Definition and history

Wise,(3) who described the history of AD since 1945, states that the AD diagnostic concept initially included the idea of a transient situational disturbance, classified by developmental epochs (T.§bJe.3). It then evolved to embody a disorder of adjustment characterized by maladaptation, for example work (or academic) inhibition, accompanied by a mood state, for example depressed, anxious, mixed (DSM-III).(4) In 1987 with the advent of DSM-IIIR, another category of adjustment disorders was included, i.e. physical complaints.(5)

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Table 3 Development of the classification of adjustment disorder

With the opportunity in 1994 to develop another evolutionary step of the DSM, i.e. DSM-IV, (4) the authors were asked to re-examine the subthreshold diagnostic category of AD with the goal of improving its acknowledged 'shortcomings.' The research included review of the literature, reanalysis of existing studies of AD and their data sets, and examination of field studies (e.g. minor depression, minor anxiety) to observe if there was sufficient differentiation among these minor disorders from the ADs (e.g. how often was a stressor identified in those patients assigned the diagnosis minor depression or minor anxiety?). From these three sources and consultations, modifications for DSM-IV and their rationale were formulated based on the best evidence extant.

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