Adjustment Disorder in Injured Workers
Adjustment disorder is one of the most commonly diagnosed psychiatric conditions in injured workers undergoing independent medical examinations (IMEs). While sometimes misunderstood or downplayed, it plays a significant role in functional outcomes and claim trajectories.
What is adjustment disorder?
Adjustment disorder is characterised by the development of emotional or behavioural symptoms in response to a clear stressor, such as workplace injury, job loss, or interpersonal conflict. Unlike major depressive disorder or post-traumatic stress disorder, it does not meet the threshold for a more severe psychiatric illness — but the distress and functional impact can still be significant.
Common symptoms include:
- Persistent low mood, anxiety, or irritability
- Sleep disturbance
- Difficulty concentrating
- Reduced ability to engage in work or social roles
Why it matters in IMEs
From a medico-legal perspective, adjustment disorder is often diagnosed when:
- Symptoms develop shortly after a work-related incident
- The condition is mild to moderate in severity
- There is no past psychiatric history or significant comorbidity
- Symptoms are expected to resolve once the stressor improves or is removed
It is frequently seen in cases involving bullying, workplace conflict, or role uncertainty following injury.
Expected Recovery and Treatment
Adjustment disorders are generally considered self-limiting, with the majority of individuals recovering within 3 to 6 months. Prolonged symptoms may indicate either:
- Ongoing exposure to the stressor (e.g. unresolved work conflict)
- The emergence of a more enduring psychiatric condition
Management includes:
- Psychological therapy (such as CBT or supportive counselling)
- Short-term pharmacological support (if needed, e.g. for sleep or anxiety)
- Encouragement of structured return-to-work planning with consideration for alternative workplaces, roles, or environments, depending on the triggers involved.
Key Medico-Legal Points
- Not typically associated with permanent impairment unless complicated
- Work capacity is often preserved or partially retained
- Recovery is strongly influenced by psychosocial factors, including employer response, return-to-work planning, and pre-existing vulnerabilities
Adjustment disorder is a valid and clinically recognised diagnosis — but requires a nuanced assessment to determine severity, causation, and prognosis.
Author:
Dr Maxwell Qu, MBBS, FRANZCP, FAChAM
Consultant Psychiatrist & Addiction Medicine Specialist
Dr Maxwell Qu is a psychiatrist with expertise in the treatment of substance use disorders and co-occurring mental health conditions.
