Preoccupation as psychopathological process and symptom in adjustment disorder: A scoping review

Abstract

In the ICD-11 diagnostic guidelines, preoccupation has been introduced as the new core symptom of adjustment disorder. Despite this essential innovation, preoccupation has so far largely been defined as rumination and worry and does not feature a distinct character as an independent symptom. In order to investigate the nature of preoccupation, various cognitive approaches are evaluated and linked to preoccupation. Furthermore, the aim of this review is to define preoccupation more precisely and to distinguish it from other symptoms in psychopathology. The evaluation of key features of cognitive dissonance theory, attention bias theory, memory theories, and other cognitive paradigms indicates that preoccupation is constituted by a complex interaction of cognitive-emotional mechanisms. In addition, this review implies that preoccupation in AjD can be defined as stressor-related factual thinking, which is time-consuming and often associated with negative emotions. It is assumed that rumination and dysfunctional worry serve as reactive processes to cope with preoccupation. For further distinction, this review presents similarities and differences of preoccupation and other symptoms, including negative automatic thoughts, flashbacks, and yearning. Finally, implications and suggestions for future research on preoccupation are offered. Overall, it is plausible that preoccupation is not only associated with adjustment disorder but also possesses a transdiagnostic character.

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

“…In line with this model, it was recently argued that preoccupation may represent a generic risk factor for the development of psychopathology [ 28 ]. The current study lends further support for the transdiagnostic potential of preoccupation.…”

“…Supportive measures should guide clients to reprocess and understand their experiences in a meaning-making process. Clients must not develop avoidance strategies because attempts to suppress distressing thoughts about the event are often doomed to failure and can perpetuate the disorder in the long term [ 28 , 30 ].…”

The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders

“…According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), some of the core characteristics of adjustment disorder include preoccupation with the stressor in the form of excessive rumination, worry, and recurrent distressing thoughts. Psychological interventions targeting these thought processes may lead to significant positive outcomes [ 10 ]. In a single case study, MCT was found to be helpful in managing symptoms of depression and anxiety in a young woman diagnosed with severe adjustment disorder secondary to pulmonary arterial hypertension [ 11 ].…”

Was bringt die ICD-11 im Bereich der trauma- und belastungsbezogenen Diagnosen?

“…Auch wenn z.B. eine Scheidung eine enorme Herausforderung für Betroffene bedeuten kann, so sind solche Ereignisse zum Zeitpunkt der Exposition typischerweise nicht identitätsbedrohend und ziehen deshalb auch nicht die typischen PTBS-Symptome nach sich [Brewin, 2009;Eberle and Maercker, 2022].…”