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The network structure of ICD-11 adjustment disorder: A comparison of clinical and non-clinical samples

Levin, Yafit; Karatzias, Thanos; Shevlin, Mark; Ben-Ezra, Menachem; Maercker, Andreas; Bachem, Rahel


Yafit Levin

Mark Shevlin

Menachem Ben-Ezra

Andreas Maercker

Rahel Bachem


Background: ICD-11 adjustment disorder (AjD) is characterized by two main symptom clusters; preoccupation with the stressor and failure to adapt to the stressor. The network analytic approach provides important information on the structural validity of a disorder and reveals which symptoms are most prominent. To date, no study compared the network structure of AjD symptoms in clinical and non-clinical samples, which could potentially inform our understanding of psychopathological mechanisms that underlie AjD and identify core targets for therapy. Methods: A network analysis was conducted on AjD symptoms as assessed by the adjustment disorder –New Module (ADNM-8) using data from 330 clinical participants from the UK and a non-clinical sample of 699 participants from Switzerland. Results: Comparisons of network structure invariance revealed differences between the network structure of the clinical and the non-clinical samples. Results highlight that in terms of both edges strength and centrality, failure to adapt symptoms were more prominent in the clinical sample, while the preoccupation symptoms were more prominent in the non-clinical sample. Importantly, global strength was similar across networks. Discussion: Results provide evidence of the coherence of AjD in the ICD-11 as assessed by the ADNM questionnaire. They tentatively suggest that subclinical AjD may be characterized by emerging preoccupation symptoms that may result in failure to adapt and functional impairment in clinical manifestation of AjD. However, there is a need for replication and longitudinal research to further validate this hypothesis.

Journal Article Type Article
Acceptance Date Jul 12, 2022
Online Publication Date Jul 29, 2022
Publication Date 2022
Deposit Date Jul 13, 2022
Publicly Available Date Jul 29, 2022
Journal European Psychiatry
Print ISSN 0924-9338
Electronic ISSN 1778-3585
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 65
Issue 1
Article Number e43
Keywords Symptoms network analysis; Adjustment Disorder; ICD-11; ADNM-8
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