Search

Background: Physical activity (PA) is crucial in the treatment of cardiac disease. There is a high prevalence of stress-response and affective disorders among cardiac patients, which might be negatively associated with their PA. This study aimed at investigating daily differential associations of International Classification of Diseases (ICD)-11 adjustment disorder, depression and anxiety symptoms with PA and sedentary behaviour (SB) during and right after inpatient cardiac rehabilitation., Methods: The sample included N = 129 inpatients in cardiac rehabilitation, M age = 62.2, s.d. age = 11.3, 84.5% male, n = 2845 days. Adjustment disorder, depression and anxiety symptoms were measured daily during the last 7 days of rehabilitation and for 3 weeks after discharge. Moderate-to-vigorous PA (MVPA), light PA (LPA) and SB were measured with an accelerometer. Bayesian lagged multilevel regressions including all three symptoms to obtain their unique effects were conducted., Results: On days with higher adjustment disorder symptoms than usual, patients engaged in less MVPA, and more SB. Patients with overall higher depression symptoms engaged in less MVPA, less LPA and more SB. On days with higher depression symptoms than usual, there was less MVPA and LPA, and more SB. Patients with higher anxiety symptoms engaged in more LPA and less SB., Conclusions: Results highlight the necessity to screen for and treat adjustment disorder and depression symptoms during cardiac rehabilitation.

Background: International Classification of Diseases, 11th revision (ICD-11) adjustment disorder (AjD) is characterized by two main symptom clusters: preoccupation with the stressor and failure to adapt to the stressor. The network analytic approach provides important information on the structural validity of a disorder and reveals which symptoms are most prominent. To date, no study compared the network structure of AjD symptoms in clinical and nonclinical samples, which could potentially inform our understanding of psychopathological mechanisms that underlie AjD and identify core targets for therapy., Methods: A network analysis was conducted on AjD symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) using data from 330 clinical participants from the UK and a nonclinical sample of 699 participants from Switzerland., Results: Comparisons of network structure invariance revealed differences between the network structure of the clinical and the nonclinical samples. Results highlight that in terms of both edges strength and centrality, failure to adapt symptoms was more prominent in the clinical sample, while the preoccupation symptoms were more prominent in the nonclinical sample. Importantly, global strength was similar across networks., Conclusions: Results provide evidence of the coherence of AjD in the ICD-11 as assessed by the ADNM questionnaire. They tentatively suggest that subclinical AjD may be characterized by emerging preoccupation symptoms that may result in failure to adapt and functional impairment in clinical manifestation of AjD. However, there is a need for replication and longitudinal research to further validate this hypothesis.

In the ICD-11 diagnostic guidelines, preoccupation has been introduced as the new core symptom of adjustment disorder. Despite this essential innovation, preoccupation has so far largely been defined as rumination and worry and does not feature a distinct character as an independent symptom. In order to investigate the nature of preoccupation, various cognitive approaches are evaluated and linked to preoccupation. Furthermore, the aim of this review is to define preoccupation more precisely and to distinguish it from other symptoms in psychopathology. The evaluation of key features of cognitive dissonance theory, attention bias theory, memory theories, and other cognitive paradigms indicates that preoccupation is constituted by a complex interaction of cognitive-emotional mechanisms. In addition, this review implies that preoccupation in AjD can be defined as stressor-related factual thinking, which is time-consuming and often associated with negative emotions. It is assumed that rumination and dysfunctional worry serve as reactive processes to cope with preoccupation. For further distinction, this review presents similarities and differences of preoccupation and other symptoms, including negative automatic thoughts, flashbacks, and yearning. Finally, implications and suggestions for future research on preoccupation are offered. Overall, it is plausible that preoccupation is not only associated with adjustment disorder but also possesses a transdiagnostic character., (© 2021 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Background: Adjustment disorder is one of the most widespread mental disorders worldwide. In ICD-11, adjustment disorder is characterised by two main symptom clusters: preoccupation with the stressor and failure to adapt. A network analytic approach has been applied to most ICD-11 stress-related disorders. However, no study to date has explored the relationship between symptoms of adjustment disorder using network analysis., Aims: We aimed to explore the network structure of adjustment disorder symptoms and whether its structure replicates across questionnaire versions and samples., Method: A network analysis was conducted on adjustment disorder symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) and an ultra-brief version (ADNM-4) using data from 2524 participants in Nigeria (n = 1006), Kenya (n = 1018) and Ghana (n = 500)., Results: There were extensive connections between items across all samples in both ADNM versions. Results highlight that preoccupation symptoms seem to be more prominent in terms of edges strengths (i.e. connections) and had the highest centrality in all networks across samples and ADNM versions. Comparisons of network structure invariance revealed one difference between Nigeria and Ghana in both ADNM versions. Importantly, the ADNM-8 global strength was similar in all networks whereas in the ADNM-4 Kenya had a higher global strength score compared with Nigeria., Conclusions: Results provide evidence of the coherence of adjustment disorder in ICD-11 as assessed by the ADNM questionnaire. The prominence of preoccupation symptoms in adjustment disorder highlights a possible therapeutic target to alleviate distress. There is a need to further replicate the network structure of adjustment disorder in non-African samples.

The ICD-11 includes a new definition of adjustment disorder (AjD). The present study aimed to examine interrater reliability, internal consistency, and construct validity of a new diagnostic interview module to assess ICD-11 AjD. Data from two studies that used a standardized diagnostic interview assessment (i.e., DIA-X/M-CIDI and updated DIA-X-5) were used. For interrater reliability, agreement indicators (i.e., κ) were calculated using data from the DIA-X-5 test-retest study (N = 60). To examine internal consistency and construct validity, Cronbach's alpha values and the Kuder-Richardson correlation coefficient were computed along with confirmatory factor and latent class analyses (LCA), using data from the Zurich Adjustment Disorder Study (N = 330). Interrater reliability analyses found an adjusted kappa of 0.807 for the ICD-11 AjD diagnosis. Few items from the impairment criterion of the diagnostic algorithm performed poorly. The internal consistency was acceptable, Cronbach's αs = .43-.80; the lower-bound estimate resulted from the two-item preoccupation symptom pattern. However, both items were significantly associated, OR = 3.14, 95% CI [1.97, 4.99]. Regarding LCA results, a two-class model was favored. We found that 94.3% of all ICD-11 AjD cases belonged to Class 2, OR = 23.69, 95% CI [7.15, 79.54], which was associated with subjectively rated distress, OR = 2.18, 95% CI [1.57, 3.02], and the external measure of the Brief Symptom Inventory global severity index, OR = 2.18, 95% CI [1.57, 3.02]. Overall, the new AjD interview module provided a reliable, valid assessment of the ICD-11 diagnosis; confirmation by other studies is needed., (© 2020 International Society for Traumatic Stress Studies.)

Background: After the new definition of adjustment disorder (AjD) by the International Classification of Diseases-11(ICD-11), AjD has attracted more and more attention. Adjustment disorder new module-20 (ADNM-20), which is used to diagnose AjD, has been verified in some countries, but it has not been verified in China. As a result, the purpose of this study was to investigate the validity and reliability of the Chinese version of the Adjustment disorder new module-20 (ADNM-20) in female breast cancer patients., Methods: The ADNM-20 translated into Chinese employed the translation and back translation technique. Three hundred fifty four newly diagnosed (< 1 year) female breast cancer patients were recruited from Tongji Hospital and Hubei Cancer Hospital in Hubei, China. The patients completed the self-report questionnaire including demographic characteristics and the scale ADNM-20. Data on psychometric properties were evaluated in terms of internal consistency, item-total correlations, test-retest reliability, and factorial validity., Results: ADNM-20 core symptoms included 8 items and two factors, which were extracted by using exploratory factor analysis (EFA). It could explain 61.74% of the total variance. ADNM-20 accessory symptoms including 12 items and four factors, which were extracted by using EFA. It could explain 68.34% of the total variance. Cronbach's α coefficient for ADNM-20 was 0.93, split-half reliability was 0.87, and the test-retest correlation coefficient was 0.74. The correlation coefficient between each subscale was ranged from 0.53 to 0.71 (P < 0.01), while the correlation coefficient between the subscales and total scale was ranged from 0.79 to 0.89 (P < 0.01)., Conclusions: The study verified the validity and reliability of the Chinese version of ADNM-20. It is applicable to measure the prevalence of adjustment disorder in the breast cancer population.

Background: International studies point to increased mental health problems of medical staff during the Corona pandemic (COVID-19). This is the first study to investigate mental health, i. e. adjustment disorder, depression, stress symptoms, Corona related fears as well as coping mechanisms in this group in a German-speaking country., Material and Methods: In April 2020, N=100 subjects were recruited that currently are engaged in a hospital. A series of standardized assessments were included: adjustment disorder (ADNM-20), depression (PHQ-9), stress symptoms and coping strategies (SCI). Currently, cross-sectional data are analyzed, because the study is still going on and longitudinal data is not yet assessed., Results: Frequencies of adjustment disorder and depression are 8 and 15%, respectively. Two hierarchical regression models were run to predict adjustment disorder and depression; predictive power was higher for the first (41 vs. 35%). Fear of infection was reported to be higher regarding one's family than oneself. Nursing staff, those with preloads, and women were found to report more mental health problems. Those with direct contact to people that fell ill with COVID-19 did not differ from those with no direct contact., Discussion: Currently, medical staff has a high risk for being mentally stressed. China, being epidemically experienced, has published principles for psychiatric interventions in January 2020. This might be relevant for Switzerland, too. Specific psychotherapeutic interventions, targeting at cognitive restructuring and sensitizing regarding dealing with alcohol and cigarettes, may be needed in order to protect this vulnerable group of person during and after the Corona pandemic., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Prolonged grief disorder (PGD) is a new disorder included in the WHO International Classification of Diseases 11th version (ICD-11). This study is the first to use these new ICD-11 PGD guidelines to examine prevalence rates, predictors of PGD and disorder co-occurrence with other stress-related disorders in a survey of 544 bereaved Israelis., Methods: Descriptive statistics, correlation, linear regression and mediation analysis examined the validity of the ICD-11 diagnostic algorithm., Results: Prevalence of PGD in the Israeli population sample is low (2%). The prevalence rate of post-traumatic stress disorder (PTSD) was 7.2% and for adjustment disorder (AjD) was 17.8%. A significant positive correlation found between scores on these measures indicates concurrent validity. Mediation analysis found that symptoms of PGD were predicted by serious life events, and significantly mediated by symptoms of PTSD and AjD. A regression analysis found significant predictors of PGD symptom severity, including socio-demographic and person-specific predictors., Limitations: This study did not assess the index-death of the grief questionnaire. No conclusions could be made regarding the relationship between the type of loss and grief severity. Furthermore, the time since loss (time criterion) was not assessed., Conclusions: This study is the first to examine prevalence rates of ICD-11 PGD in a population-based survey. The mediation relationship between serious life events, AjD, PTSD and PGD supports a vulnerability model of stress related disorders whereby the number of stressful life events may predict symptoms of stress related disorders., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In line with ICD-11 new conceptualization of Adjustment disorder (AjD), a self-report Adjustment Disorder-New Module (ADNM) was developed and validated. Nevertheless, the ADNM-20 is a long research tool and potentially problematic in the use in epidemiological and clinical studies. The present study introduces the brief ADNM-8 and the ultra-brief ADNM-4, examines their validity and establishes cut-off scores for their clinical use. The study used a representative national sample of 1003 Israelis who reported on the ICD-11 stress spectrum ranging from AjD, PTSD, complex PTSD and complicated grief. Construct validity was assessed via confirmatory factor analysis and cut-off scores were established through ROC analysis. The original and brief instruments were highly correlated (r > 0.918 or better). Cronbach's Alpha for the Brief ADNM-8 and the Ultra-Brief ADNM-4 were above 0.800. Correlations with stress related conditions indicated a good convergent and construct validity for both instruments as well. The ultra-brief ADNM-4 was found to have a very good fit with the data. These findings indicate that the brief ADNM-8 and the ultra-brief ADNM-4 can serve as a brief screening tools for assessing AjD symptoms according to the ICD-11 definition., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the International Classification of Diseases, 11th version (ICD-11). However, the symptom structure of AjD is poorly understood. The aim of the present study was to investigate the dimensionality of AjD as a stress-response syndrome., Methods: A general population sample of the Israeli population (N = 1003) completed the Adjustment Disorder - New Module 20 and the WHO-5 Wellbeing Scale. We compared seven alternative models of AjD using confirmatory factor analysis (CFA). A latent profile analysis (LPA) was performed to determine if subtypes of AjD were present. The performance of the unidimensional and multidimensional models of AjD were evaluated using regression analyses., Results: CFA results supported a unidimensional model of AjD. The LPA identified three quantitatively distinct classes (low, medium, and high) with no evidence of any subtypes of AjD. The criterion validity of AjD was superior when treated as unidimensional. AjD was associated with lower levels of psychological wellbeing (β = -.32, p < .001)., Conclusions: Our results suggest that AjD is better conceptualised as a unidimensional construct. Future work should focus on a reduction of required symptoms in order to improve clinical utility and validity of the diagnosis., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In preparation for ICD-11, the adjustment disorder (AjD) diagnosis has undergone considerable revisions; however, the latent structure of AjD remains uncertain. It is unclear whether AjD is best represented as a unidimensional or multidimensional construct. This study performed a comprehensive assessment of the latent structure of AjD symptomatology and assessed its concurrent and discriminant validity. Individuals who experienced involuntary job loss (N = 333) completed a self-report measure of AjD symptoms. Seven alternative models of AjD were tested using confirmatory factor analysis. General psychological distress, impairment in social functioning, occupational self-efficacy, and sense of coherence were used as criterion variables for construct validity. In the confirmatory factor analysis, a bifactor solution with one dominant general AjD factor and 5 correlated group factors (preoccupation, failure-to-adapt, avoidance, affective reaction, and impulsivity) provided optimal fit. As expected, the AjD factor showed strong positive associations with general psychological distress and impairments in social functioning and moderately negative associations with occupational self-efficacy and sense of coherence. With regard to unidimensionality or multidimensionality of AjD symptoms, the current results indicate the plausibility of a unidimensional conceptualization. Future research should focus on essential key characteristics and a reduction of symptoms for the AjD definition., (Copyright © 2017 John Wiley & Sons, Ltd.)

Adjustment disorder is one of the most prevalent mental disorders. However, there are almost no measures available for its assessment. We aimed to analyze the psychometric properties of a brief version of the International Classification of Diseases (ICD)-11 adjustment disorder scale (Adjustment Disorder New Module-8; ADNM-8) in a help-seeking sample. Data from 1,174 participants with an average age of 35 years who registered for the internet-based self-help adjustment disorder intervention were analyzed. Psychometric properties of the brief 8-item self-report (ADNM-8) scale measuring the 2 core adjustment disorder symptoms of preoccupation and failure to adapt were tested. Confirmatory factor analysis (CFA) was applied for the analysis of construct validity. CFA supported the 2-factor structure of ADNM-8. Further research is needed for validation of ADNM-8 in cross-cultural studies., (© 2018 S. Karger AG, Basel.)

Objectives: Adjustment disorder (AD) is a frequent diagnosis in clinical practice worldwide. After long neglect in mental health research, the new DSM definition and in particular the ICD-11 model of AD is about to create a fresh impulse for research on AD and for refined clinical use of the diagnosis., Methods: This paper outlines the clinical features of AD according to the ICD-10, ICD-11 and DSM-5 definitions, and provides case vignettes of patients with AD with clinical presentations of dominating anxiety, depressed mood or mixed symptom presentations. The available clinical assessments and diagnostic tools are described in detail, together with findings on their psychometric properties., Results: The current AD definitions are consistent with a new nosological grouping of AD with posttraumatic stress disorder in the chapter on trauma- and stressor-related disorders, or stress response syndromes., Conclusions: This nosological specification opens new avenues for neurobiological and psychological research on AD and for developing novel therapies.

Adjustment disorder (AjD) is a frequent but under-researched diagnosis due in part to a lack of specific symptom criteria and adequate tools of measurement. The ICD-11 for the first time proposes a positive symptom catalogue to define AjD. This study presents a validation of the Adjustment Disorder - New Module (ADNM), the first symptom severity measure for AjD according to the ICD-11 concept. Validity and sensitivity to change were investigated in a sample of 190 individuals with a DSM-IV diagnosis of AjD. The ADNM scales demonstrated convergent and discriminant validity for anxiety symptoms (Hamilton Anxiety Scale; psychic anxiety r = 0.18-0.31), functional impairment (Sheehan Disability Scale; r = 0.18-0.47), and depression (Montgomery-Asberg Depression Scale; r = 0.13-0.30). At baseline 78% of the individuals with a DSM-IV diagnosis of AjD were also classified so by the ADNM. Repeated-measures ANOVA indicated significant ADNM-symptom decrease during treatment, replicating the patterns of the Hamilton Anxiety Scale, Sheehan Disability Scale, and Clinical Global Impression Scale. This article presents the first use of the ADNM as a measure for ICD-11 AjD in a randomized-controlled intervention study of AjD. It provides support for the construct validity and sensitivity to symptom change of this scale during pharmacological treatment., (Copyright © 2016 John Wiley & Sons, Ltd.)

Background: Adult emotion regulation is not only occurring within the person but includes strategies that happen in social interactions and that are framed as co-regulating. The current study investigates the role of the interpersonal emotion regulation strategies of co-reappraisal and co-brooding in couples for adjustment disorder symptoms as the disorder will be outlined in the International Classification of Diseases-11 (ICD-11)., Methods: Couples registered together in an online questionnaire study reporting whether or not they are adjusting to a major stressor that is psychologically challenging to them. In total, one hundred and forty-six participants (N = 73 male; N = 73 female) reported having experienced a major stressor in the last 12 months and were thus be identified as at risk for adjustment disorder. Those individuals at risk were assessed for adjustment disorder and depressive symptoms; intra- and interpersonal emotion regulation (co-/brooding, co-/reappraisal) were assessed not only in the individual at risk but also in the romantic partner., Results: Regression-based dyadic analyses revealed that above and beyond intrapersonal emotion regulation, interpersonal co-brooding and for the female participants also co-reappraisal were significantly associated with symptoms of adjustment disorder and depression, standardized betas varied between .24 and .36, suggesting medium effect sizes. An association with the female partner's tendency to reappraise with fewer symptoms in the male partner at risk for adjustment disorder could also be observed., Conclusions: Co-brooding and co-reappraisal represent emotion regulation strategies that happen in social interaction and seem to play a relevant role in the context of adjustment disorders above and beyond the commonly assessed intrapersonal emotion regulation strategies.

Adjustment disorders (AjD) are among the most frequent mental disorders yet often remain untreated. The high prevalence, comparatively mild symptom impairment, and transient nature make AjD a promising target for low-threshold self-help interventions. Bibliotherapy represents a potential treatment for AjD problems. This study investigates the effectiveness of a cognitive behavioral self-help manual specifically directed at alleviating AjD symptoms in a homogenous sample of burglary victims. Participants with clinical or subclinical AjD symptoms following experience of burglary were randomized to an intervention group (n = 30) or waiting-list control group (n = 24). The new explicit stress response syndrome model for diagnosing AjD was applied. Participants received no therapist support and assessments took place at baseline, after the one-month intervention, and at three-month follow-up. Based on completer analyses, group by time interactions indicated that the intervention group showed more improvement in AjD symptoms of preoccupation and in post-traumatic stress symptoms. Post-intervention between-group effect sizes ranged from Cohen's d = .17 to .67 and the proportion of participants showing reliable change was consistently higher in the intervention group than in the control group. Engagement with the self-help manual was high: 87% of participants had worked through at least half the manual. This is the first published RCT of a bibliotherapeutic self-help intervention for AjD problems. The findings provide evidence that a low-threshold self-help intervention without therapist contact is a feasible and effective treatment for symptoms of AjD.

Although Adjustment Disorder as a diagnostic category is widely used in clinical practice it is critically discussed that it has not been conceptualized as a category with unique symptoms. Hence, the conceptualization of Adjustment Disorder is subject to substantive change in ICD-11 including core symptoms and additional features in a uni-faceted concept. Adjustment Disorder was assessed with a self-rating instrument in a representative sample of the German general population (N=2512). Confirmatory factor analyses (CFA) were applied to test the dimensionality of symptoms according to the new diagnostic concept. Latent class analysis (LCA) was applied to test whether there are distinguishable subgroups with respect to symptomatology. 2.0% of the sample were diagnosed with Adjustment Disorder according to the new diagnostic algorithm. The proposed six factor model shows best fit with good reliability of the factors in the CFA compared to competing models. However the factors are highly correlated and not distinguishable. The LCA identified three latent classes, reflecting low, mild and moderate to severe symptoms. The findings support the uni-faceted concept of Adjustment Disorder as it is conceptualized in the new diagnostic concept in ICD-11 in a general population sample. This clearer diagnostic concept will inform research as well as clinical practice., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Maladaptive reactions on stressful experiences justifying a diagnosis of adjustment disorder have high prevalence. Little is known about the possible risk for clinically significant maladaptation that results from the social context. The literature on the effects of depression on communication and altered support conditions in couples is suggesting this. Aim of this study was to investigate whether clinically significant depression in the romantic partner is a risk factor for adjustment disorder following a concept of stress-response disorder. Furthermore, from a dimensional point of view a possible positive association between depressive symptoms in the partner and own adjustment symptom was studied. Thereby, own depressive symptoms were controlled for in order to exclude mere depressive contagion and isolate stress-related responses. In an online-couple-study N=294 participants (N=147 couples) reported whether or not they had experienced a stressful event that is still bothering them. N=152 participants reported such an event. N=28 of this group reached the threshold of a possible diagnosis with the screening questionnaire "Adjustment disorder New Module". N=14 romantic partners reported depressive symptoms above the cut-off of the CES-D. The risk for an adjustment disorder is elevated if the female partner reports a clinically significant level of depressive symptoms (OR 7.13). This was only true when female partners were depressed, the depression of male partners did not show any significant associations. Accordingly, dimensionally there is a positive association between depressive symptoms of the female partner and adjustment symptoms of preoccupation (stressor-related repetitive negative thoughts). Depression of the romantic partner seems to be a significant risk factor for maladaptive reactions on a stressful event. This was particularly true for male participants of the study. To sum up, results encourage taking up an interpersonal perspective in research and clinical interventions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: This is the first study to estimate the prevalence of adjustment disorder (AjD) in the general population. A new conceptualisation of AjD as a stress response syndrome was applied, which allowed AjD to be assessed directly from its symptom profile, including intrusive, avoidance and failure-to-adapt symptoms (Maercker et al., Psychopathology 40:135-146, 2007)., Methods: Prevalence rates of distressing life events and AjD were estimated from a representative sample of the German general population (n = 2,512) with a broad age range (14-93 years). A questionnaire including a life events checklist and self-rating questions that assessed AjD symptoms and symptom duration were personally handed out by an interviewer., Results: The prevalence of AjD fulfilling the criterion of clinically significant impairment was 0.9%; a further 1.4% of the sample was diagnosed with AjD without fulfilling the impairment criterion. In ~72.5% of AjD cases, symptoms had developed 6-24 months prior to assessment. AjD was most often associated with acute events such as moving or chronic stressors such as serious illness, conflicts at the respondent's job or with friends or neighbours (with ~5% conditional probability each)., Conclusions: The results correspond with the few other studies that have examined the prevalence of AjD, even though a new conceptualisation of the disorder was used. Explorative results regarding the duration of AjD syndromes and symptoms call for further redefinition and empirical investigation of this under-researched mental condition.

This review focuses on the similarities and differences between prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD). It highlights how a PTSD-related understanding aids the investigation and clinical management of PGD. Grief has long been understood as a natural response to bereavement, as serious psychological and physiological stress has been regarded as a potential outcome of extreme or traumatic stress. PTSD was first included in DSM-III in 1980. In the mid-1980s, the first systematic investigation began into whether there is an extreme or pathological form of mourning. Meanwhile, there is much research literature on complicated, traumatic, or prolonged grief This literature is reviewed in this article, with the following questions: Is it possible to distinguish normal from non-normal grief? Which clinical presentation does PGD have-and how does this compare with PTSD? Finally, diagnostic, preventive, and therapeutic approaches and existing tools are presented.

Stress response syndromes like adjustment disorders or complicated grief are assumed to be shaped by social-cultural factors in addition to biological and psychological factors. In previous research, value orientations and interpersonal factors were found to jointly predict those syndromes (Maercker, A., Mohiyeddini, C., Müller, M., Xie, W., Hui Yang, Z., Wang, J., & Müller, J. ( 2009 ). Traditional versus modern values, self-perceived interpersonal factors, and posttraumatic stress in Chinese and German crime victims. Psychology and Psychotherapy, 82(Pt 2), 219-232.). In addition to the previous finding, the current study using Swiss elderly (65-97 years) aimed to replicate patterns of predictors leading to stress responses in people with recent bereavement or severe life events. Traditional (conformity, tradition and benevolence) and modern values (stimulation, hedonism and achievement) and two self-perceived interpersonal mediator processes (disclosure intentions and social acknowledgement as a victim) were assessed. The current study confirms the previous model in parts, that is, the indirect path from social acknowledgment to stress response syndrome is mediated by disclosure intentions. Traditional values and not modern values explained substantial variance for disclosure intentions and are therefore indirectly linked to worse mental health outcomes whereas the direct association appears somewhat controversial in light of previous findings.

Based on a recent diagnostic proposal for adjustment disorders a self-report assessment was developed. The current study reports validation results. Psychometric properties were examined using two different samples of 687 patients with cardiac arrhythmias and 86 patients from a psychosomatic outpatient clinic. Besides evaluating the internal structure and re-test reliability, associations with quality of life, general anxiety and depression, symptoms of posttraumatic stress disorder and coping strategies were analyzed. The factor analysis confirmed the three postulated factors: intrusion, avoidance and failure to adapt. The internal consistencies for these three scales were between α = 0.74 and 0.91. The re-rest reliability of the scales for a six-week period lay between r(tt) = 0.61 and 0.84. Medium-sized correlations were found between the scales with general anxiety and depression as well as posttraumatic stress disorder. Furthermore, the scales correlated with emotion-oriented and somewhat with proactive coping, but not with task-oriented or avoidance-oriented coping strategies. It is concluded that the self-report on adjustment disorders enables new possibilities to investigate further previously under-researched adjustment disorders.

Background: In 2003, the German psychiatrist Michael Linden proposed the new mental disorder concept of "post-traumatic embitterment disorder (PTED)". PTED is defined as the mental reaction to a critical event that is normal, but not everyday, such as conflict at work. The patient sees this event as unjust and as a violation of basic beliefs. The principal aspect of the reaction pattern is a prolonged feeling of embitterment., Aim: In the present paper, the concept of PTED is systematically evaluated. Moreover, future developments in terms of diagnostic systems of mental disorders (ICD-11, DSM-V) are addressed., Results: The evaluation of critical points concerning PTED revealed that the question of whether PTED is a mental disorder of the post-traumatic type cannot be finally answered. It is not possible to specify an empirical criterion by means of which traumatic and non-traumatic life events can be differentiated. An empirical criterion for determining the traumatic nature of a given event depends on whether this event has already been classified as traumatic (i.e. circular argument)., Conclusions: For the purpose of a clear classification of embitterment disorders, the new concept of adjustment disorders of Andreas Maercker and co-workers is introduced. Based on the criteria and their findings, the best and most viable possibility to classify embitterment disorders in accordance with the current adjustment disorder and post-traumatic stress disorder definitions of ICD and DSM is by regarding embitterment disorders as a subtype of adjustment disorders.

Objectives: Adjustment disorders (AD) represent a frequently diagnosed type of disorder for which scientific interest has been limited because of insufficient diagnostic criteria. This study presents a concept comprising cognitive, behavioural, and emotional criteria (ADNM) which investigates differences in symptom severity, willingness to change, and motivation for psychotherapy in subjects with adjustment disorders., Method: 331 outpatients were examined with a number of tools (ADNM, SCL-90-R, FPTM-23, FEVER). The ADNM is evaluated on the basis of theoretical assumptions and divides the sample into subjects with elevated and normal scores., Results: The sample comprised patients with elevated scores (61%) and normal scores (39%).Subjects with AD scored higher on depression, anxiety, and impulsivity as well as exhibiting elevated scores on the SCL-90-R, for contemplation/action, and for psychotherapy motivation., Conclusion: The ADNM identifies patients experiencing stress. Further longitudinal studies should examine whether patients more frequently enter psychotherapy or not.

Background: The present study explores whether severe life-events are associated with adjustment disorders (AD) by reanalyzing the data of a multisite epidemiological survey (de Jong et al. in Lancet 361:2128-2130, 2003). AD were diagnosed according to the new stress-response-model of AD (Maercker et al. in Psychopathology 40(3):135-146, 2007)., Method: Data from 3048 persons from four different refugee settings in Ethiopia, Algeria, Gaza, and Cambodia were reanalyzed. Life events were assessed by an adapted version of the Life Events and Social History Interview (Mollica et al. in Am J Psychiatry 144:1567-1572, 1987). The current study focuses on non-directly life threatening events related to AD (e.g. loss of property) in contrast to life-threatening events related to Posttraumatic Stress Disorders (PTSD). AD Symptom measures were obtained from available psychopathology assessments: composite international diagnostic interview (WHO in CIDI, Geneva, 1997) and structured interview for disorders of extreme stress (Pelcovitz et al. J Trauma Stress 10:3-16, 1997)., Results: The majority of the subjects had experienced one or more AD-related life event. Most common AD-related life events varied across the four sites with bad shelter conditions most prevalent in Ethiopia (100%) and Gaza (32%), forced social isolation in Algeria (61%), and lack of food in Cambodia (41%). Prevalences of AD diagnoses ranged from 6% (Ethiopia) to 40% (Algeria). The highest rates of comorbidity were between AD and PTSD, followed by anxiety disorders., Conclusion: The present study shows that the new concept of AD can be of use for psychiatric epidemiology, e.g., in migration contexts. The high-comorbidity rates could indicate that AD and PTSD are parts of a stress response spectrum.

Background: The volume of research involving adjustment disorder (AD) is limited. The scientific neglect of AD seems to result from the inadequate operationalisation of AD in DSM-IV and ICD-10. The aims of the present proposal are to discuss the shortcomings of AD conceptualisations and to present recommendations for the future., Sampling and Methods: This conceptual paper is based on an iterative process of debate between the authors., Results: The current operational definition of AD is characterised by 3 main limitations: (1) the inadequately defined clinical significance criterion, (2) the relegation of AD behind other diagnoses and (3) the missed recognition of the importance of contextual factors, such that normal human adaptive processes might be pathologised. Furthermore, subtypes of AD lack operational clarity. Based on a discussion of the limitations, recommendations for DSM-V are presented, including the addition of new subtypes., Conclusions: The revision of AD criteria will reduce the likelihood of false-positive and false-negative diagnoses. These changes will enable the scientific exploration of this common and relevant disorder, and will make epidemiological studies, and ultimately service planning based on these, more reliable than at present., (Copyright 2009 S. Karger AG, Basel.)

Objective: Diagnoses of adjustment disorders are frequent in clinical settings, although diagnostic criteria are not very reliable or valid. This has led to a neglection of this topic in research. This article presents and applies a new concept (Maercker et al., 2007) for diagnosing adjustment disorders., Methods: 96 patients of a psychosomatic policlinic were examined regarding their emotional well-being with a new questionnaire (Adjustment Disorder--New Module | ADNM). Furthermore, according to the new concept, adjustment disorders were assessed with a structured interview. Coping behaviour (CISS) as well as general self efficacy (SWE) in patients with scores within a normal range and patients with elevated scores in ADNM, respectively, were examined. The following statistical measures were used: cluster analysis, cross tables, non-metrical and metrical test procedures., Results: The theory-guided evaluation of the ADNM questionnaire divided the whole sample into patients with elevated (49 %) and with normal (51 %) scores. A cluster analysis of patients with elevated scores showed two groups, so that a total of three groups were compared: patients with scores in a normal range; patients with elevated scores and a low number of symptoms; patients with elevated scores and a high number of symptoms. Patients with elevated scores showed significantly more emotion-oriented coping strategies (t = - 6.338; p = 0.000) and reported, referring to present stress, on being less able to cope with it (Z = - 4.445; p = 0.000). Patients with elevated scores and a high number of symptoms named more stress factors (Z = - 2.634; p = 0.008) and reported on being more impulsive and irritable (Z = - 3.406; p = 0.003). The comparison of the ADNM questionnaire and the clinical main diagnoses shows a separation between emotional and non-emotional disturbances according to ICD-10 (chi2(2, n = 96) = 6.928; p = 0.031)., Discussion: The results show that the ADNM questionnaire according to the new diagnostic concept of adjustment disorders (Maercker et al., 2007) identifies patients who experience a high degree of stress caused by adverse life events of life conditions. The ADNM reliably differentiates non-emotional from emotional ICD-10 diagnoses. Further studies should examine, whether the new concept as well as the questionnaire are able to assess adjustment disorders in a valid and reliable way.

Based on a new psychopathological model of adjustment disorders (AJD), we propose that AJDs are particular forms of stress response syndromes, in which intrusions, avoidance of reminders, and failure to adapt are core symptoms. We aim to demonstrate that these AJD symptom groups constitute a disorder that is distinct from posttraumatic stress disorder (PTSD), complicated grief disorder, major depressive disorder, and subsyndromal depression, by estimating their prevalence and comorbidities. A representative sample of elderly persons from Zurich, aged 65 to 96 years, was assessed by standardized interviews or self-report questionnaires. Index events for AJD were indicated by 52% of the sample set, with a 2.3% current prevalence of AJD. Prevalence rates for other disorders were 0.7% PTSD, 4.2% subsyndromal PTSD, 4.2% complicated grief disorder, 2.3% major depressive disorder, and 9.3% subsyndromal depression. The comorbidity rate for AJD and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders is 46%, and that between AJD and subsyndromal disorders is 38%. Use of mental health care for AJD is low. This article concludes that the new concept of AJD constitutes a meaningful psychopathological model and thus warrants a place in standardized psychiatric taxonomies. Although this study was restricted to a sample of the elderly, it provides evidence regarding AJD prevalence, comorbidity, and associated health care use, all of which indicate its utility.

Background: To date, there are mainly two diagnostic systems that have been proposed for the diagnosis of Complicated Grief [Horowitz, M.J., Siegel, B., Holen, A., Bonanno, G.A., Milbrath, C., Stinson, C.H., 1997. Diagnostic criteria for complicated grief disorder. American Journal of Psychiatry 154, 904-910; Prigerson, H.G., Shear, M.K., Jacobs, S.C., Reynolds, C.F., Maciejewski, P.K., Davidson, J.R., Rosenheck, R., Pilkonis, P.A., Wortman, C.B., Williams, J.B., Widiger, T.A., Frank, E., Kupfer, D.J., Zisook, S., 1999. Consensus criteria for traumatic grief: a preliminary empirical test. British Journal of Psychiatry 174, 67-73]. There is also no data about prevalence rates of Complicated Grief in a representative sample. The purpose of this study was to compare the diagnostic systems with regard to prevalence, conditional probabilities, and agreement., Methods: In a sample of elderly persons, features of bereavement, diagnoses of Complicated Grief and related symptoms were assessed. Agreement between the diagnostic systems was determined by kappa statistics., Results: 18.9% of the sample had experienced a major bereavement, in average 15 years before measurement. The prevalence rates were 4.2% (Horowitz et al.) and 0.9% (Prigerson et al.). The agreement was poor (kappa=.13), i.e. the minority of cases received both diagnoses. The conditional probabilities of developing CG after experiencing a major bereavement were 22.2% (Horowitz et al.) and 4.6% (Prigerson et al.)., Limitations: The findings are constrained to an elderly, urban population. Screening instruments, no clinical interviews, were used to assess psychopathology., Conclusions: The Horowitz et al. criteria set is more inclusive and less strict than the Prigerson et al. criteria set. The importance of functional impairment and the number of symptoms needed account for this difference. Further research should integrate diagnostic systems in order to achieve international standardization of diagnostic criteria for Complicated Grief.

Objective: Adjustment disorders (AD) are an ill-defined category in the present diagnostic nomenclature. We propose a new diagnostic model that describes AD as particular forms of stress response syndrome, in which intrusions, avoidance of reminders and failure to adapt are the central processes and symptoms. In line with the existing classification, the description of AD subtypes is included. Backgrounds on existing psychopathological models of stress response disorders are outlined., Methods: Data from a clinical sample of patients with an automatic implantable cardioverter defibrillator (n = 160, mean age 63 years, 90% males) are investigated., Results: The items tapping the individual symptoms meet psychometric requirements for diagnostic applications. The diagnostic algorithm chosen indicates a 17% prevalence of AD in the sample. The subtype most commonly diagnosed is AD with mixed emotional features (41%). In a subsample, diagnostic sensitivity was 0.58 and specificity 0.81 in relation to traditional AD cases diagnosed by the Structured Clinical Interview for DSM-IV. By applying the most strongly conservative exclusion rule analogous to the Structured Clinical Interview for DSM-IV, the AD prevalence was reduced to 9%., Conclusion: The new AD concept is theory driven and shows methodological soundness. Its application to further samples is recommended.

Background: Complicated grief has been described as a diagnosis candidate for DSM-V. On the basis of the stress response theory, Horowitz et al. [Am J Psychiatry 154 (1997) 904-10] characterized complicated grief as a combination of sustained intrusion, avoidance, and maladaptation symptoms following the loss of a close person. This study aimed at evaluating diagnostic criteria based on the stress response model of complicated grief., Methods: We administered a symptom list derived from Horowitz et al.'s operationalization to a sample of bereaved persons and evaluated the psychometric properties of the symptom criteria and symptom category subscales. Using this symptom list and other self-report measures of psychopathology and normal grief reactions, we examined a German sample consisting of 75 participants who had lost either siblings, children, parents, or spouses, on average, 5.4 years prior to the study., Results: Analyses confirmed the classification of symptoms into intrusion, avoidance, and failure-to-adapt categories with only minimal reordering (two symptom criteria). The symptom category subscales showed favourable psychometric characteristics, receiver operating characteristic (ROC) analyses indicated high diagnostic accuracy of the symptom criteria, and predictive validation revealed a meaningful correlational pattern to standard measures of divergent psychopathology and normal grief reactions., Conclusions: The application of a stress response operationalization of complicated grief is supported.

The ICD‐11 features a new group of disorders specifically associated with stress, which are interlinked by various symptoms, such as intrusive memory symptoms. Although research interest in these new ICD‐11 diagnoses is growing rapidly, so far, no studies have systematically investigated the transdiagnostic distribution of stress‐associated symptoms in these disorders. In the present study, 447 individuals completed a series of online questionnaires, which measured various stress‐associated symptoms, e.g., flashbacks, preoccupation or yearning. Findings showed that the majority of correlations between the measured psychopathological constructs was between 0.30 and 0.60. Furthermore, with regard to specific diagnostic groups, a complex variation of stress‐associated symptoms was observed, with preoccupation as a predominant symptom in all disorders. Results demonstrate that stress‐associated symptoms are inherently interconnected yet possess an individual variation in different disorders. Furthermore, findings illustrate that preoccupation represents a major feature in all stress‐associated disorders. [ABSTRACT FROM AUTHOR]

In the ICD-11, posttraumatic stress disorder (PTSD), adjustment disorder (AjD), and prolonged grief disorder (PGD) belong together to the new grouping of disorders specifically associated with stress, which are all characterized by intrusive core symptoms. As previous studies suggest that intrusive symptoms are associated with attentional biases, it is plausible that PTSD, AjD, and PGD are characterized by the same attentional biases as a transdiagnostic feature. The present study investigated 90 participants with symptoms of PTSD, AjD, or PGD. Individuals with a subclinical symptom presentation were also able to participate, resulting in an analogue sample with the group labels aPTSD, aAjD, and aPGD. All participants completed a symptom induction task to provoke symptoms related to attentional biases. Subsequently, a visual search task (VST) was implemented. This test assessed reaction times to trials that include stress-related, neutral, and generally negative stimuli. The VST featured an interference and facilitation condition to investigate different types of attentional biases. Findings showed that all groups were characterized by particularly fast reaction times to trials which included stressrelated stimuli in the interference condition, which indicates a reversed attentional interference bias. This bias has not been reported before and is perhaps related to an avoidance behavior. [ABSTRACT FROM AUTHOR]

A scoping review was conducted to explore the metaphors and related expressions older adults use to describe extremely stressful events that may lead to Post-Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Prolonged Grief Disorder (PGD), or Adjustment Disorder (AjD). Relevant databases from psychology, gerontology, and related fields were searched. In addition, relevant references found in included papers were considered. Inclusion criteria were: qualitative study, sample of older adults (age 65+), and focus on maladaptive rather than adaptive psychological aspects. Eleven studies focusing on PTSD, 5 on CPTSD, 13 on PGD, and 10 on AjD were included. Metaphors and other expressions related to extremely stressful events were then extracted and analyzed. Multiple linguistic expressions to describe extremely stressful events and stress-related symptoms were identified. Metaphors and related expressions often referred to the body and the theme of moving on with one's life. [ABSTRACT FROM AUTHOR]

The ICD‐11 has introduced a new conceptualization of adjustment disorder (AjD) as a stress response syndrome with core symptoms of preoccupations and failure to adapt to the stressor. The current study aimed to assess the reliability and validity of the International Adjustment Disorder Questionnaire (IADQ) in two culturally distinct samples from Israel and Switzerland. Two samples were recruited in Israel (N = 1142) and Switzerland (N = 699) during the initial stages of the COVID‐19 pandemic. Confirmatory factor analysis indicated that a correlated two‐factor model provided an excellent fit to the Israeli and Swiss sample data. The IADQ scores correlated strongly with another measure of AjD symptoms and with symptoms of depression, anxiety, acute stress and negative emotions, whereas correlations with posttraumatic stress disorder, complex posttraumatic stress disorder and positive emotions were weaker. In the Swiss sample, 18.8% met diagnostic criteria for probable AjD and 10.2% in the Israeli sample. The current study provides the first evidence of the validity of the German and Hebrew versions of the IADQ and can be used for the screening of this debilitating condition. [ABSTRACT FROM AUTHOR]

The Adjustment Disorder – New Module 20 (ADNM-20) was developed for the assessment of adjustment disorder symptoms. The aim of the present study was to translate and conduct psychometric testing of the Chinese version of the ADNM-20. The English version was translated into traditional Chinese in an iterative process with an expert panel of mental health professionals. A total of 433 university students in Hong Kong between ages 18–24 years completed the Chinese ADNM-20 and the Hospital Anxiety and Depression Scale via an online survey; 32 were retested after two weeks. The content validity indices were excellent for most of the items. Confirmatory factor analysis supported a unidimensional first-order structure with excellent composite reliability. The test–retest reliability of the Chinese version was below satisfactory for the individual items; the intra-class correlation for the overall scale was moderate. The Chinese version of the ADNM-20 also indicated a moderate positive correlation with anxiety and depression symptoms. Initial results support the content, factorial, and discriminant validity of the translated scale. More research is needed to assess its reliability in this cultural context. The ADNM-20 can be quickly employed for the assessment of adjustment disorder as proposed for ICD-11. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)