Adjustment Disorders as Stress Response Syndromes: A New Diagnostic Concept and Its Exploration in a Medical Sample
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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.
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Prevalence rates for adjustment disorders range from 7.1% in patients with breast cancer to 12% in a consultation-liaison psychiatry service and to 17% in patients with cardiovascular diseases.
“Prevalence rates for adjustment disorders range from 7.1 % in patients with breast cancer [8] to 12 % in a consultation-liaison psychiatry service [9] and to 17 % in patients with cardiovascular diseases [10].”
From Immediate help through group therapy for patients with somatic diseases and depressive or adjustment disorders in outpatient care: study protocol for a randomized controlled trial. (2015) · cites this paper as [10]
The Prevalence of AD and Its Subtypes section reports adjustment disorder in 16.9% of the sample, supporting the rounded 17% figure. But the Participants section identifies the sample specifically as patients with implanted defibrillators at a specialist cardiology clinic; the finding does not establish that prevalence for patients with cardiovascular diseases generally. The 7.1% and 12% figures have separate citations and are not attributed to this paper. (LLM, conf=0.86)
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- Authors
- Maercker, A., Einsle, F., & Köllner, V.
- Affiliations
- University Hospital Carl Gustav Carus (DE)
- Universitätsklinikum des Saarlandes (DE)
- ORCID
- Köllner, Volker
- Venue
- Psychopathology
- Publisher
- S. Karger AG
- Published
- 2007
- Volume
- 40
- Issue
- 3
- Pages
- 135-146
- ISSN
- 0254-4962 (ISSN-L)
- 1423-033X
- OpenAlex
- W2042418558
- Cited by
- 202
- References
- 46
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 13 · 2021: 9 · 2020: 10 · 2019: 16 · 2018: 19 · 2017: 14 · 2016: 12 · 2015: 12 · 2014: 10 · 2013: 8 · 2012: 13
- FWCI
- 10.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- adjustment disorder, stress response syndromes, diagnostic model, intrusion symptoms, prevalence, sensitivity and specificity, psychometric validation
- MeSH terms
- Adjustment Disorders, Adolescent, Adult, Aged, Aged, 80 and over, Depression, Diagnosis, Differential, Female, Heart Diseases, Humans, Male, Middle Aged, Terminology as Topic, Psychological Theory, Psychometrics, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Reproducibility of Results, Comorbidity, Defibrillators, Implantable, Empirical Research
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