Multiple stressors and stressor identification across assessment methods: findings from a psychosomatic rehabilitation sample within the ICD-11 adjustment disorder framework.

Abstract

Background: Adjustment disorder (AjD) is defined in ICD-11 by core symptoms of preoccupation and failure to adapt in response to a clearly identifiable stressor. Disorder-specific instruments, including the self-report questionnaire Adjustment Disorder - New Module 20 (ADNM-20) and the Composite International Diagnostic Interview - Module Adjustment Disorder (CIDI-AD), have been developed to operationalize these core features. However, it remains unclear to how consistently triggering events are identified across different assessment approaches. The present study aimed to identify the most frequent triggering events associated with AjD symptoms in psychosomatic rehabilitation and to examine the concordance of stressor identification across assessment approaches.

Method: The ADNM-20 was administered to a clinical sample of psychosomatic inpatients (N = 2063). The CIDI-AD interview was conducted with a random subsample (n = 373) on the same day or the following day. Stressor categories (work, own illness, family, illness/death in family, other) were coded to enable comparison of stressor categories across instruments.

Results: Work-related problems were the most common triggers in both instruments, followed by own illness. Approximately half of the participants (≈ 49%) reported different primary stressors in the questionnaire and the interview. On average, participants reported nine stressors in the ADNM-20 (range 1-19 events) and five stressors in the CIDI-AD (range 1-19 events), indicating that many individuals in psychosomatic rehabilitation experience multiple concurrent stressors.

Conclusion: The findings indicate that stressor identification varies substantially across assessment methods in psychosomatic rehabilitation settings. The frequent occurrence of multiple, overlapping stressors suggests that AjD-related symptoms may not always be attributable to a single dominant event. These results underscore the importance of considering cumulative stress exposure in AjD assessment and highlight the need for future research to clarify how the ICD-11 single-stressor assumption applies in populations with concurrent stressors.