On the Concept of Adjustment Disorder and Psychogenic Reaction Depression

 From psychogenic reaction to PTSD and Adjustment disorder.


Takeshi Matsuishi

 


Yokohama Research Institute of disability, education and industry

 

 

The original concept of “Psychogenic reaction” of Karl Jaspers (Allegemaine Psychopathologie 1913) and modified by Kurt Schneider’ concept “abnorme Erlebnisreaction(abnormal experience reaction)” was divided two categories that the one is PTSD and the other is adjustment disorders because of DSM-3 must make the new concept named as Posttraumatic Stress Disorder. And in DSM-5, the both are gathered under the title of Trauma- and Stressor-Related Disorder.

 

In the original concept of “psychogenic reaction” of Jaspers and “abnormal experience reaction” of Kurt Schneider did not include the degree of the strength of stress. The symptoms appear together with stressor and personality. *The concept of Adjustment disorder borrows the concept of Karl Jaspers’ psychogenic reaction, but there is a neglect of personality.

Among Adjustment with Disorder mood pattern are most numerous. Many cases can be diagnosed as Major depression. This adjustment disorder was called as neurotic depression, reactive depression, depression by the circumstance. Only melancholic type was called as endogenous depression. Before DSM-3, depression was indicated to endogenous depression.

Endogenous depression’s prevalence rate was 1% and not so changeable in the area and period. In the following figure I wrote tow disorders overlap each other.

 

The original concept of “Psychogenic reaction” of Karl Jaspers (Allegemaine Psychopathologie 1913) and modified by Kurt Schneider’ concept “abnorme Erlebnisreaction(abnormal experience reaction)” was divided two categories that the one is PTSD and the other is adjustment disorders because of DSM-3 must make the new concept named as Posttraumatic Stress Disorder. And in DSM-5, the both are gathered under the title of Trauma- and Stressor-Related Disorder.


 Fig.1



Fig.2       


In the original concept of “psychogenic reaction” of Jaspers and “abnormal experience reaction” of Kurt Schneider did not include the degree of the strength of stress. The symptoms appear together with stressor and personality. The strength of stressor is not problem but the patient’ way of reaction is just problem. In the definition of DSM-5, the description that marked distress that is out of proportional to the severity or intensity of the stressor indicates the factor of the patient side’ problem. It is the same of the Karl Jaspers’ description (1913)[Fig.3].



Fig..3

But Kurt Schneider wrote very precise symptoms in the course of psychogenic reaction based on his rich clinical experience.

The definition of adjustment disorder in DSM-5 is almost based on the Karl Jaspers, but the counterargument of Kurt Schneider emphasized that the psychogenic experience and reactive cause is not so exactly in correction with psychiatric symptoms. From the point of view, Kurt Schneider’s indication is very important[Fig.4].

Fig.4

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