The Adjustment Disorders in the Structure of Post-Stress Disorders: Social and Clinical Aspects

Introduction. Adjustment disorders (AD) occupy a vast but poorly understood niche in the spectrum of social stress disorders. Despite their high prevalence, their clinical significance has long been underestimated due to blurred diagnostic criteria. Objective. To summarize current data on AD with a focus on diagnostic evolution, epidemiology, social significance, mechanisms of formation, and therapeutic strategies. Material and methods. Publications indexed in eLibrary.ru, PubMed, Scopus, and RSCI (2010–2025) were analyzed. The review includes 59 sources. Results. In ICD11, AD is operationalized through the symptoms of “preoccupation with the stressor” and “failure to adapt” with a time criterion of one month. In outpatient practice, AD accounts for 5–21%; in social risk groups – 15–35%; among military personnel evacuated from combat zones – 37.6%. Russian researchers have confirmed the role of neuroimmunoendocrine disturbances as an etiological factor. Cognitive behavioral therapy is most effective; pharmacotherapy is adjunctive but widely used in practice. Suicidal risk in AD is high: the risk of suicide attempts is increased 4.7fold, and the risk of completed suicide – 6fold. Conclusions. AD is an independent clinical category requiring a personalized approach and close attention from clinicians, especially in the context of social changes.

1. Aleksandrovskii Yu.A. Mental Maladaptation States and Their Compensation (Borderline Neuropsychiatric Disorders). Moscow: Nauka; 1976. 272 p. (In Russ.)

2. Aleksandrovskii Yu.A. [Borderline Mental Disorders: a Guide for Physicians. 6th ed. Moscow: GEOTAR-Media; 2019. 720 p. (In Russ.)

3. Svechnikov D.V., Kurasov E.S. Adjustment Neurotic Disorders in the Modern Psychiatric Practice (Analysis of the Problem). Bulletin of Pirogov National Medical & Surgical Center. 2013;8(4):72-76. (In Russ.)

4. Zelviene P., Kazlauskas E. Adjustment Disorder: Current Perspectives. Neuropsychiatric Disease and Treatment. 2018;14:375-381. https://doi.org/10.2147/NDT.S121072

5. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO; 1992. 362 p.

6. Antipova O.S. Adjustment Disorders: Modern Approaches to Diagnosis and Therapy. Effective Pharmacotherapy. Neurology and Psychiatry. 2015;(1):32-36. (In Russ.) Available by: https://umedp.ru/upload/iblock/dba/dba131c9bd320db89af2ded45c7098ed.pdf

7. Maercker A., Brewin C.R., Bryant R.A. et al. Diagnosis and Classification of Disorders Specifically Associated with Stress: Proposals for ICD-11. World Psychiatry. 2013;12(3):198-206. https://doi.org/10.1002/wps.20057

8. First M.B., Gaebel W., Maj M. et al. An Organization- and Category-level Comparison of Diagnostic Requirements for Mental Disorders in ICD-11 and DSM-5. World Psychiatry. 2021;20(1):34-51. https://doi.org/10.1002/wps.20825

9. Strain J.J., Friedman M.J. Considering Adjustment Disorders as Stress Response Syndromes for DSM-5. Depression and Anxiety. 2011;28(9):818-823. https://doi.org/10.1002/da.20782

10. Bachem R., Casey P. Adjustment Disorder: a Diagnosis Whose Time Has Come. Journal of Affective Disorders. 2018;227:243-253. https://doi.org/10.1016/j.jad.2017.10.034

11. Horowitz M.J. Stress Response Syndromes: PTSD, Grief, Adjustment, and Dissociative Disorders. 5th ed. Lanham: Jason Aronson; 2011. 384 p.

12. Peter C., Dahale A.B., Muliyala K.P., Desai G. Nature of Stressors, Clinical Manifestations and Diagnostic Concurrence with the New ICD-11 Criteria in Adjustment Disorder: a Retrospective Data Review. Nordic Journal of Psychiatry. 2025;79(2):175-183. https://doi.org/10.1080/08039488.2025.2468732

13. Karatzias T., Shevlin M., Hyland P. et al. ICD-11 Posttraumatic Stress Disorder, Complex PTSD and Adjustment Disorder: the Importance of Stressors and Traumatic Life Events. Anxiety, Stress and Coping. 2021;34(2):191-202. https://doi.org/10.1080/10615806.2020.1803006

14. Quero S., Fernández-Buendía S., Privado J. et al. Validation of the Spanish Version of the Adjustment Disorder New Module-20 (ADNM-20) in a Non-clinical Sample. BMC Psychology. 2024;12(1):771. https://doi.org/10.1186/s40359-024-02298-0

15. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. 1120 p.

16. O'Donnell M.L., Agathos J.A., Metcalf O. et al. Adjustment Disorder: Current Developments and Future Directions. International Journal of Environmental Research and Public Health. 2019;16(14):2537. https://doi.org/10.3390/ijerph16142537

17. Casey P., Doherty A. Adjustment Disorder: Diagnostic and Treatment Issues. In: Casey P, editor. Adjustment Disorder: From Controversy to Clinical Practice. Oxford: Oxford University Press; 2018. p. 215-228.

18. O'Donnell M.L., Alkemade N., Creamer M. et al. A Longitudinal Study of Adjustment Disorder after Trauma Exposure. American Journal of Psychiatry. 2016;173(12):1231-1238. https://doi.org/10.1176/appi.ajp.2016.16010071

19. Mitchell A.J., Chan M., Bhatti H. et al. Prevalence of Depression, Anxiety, and Adjustment Disorder in Oncological, Haematological, and Palliative Care Settings: a Meta-analysis of 94 Interview-based Studies. The Lancet Oncology. 2011;12(2):160-174. https://doi.org/10.1016/S1470-2045(11)70002-X

20. Mosolova E.S., Sosin D.N. Stress, Anxiety, Depression and Burnout in Healthcare Workers During the First Two Outbreaks of COVID-19 in Russia. S.S. Korsakov Journal of Neurology and Psychiatry. 2022;122(6):128-133. (In Russ.) https://doi.org/10.17116/jnevro2022122061128

21. Redican E., Rohner S.L., Adank N. et al. Adjustment Disorder and the “Stress Response Continuum” in Older Adults. Traumatology. 2025. In press.

22. Kelber M.S., Morgan M.A., Beech E.H. et al. Systematic Review and Meta-analysis of Predictors of Adjustment Disorders in Adults. Journal of Affective Disorders. 2022;304:43-51. https://doi.org/10.1016/j.jad.2022.02.038

23. Morgan M.A., Kelber M.S., Bellanti D.M. et al. Diagnostic and Functional Outcomes of Adjustment Disorder in U.S. Active Duty Service Members. Journal of Affective Disorders. 2023;323:185-192. https://doi.org/10.1016/j.jad.2022.11.079

24. Randell J.R. Demographics of and Diagnoses in Operation Enduring Freedom and Operation Iraqi Freedom Personnel Who Were Psychiatrically Evacuated from the Theater of Operations. General Hospital Psychiatry. 2006;28(4):352-356. https://doi.org/10.1016/j.genhosppsych.2006.04.006

25. Jones R., Yates W.R., Williams S. et al. Outcome for Adjustment Disorder with Depressed Mood: Comparison with Other Mood Disorders. Journal of Affective Disorders. 1999;55(1):55-61. https://doi.org/10.1016/S0165-0327(98)00202-X

26. Greenberg W.M., Rosenfeld D.N., Ortega E.A. Adjustment Disorder as an Admission Diagnosis. The American Journal of Psychiatry. 1995;152(3):459-461. https://doi.org/10.1176/ajp.152.3.459

27. Kalimullina I.R., Sumina N.E. The Relationship between Coping Strategies and Emotional Intelligence in Persons with Different Locus of Control. Personality in a Changing World: Health, Adaptation, Development. 2025;133(50):291-298. (In Russ.)

28. Stevelink S.A.M., Jones M., Hull L. et al. Mental Health Outcomes at the End of the British Involvement in the Iraq and Afghanistan Conflicts: a Cohort Study. Br J Psychiatry. 2018;213(6):690-697. https://doi.org/10.1192/bjp.2018.175

29. McKenzie A., Burdett H., Rafferty L. et al. Probable Adjustment Disorder in the UK Armed Forces: Prevalence, Stressors and Risk Factors Among Serving Personnel and Ex-serving Personnel. Journal of Affective Disorders. 2025;391:119987. https://doi.org/10.1016/j.jad.2025.119987

30. Nikitina V.B., Belokrylova M.F., Rudnitskii V.A. et al. Immunobiological Model for Diagnosing the Course of Adjustment Disorder in Women. Siberian Herald of Psychiatry and Narcology. 2025;1(126):5-14. (In Russ.) https://doi.org/10.26617/1810-3111-2025-1(126)-5-14

31. Ivanova S.A. Psychoemotional Stress and Immunity (Review). Siberian Herald of Psychiatry and Narcology. 2000;(1):31-37. (In Russ.)

32. Vialova N.M., Ivanova S.A. Programmed Death of Peripheral Blood Leukocytes in Normal Conditions and in Mental Maladjustment. Siberian Medical Review. 2007;3(44):23-27. Available from: https://cyberleninka.ru/article/n/zaprogrammirovannaya-gibel-leykotsitov-perifericheskoy-krovi-v-norme-i-pri-psihicheskoy-dezadaptatsii/viewer. (In Russ.)

33. Koo J.W., Wohleb E.S. How Stress Shapes Neuroimmune Function: Implications for the Neurobiology of Psychiatric Disorders. Biological Psychiatry. 2021;90(2):74-84. https://doi.org/10.1016/j.biopsych.2020.11.007

34. McGregor B.A., Murphy K.M., Albano D.L., Ceballos R.M. Stress, Cortisol, and B Lymphocytes: a Novel Approach to Understanding Academic Stress and Immune Function. Stress. 2016;19(2):185-191. https://doi.org/10.3109/10253890.2015.1127913

35. Patrakeeva V.P., Kontievskaya E.V. The Relationship between the Variants of Immune Response and the Cortisol and Adrenaline Levels Associated with Cooling. Extreme Medicine. 2023;25(2):58-62. https://doi.org/10.47183/mes.2023.020 (In Russ.)

36. 36. Zaitseva N.S., Siziakina L.P. Characteristics of Cytokine Imbalance in Chronic Comorbid Stress-induced Disorders in Combatants in the Long-term Follow-up Period. Immunology. 2023;44(3):326-332. https://doi.org/10.33029/0206-4952-2023-44-3-326-332 (In Russ.)

37. Doney E., Cadoret A., Dion-Albert L. et al. Inflammation-driven Brain and Gut Barrier Dysfunction in Stress and Mood Disorders. European Journal of Neuroscience. 2022;55(9-10):2851-2894. https://doi.org/10.1111/ejn.15239

38. Nunez S.G., Rabelo S.P., Subotic N. et al. Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation. Int J Mol Sci. 2025;26(20):9994. https://doi.org/10.3390/ijms26209994

39. Yasenevskaia A.L. Neuroimmunoendocrine Effects of Antioxidants in Stress-induced Conditions]. Dissertation. Volgograd; 2013. (In Russ.)

40. Lysenko N.E., Bulygina V.G., Rashevskaia OI.U. et al. Psychophysiological Profiles of Adaptation under Stress Simulation in Specialists of Hazardous Professions. Russian Journal of Psychiatry. 2024;(2):79-87. (In Russ.)

41. Cloitre M., Hyland P., Bisson J.I. et al. ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: a Population-based Study. Journal of Traumatic Stress. 2019;32(6):833-842. https://doi.org/10.1002/jts.22454

42. Krasnov V.N. Acute Stress Disorders as a Problem of Disaster Psychiatry. Social and Clinical Psychiatry. 2005;15(2):5-10. (In Russ.)

43. Poremski D., Hariram J., Wong W.K. et al. The Longitudinal Dispositions of People Diagnosed with Adjustment or Severe Stress Disorders. BMC Psychiatry. 2024;24(1):457. https://doi.org/10.1186/s12888-024-05904-y

44. Casey P, Jabbar F. O’Leary E., Doherty A.M. DohertySuicidal behaviours in adjustment disorder and depressive episode. Journal of Affective Disorders. 2015;174:441-446. https://doi.org/10.1016/J.JAD.2014.12.003

45. Chiou P.N., Chen Y.S., Lee Y.C. Characteristics of Adolescent Suicide Attempters Admitted to an Acute Psychiatric Ward in Taiwan. Journal of the Chinese Medical Association. 2006;69(9):428-435. Available from: https://www.sci-hub.ru/10.1016/S1726-4901(09)70286-2

46. Polyakova I., Knobler H.Y., Ambrumova A. et al. Characteristics of Suicidal Attempts in Major Depression Versus Adjustment Reactions. Journal of Affective Disorders. 1998;47:159-167. https://doi.org/10.1016/S0165-0327(97)00137-7

47. Cowansage K.P., Milligan T., Morgan M.A. et al. Treatments for Adjustment Disorder: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Psychiatry Research. 2025;353:116739. https://doi.org/10.1016/j.psychres.2025.116739

48. Domhardt M., Baumeister H. Psychotherapy of Adjustment Disorders: Current State and Future Directions. World Journal of Biological Psychiatry. 2018;19(1):21-35. https://doi.org/10.1080/15622975.2018.1467041

49. Carta M.G., Balestrieri M., Murru A., Hardoy M.C. Adjustment Disorder: Epidemiology, Diagnosis and Treatment. Clinical Practice and Epidemiology in Mental Health. 2009;5:15. https://doi.org/10.1186/1745-0179-5-15

50. Strain J.J., Diefenbacher A. The Adjustment Disorders: the Conundrums of the Diagnoses. Comprehensive Psychiatry. 2008;49(2):121-130. https://doi.org/10.1016/j.comppsych.2007.10.002

51. Guzman M., Lal R., Mackinnon D.F. Adjustment Disorder. In: Johns Hopkins Psychiatry Guide. Baltimore: Johns Hopkins University; 2025. Available from: https://www.hopkinsguides.com (Accessed 28 February 2026)

52. Leterme A.C., Behal H., Demarty A.L. et al. A Blended Cognitive Behavioral Intervention for Patients with Adjustment Disorder with Anxiety: a Randomized Controlled Trial. Internet Interventions. 2020;21:100329. https://doi.org/10.1016/j.invent.2020.100329

53. Fernández B., Freitas R., Valadas T., Areias D. Adjustment Disorder in Mental Health Unit of Matosinhos Hospital: a Retrospective Observational Study of 420 Patients. European Psychiatry. 2025;66:S976. https://doi.org/10.1192/j.eurpsy.2025.1198

54. Department of Veterans Affairs, Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder. Version 4.0. Washington, DC: Department of Veterans Affairs, Department of Defense; 2016. 173 p.

55. Greiner T., Haack B., Toto S. et al. Pharmacotherapy of Psychiatric Inpatients with Adjustment Disorder: Current Status and Changes Between 2000 and 2016. European Archives of Psychiatry and Clinical Neuroscience. 2020;270(1):107-117. https://doi.org/10.1007/s00406-019-01058-1

56. Semaan W., Hergueta T., Bloch J. et al. Étude Transversale de la Prévalence du Trouble de L'adaptation Avec Anxiété en Médecine Général [Cross-sectional Study of the Prevalence of Adjustment Disorder with Anxiety in General Practice]. L'Encéphale. 2001;27(3):238-244. PMID: 11488254 (In French).

57. Fernández A., Mendive J.M., Salvador-Carulla L. et al. Adjustment Disorders in Primary Care: Prevalence, Recognition and Use of Services. The British Journal of Psychiatry. 2012;201(2):137-142. https://doi.org/10.1192/bjp.bp.111.096305

58. Shishkova VN. Stress-related Emotional Disturbances in Patients with Cardiovascular Diseases. Medical Council. 2023;17(21):70-78. (In Russ.) https://doi.org/10.21518/ms2023-322

59. Chutko L.S., Surushkina S.Yu., Yakovenko E.A. et al. Clinical Features of Asthenia in the Context of Adjustment Disorders. S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(7):55-63. (In Russ.) https://doi.org/10.17116/jnevro202112107155