S. Armed Forces, 2000-2012. MSMR. 2013 Jul. 20(7):4-11. [Medline].

  16. Schnyder U, Valach L. Suicide attempters in a psychiatric emergency room population. Gen Hosp Psychiatry. 1997 Mar. 19(2):119-29. [Medline].

  17. Casey P, Bailey S. Adjustment disorders: the state of the art. World Psychiatry. 2011 Feb. 10(1):11-8. [Medline]. [Full Text].

  18. Jones R, Yates WR, Williams S, Zhou M, Hardman L. Outcome for adjustment disorder with depressed mood: comparison with other mood disorders. J Affect Disord. 1999 Sep. 55(1):55-61. [Medline].

  19. Dobricki M, Komproe IH, de Jong JT, Maercker A. Adjustment disorders after severe life-events in four postconflict settings. Soc Psychiatry Psychiatr Epidemiol. 2010 Jan. 45(1):39-46. [Medline].

  20. Montgomery C, Lydon A, Lloyd K. Psychological distress among cancer patients and informed consent. J Psychosom Res. 1999 Mar. 46(3):241-5. [Medline].

  21. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011 Feb. 12(2):160-74. [Medline].

  22. Aghanwa HS, Erhabor GE. Demographic/socioeconomic factors in mental disorders associated with tuberculosis in southwest Nigeria. J Psychosom Res. 1998 Oct. 45(4):353-60. [Medline].

  23. Popkin MK, Callies AL, Colón EA, Stiebel V. Adjustment disorders in medically ill inpatients referred for consultation in a university hospital. Psychosomatics. 1990 Fall. 31(4):410-4. [Medline].

  24. Perez Jimenez JP, Gomez Bajo GJ, Lopez Castillo JJ, Salvador-Robert M, Garcia Torres V. Psychiatric consultation and post-traumatic stress disorder in burned patients. Burns. 1994 Dec. 20(6):532-6. [Medline].

  25. Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Lash TL. The association between adjustment disorder diagnosed at psychiatric treatment facilities and completed suicide. Clin Epidemiol. 2010 Aug 9. 2:23-8. [Medline]. [Full Text].

  26. Mitrev I. A study of deliberate self-poisoning in patients with adjustment disorders. Folia Med (Plovdiv). 1996. 38(3-4):11-6. [Medline].

  27. Runeson BS, Beskow J, Waern M. The suicidal process in suicides among young people. Acta Psychiatr Scand. 1996 Jan. 93(1):35-42. [Medline].

  28. Portzky G, Audenaert K, van Heeringen K. Adjustment disorder and the course of the suicidal process in adolescents. J Affect Disord. 2005 Aug. 87(2-3):265-70. [Medline].

  29. Taggart C, O'Grady J, Stevenson M, Hand E, Mc Clelland R, Kelly C. Accuracy of diagnosis at routine psychiatric assessment in patients presenting to an accident and emergency department. Gen Hosp Psychiatry. 2006 Jul-Aug. 28(4):330-5. [Medline].

  30. Casey P. Adjustment disorder: epidemiology, diagnosis and treatment. CNS Drugs. 2009 Nov. 23(11):927-38. [Medline].

  31. Greenberg WM, Rosenfeld DN, Ortega EA. Adjustment disorder as an admission diagnosis. Am J Psychiatry. 1995 Mar. 152(3):459-61. [Medline].

  32. Presicci A, Lecce P, Ventura P, Margari F, Tafuri S, Margari L. Depressive and adjustment disorders - some questions about the differential diagnosis: case studies. Neuropsychiatr Dis Treat. 2010 Sep 7. 6:473-81. [Medline]. [Full Text].

  33. Chen PF, Chen CS, Chen CC, Lung FW. Alexithymia as a screening index for male conscripts with adjustment disorder. Psychiatr Q. 2011 Jun. 82(2):139-50. [Medline].

  34. Maercker A, Forstmeier S, Enzler A, Krüsi G, Hörler E, Maier C, et al. Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: findings from a community survey. Compr Psychiatry. 2008 Mar-Apr. 49(2):113-20. [Medline].

  35. Akizuki N, Yamawaki S, Akechi T, Nakano T, Uchitomi Y. Development of an Impact Thermometer for use in combination with the Distress Thermometer as a brief screening tool for adjustment disorders and/or major depression in cancer patients. J Pain Symptom Manage. 2005 Jan. 29(1):91-9. [Medline].

  36. Strain JJ, Diefenbacher A. The adjustment disorders: the conundrums of the diagnoses. Compr Psychiatry. 2008 Mar-Apr. 49(2):121-30. [Medline].

  37. Beck JC. Legal and ethical duties of the clinician treating a patient who is liable to be impulsively violent. Behav Sci Law. 1998 Summer. 16(3):375-89. [Medline].

  38. Uhlenhuth EH, Balter MB, Ban TA, Yang K. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: III. Clinical features affecting experts' therapeutic recommendations in anxiety disorders. Psychopharmacol Bull. 1995. 31(2):289-96. [Medline].

  39. Schatzberg AF. Anxiety and adjustment disorder: a treatment approach. J Clin Psychiatry. 1990 Nov. 51 Suppl:20-4. [Medline].

  40. Newcorn JH, Strain J. Adjustment disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1992 Mar. 31(2):318-26. [Medline].

  41. Walcott DM, Cerundolo P, Beck JC. Current analysis of the Tarasoff duty: an evolution towards the limitation of the duty to protect. Behav Sci Law. 2001. 19(3):325-43. [Medline].

  42. Andreasen NC, Hoenk PR. The predictive value of adjustment disorders: a follow-up study. Am J Psychiatry. 1982 May. 139(5):584-90. [Medline].

  43. Sifneos PE. Brief dynamic and crisis therapy. Kaplan HI, Sadcock BJ, eds. Comprehensive Textbook of Psychiatry. 5th ed. Baltimore, Md: Williams & Wilkins; 1989. Vol 2.: 1562-7.

  44. Kisely S, Preston N, Rooney M. Pathways and outcomes of psychiatric care: does it depend on who you are, or what you've got?. Aust N Z J Psychiatry. 2000 Dec. 34(6):1009-14. [Medline].

  45. González-Jaimes EI, Turnbull-Plaza B. Selection of psychotherapeutic treatment for adjustment disorder with depressive mood due to acute myocardial infarction. Arch Med Res. 2003 Jul-Aug. 34(4):298-304. [Medline].

  46. 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 Jun. 60(6):429-37. [Medline]. [Full Text].

  47. Brown RL, Brown RL, Saunders LA, Castelaz CA, Papasouliotis O. Physicians' decisions to prescribe benzodiazepines for nervousness and insomnia. J Gen Intern Med. 1997 Jan. 12(1):44-52. [Medline]. [Full Text].

  48. Stewart JW, Quitkin FM, Klein DF. The pharmacotherapy of minor depression. Am J Psychother. 1992 Jan. 46(1):23-36. [Medline].

  49. Shaner R. Benzodiazepines in psychiatric emergency settings. Psychiatr Ann. ;():. 2000. 30: 4:268-75.

  50. Razavi D, Kormoss N, Collard A, Farvacques C, Delvaux N. Comparative study of the efficacy and safety of trazodone versus clorazepate in the treatment of adjustment disorders in cancer patients: a pilot study. J Int Med Res. 1999. 27(6):264-72. [Medline].

  51. Bourin M, Bougerol T, Guitton B, Broutin E. A combination of plant extracts in the treatment of outpatients with adjustment disorder with anxious mood: controlled study versus placebo. Fundam Clin Pharmacol. 1997. 11(2):127-32. [Medline].

  52. Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry. 1997 Jan. 30(1):1-5. [Medline].

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