The adjustment disorders, a diagnostic category of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),[1] are defined as reactions to an identifiable psychosocial stressor (e.g., cancer diagnosis) with a degree of psychopathology that is less severe than diagnosable mental disorders such as major depressive disorder or generalized anxiety disorder and yet are "in excess of what would be expected" or result in "significant impairment in social or occupational functioning."

Diagnostic Criteria for the Adjustment Disorders

• Criterion A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
• Criterion B. These symptoms or behaviors are clinically significant as evidenced by either of the following:
  • Marked distress that is in excess of what would be expected from exposure to the stressor.
  • Significant impairment in social or occupational (academic) functioning.
• Criterion C. The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
• Criterion D. The symptoms do not represent bereavement.
• Criterion E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months. Specify:
  • Acute if the disturbance lasts less than 6 months.
  • Chronic if the disturbance lasts for 6 months or longer.
• Specific subtypes represent the predominant symptoms and include:
  • With depressed mood.
  • With anxiety.
  • With mixed anxiety and depressed mood.
  • With disturbance of conduct.
  • With mixed disturbance of emotions and conduct unspecified.

Adapted from American Psychiatric Association, 2000.[1]

Prevalence

In the general population, adjustment disorders are thought to be common, though prevalence rates vary by population studied. In studies of community samples of children, adolescents, and the elderly, prevalence estimates have ranged from 2% to 8%. In outpatient mental health settings, prevalence rates have been as high as 10% to 30%; while in general hospital inpatients, prevalence rates have been as high as 12% of those referred for a mental health consultation.[1]

Nearly every cancer patient experiences what could be considered an identifiable stressor, whether that is diagnosis, treatment, recurrence, or side effects. The presence of an adjustment disorder is determined more by the patient's response to the identifiable stressor, and whether that response is considered in excess of what would be expected or results in significant impairment, typically in social or occupational functioning.

One study [2] evaluated 215 randomly selected hospitalized and ambulatory cancer patients in three different cancer centers and found that of this group, slightly fewer than half (47% or 101 patients) met the diagnostic criteria for any mental disorder (DSM-III criteria). From this group of 101, 68% (69 patients) met the diagnostic criteria for an adjustment disorder. Of the entire 215 patients evaluated, approximately 32% were identified as meeting the diagnostic criteria for an adjustment disorder-the highest prevalence of any diagnostic category.