Talk:Adjustment disorder/Archive 1

Is PSTD an anxiety disorder or not?
At the first paragraph of this article it says:


 * "The condition is different from anxiety disorder which lacks the presence of a stressor, or post-traumatic stress disorder and acute stress disorder which usually are associated with a more intense stressor."

However, if you read the article about anxiety disorder, it lists PTSD as being a type of anxiety disorder. Therefore, I found this paragraph confusing. Does anxiety disorders lack the presence of a stressor or not? If they do lack a stressor, why is PTSD classified as an anxiety disorder then, since it says in this article (and others that mention PSTD) that PSTD is associated with an intense stressor?

It is worth mentioning that in the article about anxiety disorder, the only type that mentions a stressor is PTSD. --Pinnecco (talk) 01:05, 13 October 2009 (UTC)

Cleanup-Rewrite
I added the cleanup-rewrite tag because the article is out-of-date, poorly written, and contains many factual inaccuracies. I will edit this article when I am able, but like most of us, my time is limited and I cannot make any firm commitments in this regard. If you are reading this, you presumably have some interest in the topic. Perhaps you could begin to improve the article (be bold!) or solicit help from others. :o)

If the article languishes without improvement for several weeks, I will nominate it for deletion with an eye toward incubation until it is rehabilitated. I would rather not nominate for deletion because Adjustment Disorder is a common mental disorder and many, many other Wikipedia articles link to this one. On the other hand, I worry about visitors to the page obtaining misleading, inaccurate information.

Here are some specifics regarding my assertion that "the article is out-of-date, poorly written, and contains many factual inaccuracies." I recognize that previous edits have been conducted in good faith. I intend the following as (1) Support for my contention that the article needs a major overhaul or should be incubated; and (2) Constructive criticism.

Dated

 * The article is out-of-date. It references DSM-III-R and DSM-IV; it needs updating to DSM-5, which introduced a significant change to how adjustment disorders are conceptualized.

In DSM-5, adjustment disorders are reconceptualized as a heterogeneous array of stress-response syndromes that occur after exposure to a distressing (traumatic or nontraumatic) event, rather than as a residual category for individuals who exhibit clinically significant distress without meeting criteria for a more discrete disorder (as in DSM-IV ).

Poorly Written

 * The article is poorly written. Examples:

(a) "An adjustment disorder occurs when an individual is unable to adjust to or cope with a particular stressor, like a major life event." Defining the disorder as "an individual is unable to cope..." is pejorative and not at all consistent with how the DSM or other nosological systems describe the disorder.

(b) "However, the stress-related disturbance does not only exacerbation of a pre-existing axis 1 or axis 2 disorder and cannot be diagnostic as axis 1 disorder." I have no idea what this sentence means. Incoherent.

(c) "Some signs and criteria used to establish a diagnosis are important, however." English teachers everywhere hang their heads in despair, however.

(d) "Adjustment disorders have the ability to be self-limiting." How did the entity, "Adjustment disorders" acquire this ability?

(e) "...parents and caregivers can help their children with their difficulty adjusting by..." Whose children? Whose difficulty?

(f) "The symptoms should be more severe than would be expected." Than would be expected by whom? This statement is also factually inaccurate. There is no such diagnostic criterion for adjustment disorders.

Factually Inaccurate

 * The article is factually inaccurate, misleading, misinformed, and more likely to confuse than enlighten. Examples:

(i) "Since people with this disorder normally have symptoms that depressed people do, such as general loss of interest, feelings of hopelessness and crying, this disorder is also sometimes known as situational depression." This statement lacks a citation, which is not surprising since it is an erroneous, false assertion. Someone with Adjustment Disorder With Disturbance of Conduct (309.3) might experience a euthymic mood, have many mischievous interests, and display great optimism.

(ii) "Suicidal behavior is prominent among people with AD of all ages..." is a misleading, inaccurate, unsupported, and untrue statement.

(iii) "Various factors have been found to be more associated with a diagnosis of AD than other Axis I disorders, including..." The examples provided reflect a misunderstanding of the referenced article's conclusions. For example, "increased suicidal behaviour" is not more prevalent with Adjustment Disorder compared to other Axis I disorders, e.g., Major Depressive Disorder, Borderline Personality Disorder, and Schizophrenia have substantially higher suicide rates.

(iv) "The basis of the diagnosis is the presence of a precipitating stressor and a clinical evaluation of the possibility of symptom resolution on removal of the stressor due to the limitations in the criteria for diagnosing AD." No citation, which is again not surprising because this editorial opinion lacks empirical evidence.

(v) "Like many of the items in the DSM, adjustment disorder receives criticism from a minority of the professional community as well as those in semi-related professions outside the health-care field." Poorly written editorial statement lacking a citation. And gosh darn those "semi-related professions" sticking their noses in the healthcare professionals' domain!

 Mark D Worthen PsyD  01:54, 29 August 2013 (UTC)

Adding detail to psychotherapy treatment of adjustment disorder
After mentioning general psychotherapy treatment for the disorder, interpersonal psychotherapy could be discussed. something like "Originally developed in the 1960’s for adult depression, interpersonal psychotherapy (IPT) focuses on the context of an individual’s relationships as the cause of depression regardless of its biological or genetic origins. The therapist helps the client identify areas of relational depression in which skill-building is needed to improve such relationships and decrease depressive symptoms. The IPT model of treatment classifies four of these areas of relationship difficulties:  1.) grief after the loss of a loved one; 2)conflict in significant relationships ; 3) difficulties adapting to change sin relationships or life circumstances; and 4) difficulties stemming from social isolation. As IPT progresses, the client learns how to link changes in their mood with events that are occurring in their relationship, communicate feelings and expectations for the relationship, and problem-solve solutions to relationship difficulties."

http://effectivechildtherapy.org/content/what-interpersonal-psychotherapy

Adding Citations
I don't know how to add citations properly, but I thought you all should know that the citations, in APA format at least, for the studies listed in the Suicide section are:

Bronish, T., & Hecht, H. (1989). Validity of adjustment disorder, comparison with major depression. Journal of Affective Disorders, 17, 229–236.

Asnis, G. M., Friedman, T. A., Sanderson, W. C., Kaplan, M. L., van Praag, H. M., & Harkavy-Friedman, J. M. (1993). Suicidal behavior in adult psychiatric outpatients: Description and prevalence. American Journal of Psychiatry, 150, 108–112.

Thanks. 130.166.165.15 (talk) 07:28, 15 April 2009 (UTC)

Explanation of men being more vulnerable to stressors
Should this explanation be added? See the one near "hardiness and gender" at: http://web.mst.edu/~pfyc212b/stress2.htm —Preceding unsigned comment added by 74.58.84.24 (talk) 13:08, 18 August 2008 (UTC)

This reference is inappropriate. It refers to differences in immune system functioning and physical health. The higher incidence of adjustment disorder in females relative to males is consistent with sex differences in vulnerability to stress. Women have consistently been found to be more vulnerable to stress than men. See Turner, R.J., Wheaton, B. & Lloyd, D.A. (1995). The epidemiology of social stress. American Sociological Review, 60, 104-125. —Preceding unsigned comment added by Pmforster (talk • contribs) 12:50, 2 September 2009 (UTC)

Copy vio?
The section on Diagnostic Criteria for Adjustment Disorders appears to be stolen from: http://www.behavenet.com/capsules/disorders/adjdis.htm

or from that page's primary source: Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association. Jarich 06:30, 23 August 2006 (UTC)

I totally didn't finish the citations (I was going to do it later), I was going to cite the book that they got it from (The DSM) for the diagnostic criteria, not behavenet. Is it still a copyright violation to directly quote a book if I would've cited it? The Man o Steel (talk) 00:04, 14 December 2007 (UTC)

Removed diagnostic criteria
The criteria refer to things like Axis I or Axis II disorders without context. Since I'm fairly certain these were just copied directly from either the link above or behavenet, I don't feel this section belongs on this page. Jarich 13:01, 24 December 2006 (UTC)

Remove the whole thing? Shouldn't somebody just write a page on Axis I and II disorders? Wouldn't it be preferable that what an Axis I and II disorders are should be added, rather than getting rid of the references to them? The Man o Steel (talk) 00:04, 14 December 2007 (UTC)

Can anyone make sense of this sentence?
I would edit it but don't what I would change it to.

"Stressors thought to involve a loss are thought to have particular significance like an interpersonal failure, physical or sexual abuse, cognitive impairment, a lengthy duration of frequent recurrence, or cognitive uncertainty."

Is the list of examples a list of "stressors thought to involve a loss," or are they examples of what could happen as a result of the concomitant "particular significance"? That is, are they examples or effects of perceived losses? —Preceding unsigned comment added by 140.180.5.235 (talk • contribs) 01:03, 22 April 2008


 * I can't parse that sentence either. Vithos (talk) 22:19, 9 March 2009 (UTC)

Some clarification by an expert would be appreciated. It's very hard to interperet this sentence, and whether it's talking about cause, effect, or making a comparison. 207.47.36.238 (talk) 02:51, 25 April 2009 (UTC)

Phrasing that might be more clear:
From the Section "Adjustment disorder link to suicide"

This sentence: "Bronish and Hecht (1989) found that 70% of a series of patients with AD attempted suicide immediately before their index admission and they remitted faster than a comparison group with major depression." uses vague phrasing with a statistic.

Some clarification of "index admission" might make the statistic and sentence more relevant. As an aside, this is the only article in Wikipedia that uses that particular phrase. —Preceding unsigned comment added by FourthFelix (talk • contribs) 08:35, 5 October 2008 (UTC)

"It has been criticized for its lack of specificity of symptoms, behavioral parameters, and close links with environmental factors"

Parameter is a mathematical term that has nothing to do with boundaries. I'd suggest perimeters be a more appropriate word. —Preceding unsigned comment added by Molyneux1000 (talk • contribs) 20:46, 9 July 2009 (UTC)