Adjustment Disorder – a Common but Controversial Diagnosis

Adjustment disorder – a common but controversial diagnosis

Presented by Dr Anna Lenardon mlcoa Consultant Forensic Psychiatrist Overview

Introduction – general definitions and concepts Definition Assessment Prognosis Challenges The impact of compensation on health outcomes and recovery References

Work-related stress is experienced when the demands of the work environment exceed the employees’ ability to cope with (or control) them Mental stress is the major causative mechanism of work-related mental disorders Over the last decade – there has been a consistent increase in workplace stress-related psychological injuries Causative factors - work pressure (work backlogs, deadlines, organisational re- structures, interpersonal conflicts, disciplinary actions, promotion disappointment), harassment, workplace or occupational violence, exposure to a traumatic events, suicide or attempted suicide and other mental stress factors

Claims involving a mental health condition are usually associated with an above average time off work and a higher than average claim benefit payment Claims data show that the median time off work for a mental disorder claim (14.8 weeks) and median claim payment ($23 600) was 2.8 and 2.7 times higher than the median time off work and median claim payment for all claims (5.3 weeks, $8700)

© COPYRIGHT 2020 Introduction Work-related mental illness is a complex field due to: significant interplay between medical, psychological, social and cultural factors - a worker’s mental health can be affected by extra-occupational stressors (remember that 1 in 4 Australians will suffer from at least one mental disorder in their lifetime) work is the source of the illness financial implication, litigations Dilemma of work as a potentially harmful ‘exposure’ and work being for most people beneficial for mental health: being in work is associated with lower prevalence of depression and lower incidence of suicide, while longstanding worklessness carries its own risks

Abnormal and excessive reaction to an identifiable life stressor. The reaction is more severe than would normally be expected, and can result in significant impairment in social, occupational or academic functioning. AD occurs when an individual is unable to cope and develops behavioural or emotional symptoms.

It’s a type of stress/trauma-related syndrome, together with acute stress reaction and PTSD

Common mental illness and most common diagnosis in occupational psychiatry Despite research indicating significant prevalence rates that are often greater than depressive and anxiety disorders in some populations, adjustment disorder has historically attracted little empirical research Prevalence varies: In a global sample of psychiatrists, adjustment disorder was ranked as the seventh most frequently diagnosed disorder In a large sample of 56 centres across 11 European countries adjustment disorder was found to be the primary clinical diagnosis A study of returning US soldiers from OEF/OIF operations found a prevalence of 6% for adjustment disorder, which was the third most common psychiatric diagnoses, behind PTSD (12%) and depression (13%) Hospital population (chronic illness) up to 35%