Difference Between Adjustment Disorder and PTSD

Adjustment Disorder (AD) vs. Post-traumatic Stress Disorder (PTSD)

Adjustment Disorder (AD) and Post-traumatic Stress Disorder (PTSD) are both caused by stressors and are mainly characterized by out of proportion distress. Individuals with these disorders suffer from impairment in various areas of their life due to a previous traumatic event. Regarding their general distinctions, AD is given as a diagnosis if the symptoms are in response to coping with a certain life change or event and if the maladaptive behavior manifested within three months of the onset of the stressor and that the disturbance should not last for more than six months.  On the other hand, PTSD diagnosis specifies that the duration of the disturbance should be more than one month, and they may manifest 6 months after the life-threatening event. The following discussions further look into such differences.

What is Adjustment Disorder (AD)?

AD is sometimes called as situational depression, reactive depression, or exogenous depression. This disorder is due to the inability of the individual to cope with a new life situation such as unemployment, marriage, change of community, and others. As compared to the other diagnoses, this is most probably the least stigmatizing of them all. The Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM 5) specifies the following criteria for AD:

• The emotional or behavioral symptoms manifested within three months of the onset of the stressor.
• The experienced distress is out of proportion to the severity of the source of stress.
• There is a significant impairment in various areas of functioning such as work and family.
• The symptoms do not last longer for more than an additional six months.
• AD may be specified as: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, or unspecified.

What is Post-traumatic Stress Disorder (PTSD)?

PTSD is triggered by experiencing or witnessing a traumatic event such as war, calamity, and abuse.  It was first specified in 1980 in DSM III. The DSM 5 specifies the following criteria:

• Exposure to a threatening situation, injury, or violence through direct experience, as a witness, by knowing that the event happened to a close family member or friend, and through repeated exposure to emergency situations as in the case of first responders, firefighters, and policemen.
• Presence of intrusive memories, recurrent nightmares, dissociative reactions like flashbacks of the traumatic experience, intense psychological distress at the presence of triggering stimuli, significant physiological reactions such as panic attacks, dizziness, and palpitations in response to triggering stimuli.
• Persistent avoidance of reminders which cause distressing memories, thoughts, or feelings.
• Pessimistic changes in thinking and feelings as characterized by forgetting certain aspects of the traumatic event, negative self-concept, irrational guilt, persistent negative feelings such as anger and shame, lack of interest in social relationships, and feelings of detachment. 
• Significant changes in arousal and reactivity as evidenced by irritability, aggression, hypervigilance, inability to concentrate, and sleep disturbance.
• The disturbance lasts for at least one month.
• The distress, which is not caused by any kind of substance, impairs important areas of functioning.
• PTSD may be specified as with dissociated symptoms or with delayed expression.

Difference between AD and PTSD

Stressor

The common stressors in AD are significant changes in life situations such as unemployment, moving to another area, and sickness. On the other hand, the usual triggers for PTSD are more serious events such as sexual violence, serious injury, and threatened death.

Duration

The DSM 5 indicates that AD symptoms should manifest within three months of the onset of the stressor and that they should not last for more than 6 months while PTSD symptoms should last for more than one month and delayed expression may occur (at least six months after the event). 

Specifiers

AD may be specified as with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, or unspecified. As for PTSD, it may be specified as with dissociative symptoms or delayed expression.

Symptoms

The symptoms of AD are less intense as well as less numerous such as marked distress and significant impairment in functioning. On the other hand, the symptoms of PTSD are more intense such as intrusive and distressing memories, recurrent nightmares, dissociative reactions, persistent avoidance of stimuli, negative changes in mood and cognition, and marked changes in arousal and reactivity.

Prevalence

AD is often the most common diagnosis in a hospital psychiatric consultation in the United States as the percentage usually reaches 50%. This may also be due to the fact that it is probably the least stigmatizing diagnosis. As for PTSD, the projected life-time risk for Americans is estimated to be at 8.7%. The individuals who are at most risk are the survivors of sexual assault, military combat, and captivity.

AD vs PTSD

Summary of AD vs PTSD

• Adjustment Disorder (AD) and Post-traumatic Stress Disorder (PTSD) are both caused by stressors and are mainly characterized by out of proportion distress.
• AD is due to the inability of the individual to cope with a new life situation such as unemployment, marriage, change of community, and others.
• PTSD is triggered by experiencing or witnessing a traumatic event such as war, calamity, and abuse. 
• AD manifests within 3 months of the onset of stressor while PTSD may manifest much later.
• AD has more specifiers and has a higher prevalence while PTSD has less specifiers and has a lower prevalence.
• AD has less serious symptoms while PTSD has more serious manifestations such as recurrent nightmares, flashbacks, and hypervigilance.

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