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Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation


Glaesmer, Heide; Romppel, Matthias; Brähler, Elmar; Hinz, Andreas; Maercker, Andreas (2015). Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation. Psychiatry Research, 229(3):940-948.

Abstract

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.

Abstract

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.

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7 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:06 Faculty of Arts > Institute of Psychology
Dewey Decimal Classification:150 Psychology
Language:English
Date:2015
Deposited On:27 Aug 2015 10:11
Last Modified:05 Apr 2016 19:22
Publisher:Elsevier
ISSN:0165-1781
Publisher DOI:https://doi.org/10.1016/j.psychres.2015.07.010
PubMed ID:26272020

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