288 Trauma- and Stressor-Related Disorders
Risk and Prognostic Factors
Environmental. Individuals from disadvantaged lif e circumstances experience a high
rate of stressors and may be at increased risk for adjustment disorders.
Culture-Related Diagnostic Issues
The context of the individual’s cultural setting should be taken into account in making the
clinical judgment of whether the individual’s response to the stressor is maladaptive or
whether the associated distress is in excess of what would be expected. The nature, mean-
ing, and experience of the stressors and the ev aluation of the response to the stressors may
vary across cultures. 
Functional Consequences of Adjustment Disorders
The subjective distress or impa irment in functioning associat ed with adjustment disorders
is frequently manifested as decreased perf ormance at work or school and temporary
changes in social relationships. An adjustment disorder may complicate the course of ill-
ness in individuals who have a general medica l condition (e.g., decreased compliance with
the recommended medical regimen; incr eased length of hospital stay). 
Differential Diagnosis
Major depressive disorder. If an individual has symptoms that meet criteria for a major
depressive disorder in response  to a stressor, the diagnosis of an adjustment disorder is
not applicable. The symptom profile of major depressive disorder differentiates it from ad-
justment disorders.
Posttraumatic stress disorder and acute stress disorder. In adjustment disorders, the
stressor can be of any severity rather than of  the severity and type required by Criterion A
of acute stress disorder and posttraumatic st ress disorder (PTSD). In distinguishing ad-
justment disorders from thes e two posttraumatic diagnoses,  there are both timing and
symptom profile considerations. Adjustment disorders can be diagnosed immediately
and persist up to 6 months afte r exposure to the traumatic event, whereas acute stress dis-