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

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

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background International Classification of Diseases, 11th revision (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 nonclinical 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 nonclinical sample of 699 participants from Switzerland. Results Comparisons of network structure invariance revealed differences between the network structure of the clinical and the nonclinical samples. Results highlight that in terms of both edges strength and centrality, failure to adapt symptoms was more prominent in the clinical sample, while the preoccupation symptoms were more prominent in the nonclinical sample. Importantly, global strength was similar across networks. Conclusions 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.

Original languageEnglish
Article numbere43
JournalEuropean Psychiatry
Issue number1
StatePublished - 29 Jul 2022


  • ADNM-8
  • Adjustment disorder
  • ICD-11
  • symptoms network analysis


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