Adjustment disorder

Status
Not open for further replies.

anthony

Founder
Dead Link Removed covers those stressful times in our lives due to anticipated, expected, and unexpected events, yet our reactions disorient us from continuing our normal daily life. For example, unless you've been cheated on by a long-term partner you don't really know how you'll handle it; until you have a mortgage commitment then lose your job, you don't know how you will cope with stress that you haven't otherwise experienced; you could be mugged or sexually assaulted without feeling your life was threatened. These are events that can cause depression, anxiety and moods that affect us from functioning as we normally do. These are adjustment disorders.

Diagnostic Features

The presence of emotional or behavioral symptoms in response to an identifiable stressor is the essential feature of adjustment disorders (Criterion A). The stressor may be a single event (e.g., the termination of a romantic relationship), or there may be multiple stressors (e.g., marked business difficulties and marital problems). Stressors may be recurrent (e.g., seasonal business crises, unfulfilling sexual relationships) or continuous (e.g., a persistent painful illness with increasing disability, living in a crime-ridden neighborhood). Stressors may affect an individual, a family or larger group or community (e.g., natural disaster). Some stressors may accompany specific developmental events (e.g., going to school, leaving a parental home, reentering a parental home, getting married, becoming a parent, failing to attain occupational goals, retirement).

Adjustment disorders may be diagnosed following the death of a love one when the intensity, quality, or persistence of grief reactions exceeds what normally might be expected, when cultural, religious, or age-appropriate norms are taken into account. A more specific set of bereavement-related symptoms has been designated persistent complex bereavement disorder.

By definition, adjustment disorders begin within 3 months of the onset of a stressor and lasts no longer than 6 months after the stressor or its consequences have ceased. If the stressor or consequence persist, the adjustment disorder may also continue to be present and become the persistent form (e.g., living in a high crime neighborhood).

Adjustment disorders are associated with an increased risk of suicide attempts and completed suicide.

Risk & Prognostic Factors

Environmental: Individuals from disadvantaged life circumstances experience a high rate of stressors and may be at increased risk for adjustment disorders.

Diagnostic Criteria

A. The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

B. The symptoms or behaviors are clinically significant, as evidenced by one or both of the following:
  1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
  2. Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.

D. The symptoms do not represent normal bereavement.

E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

Specify whether:
  1. 309.0 (F43.21) With depressed mood: Low mood, tearfulness, or feelings of hopelessness are predominant.
  2. 309.24 (F43.22) With anxiety: Nervousness, worry, jitteriness, or separation anxiety is predominant.
  3. 309.28 (F43.23) With mixed anxiety and depressed mood: A combination of depression and anxiety is predominant.
  4. 309.3 (F43.24) With disturbance of conduct: Disturbance of conduct is predominant.
  5. 309.4 (F43.25) With mixed disturbance of emotions and conduct: Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
  6. 309.9 (F43.20) Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
Prevalence

Adjustment disorders are common, although prevalence may vary widely as a function of the population studied and the assessment methods used. The percentage of individuals in outpatient mental health treatment with a principle diagnosis of an adjustment disorder ranges from approximately 5% to 20%. In a hospital consultation setting, it is often the most common diagnosis, frequently reaching 50%.

Differential Diagnosis

Major Depressive Disorder: If an individual has symptoms that meet criteria for a major depressive disorder in response to a stressor, the diagnosis of an adjustment disorder is not applicable. The symptom profile of major depressive disorder differentiates it from adjustment disorders.

Posttraumatic Stress Disorder and Acute Stress Disorder: In adjustment disorders, the stressor can be of any severity rather than of the severity and type required by Criterion A of ASD and PTSD. In distinguishing adjustment disorders from these two posttraumatic diagnoses, there are both timing and symptom profile considerations. Adjustment disorders can be diagnosed immediately and persist up to 6 months after exposure to the traumatic event, whereas ASD can only occur between 3 days and 1 month of exposure to the stressor, and PTSD cannot be diagnosed until at least 1 month has passed since the occurrence of the traumatic stressor. The required symptom profile for PTSD and ASD differentiates them from adjustment disorders. With regard to symptom profiles, an adjustment disorder may be diagnosed following a traumatic event when an individual exhibits symptoms of either ASD or PTSD that do not meet or exceed the diagnostic threshold for either disorder. An adjustment disorder should also be diagnosed for individuals who have not been exposed to a traumatic event but who otherwise exhibit the full symptom profile of either ASD or PTSD.

Personality Disorders: With regard to personality disorders, some personality features may be associated with a vulnerability to situational distress that may resemble an adjustment disorder. The lifetime history of personality functioning will help inform the interpretation of distressed behaviors to aid in distinguishing a long-standing personality disorder from an adjustment disorder. In addition to some personality disorders incurring vulnerability to distress, stressors may also exacerbate personality disorder symptoms. In the presence of a personality disorder, if the symptom criteria for an adjustment disorder are met, and the stress-related disturbance exceeds what may be attributable to maladaptive personalty disorder symptoms (i.e., Criterion C is met), then the diagnosis of an adjustment disorder should be made.

Psychological Factors Affecting Other Medical Conditions: Specific psychological entities (e.g., psychological symptoms, behaviors, other factors) exacerbate a medical condition. These psychological factors can precipitate, exacerbate, or put an individual at risk for medical illness, or they can worsen an existing condition. In contrast, an adjustment disorder is a reaction to the stressor (e.g., having a medical illness).

Normative Stress Reactions: When bad things happen, most people get upset. This is not an adjustment disorder. The diagnosis should only be made when the magnitude of the distress (e.g., alterations in mood, anxiety or conduct) exceeds what would normally be expected (which may vary in different cultures) or when the adverse event precipitates functional impairment.

Comorbidity

Adjustment disorders can accompany most mental disorders and any medical disorder. Adjustment disorders can be diagnosed in addition to another mental disorder only if the latter does not explain the particular symptoms that occur in reaction to the stressor. For example, an individual may develop an adjustment disorder, with depressed-mood, after losing a job and at the same time have a diagnosis of obsessive-compulsive disorder. Or, an individual may have a depressive or bipolar disorder and an adjustment disorder as long as the criteria for both are met. Adjustment disorders are common accompaniments of medical illness and may be the major psychological response to a medical disorder.
 
M

Marcella1

Is Adjustment Disorder with Anxiety and Depression from Medical problems and loss of body parts a part of PTSD?
 

anthony

Founder
Hi Marcella, adjustment disorder is the precursor more often than not, to PTSD. If you begin experiencing symptoms, yet have not experienced them enough to meet PTSD, i.e. they do not last longer than a month, then adjustment disorder may be a diagnosis. I find it rare, as most go to PTSD when the symptoms are severe enough / been bothering the person enough to warrant. Adjustment disorder is like a mild form though, you could say, of PTSD.

Its really just a diagnostic play on duration for experiencing the symptoms.
 
R

Rafael A Rivera

Can a child be diagnosed with Adjustment Disorder with Anxiety and Depression from an initial visit? My child was taken to a psychologist and the ICD-10 code used is F43.23. If the psychologist only spoke to one parent and not the child how could this already be diagnosed? Any insight will be helpful.
 

anthony

Founder
Based on that code, your child hasn’t been diagnosed with adjustment disorder + anxiety + depression, but simply: adjustment disorder with mixed anxiety and depressed mood. Most diagnoses have common variations and assigned codes where certain symptoms are common with specific disorders. Adjustment disorder does not have anxiety and depression built-in, so they do it via a code to say you have this, and these are present with it, which is common, all wrapped up in one neat package.

Does that make sense?

If the specific issues where, by themselves, significant to meet individual diagnosis, then you have would multiple diagnostic codes where disorders standalone as cormorbid vs mixed features that are common.
 
A

alex1

What does it mean if an adjustment disorder goes on for longer than 6 months? does that mean it has turned into something else or does it remain the same disorder?
 

anthony

Founder
It can still be the same. AD was originally thought to be a precursor to PTSD, but now it is more thought as its own, lesser, version.
 
R

rebeccacresswel

Is an Adjustment Disorder with Anxiety (DSM-V 309.24) classed as PTSD?
 

anthony

Founder
No. Adjustment disorder is a separate diagnosis, as fall many anxiety diagnoses under that umbrella too.
 
Status
Not open for further replies.
Top