Adjustment Disorders

A Category of Compromise?

Some people react to a major stressor in their lives

with extended and excessive feelings of anxiety,

depressed mood, or antisocial behaviors.

The symptoms do not quite add up to acute stress disorder

or posttraumatic stress disorder, nor do they reflect an anxiety or mood

disorder…but they do cause considerable distress

or interfere with the person’s job, schoolwork, or social life.

Should we consider such reactions normal?

No!says the DSM-IV-TR

Somewhere between effective coping strategies

and stress disorders lie the Adjustment Disorders.

The essential feature of Adjustment Disorder is:

The development of clinically significant emotional or behavioral symptoms

in response to an identifiable psychosocial stressor or stressors.

DSM-IV-TR lists six types

of Adjustment Disorders

1. 309.0 With Depressed Mood: Depressed mood, tearfulness,

feelings of hopelessness2. 309.24 With Anxiety: Nervousness, worry, jitteriness, or (in children) fears of separation from attachment figures.

DSM-IV-TR lists six types

of Adjustment Disorders

3. 309.28 With Mixed Anxiety and Depressed MoodCombination of depressed mood, tearfulness, feelings of hopelessness and nervousness, worry, jitteriness, or

(in children) fears of separation from attachment figures.

DSM-IV-TR lists six types

of Adjustment Disorders

4. 309.3 With Disturbance of ConductViolation of rights of others; e.g., truancy, vandalism, reckless driving, fighting.

DSM-IV-TR lists six types

of Adjustment Disorders

5. 309.4 With Mixed Disturbance of Emotions and ConductBoth emotional symptoms (e.g., depression, anxiety) and disturbance of conduct

DSM-IV-TR lists six types

of Adjustment Disorders

6. 309.9 UnspecifiedMaladaptive reactions (e.g., physical complaints, social withdrawal) that is not one of the subtypes.

Adjustment Disorder (con’t.)

Adjustment Disorder should not be diagnosed if the reaction to stress is:

– What might be expected, given the situationand

– Does not cause significant impairment in social or occupation functioning

Adjustment Disorder (con’t.)

Characteristics

a. Symptoms must develop within 3 months after the onset of the stressor

b. Client must have marked distress in excess of what would be expected given the nature of the stressor

c. Diagnosis is not used if disturbance meets the criteria for another specific Axis I disorder or is an exacerbation of a preexisting Axis I or Axis II disorder.

Adjustment Disorder (con’t.)

d. Diagnosis may be used with an Axis I or Axis II disorder if they do not account for the pattern of symptoms that have occurred in response to the

stressor.d. Diagnosis is not used when symptoms represent

Bereavement.e. Adjustment Disorder must be resolved within 6

months of termination of the stressor (or its consequences).

f. May persist longer than 6 months if it occurs in response to a chronic stressor

Adjustment Disorder (con’t.)

• Adjustment Disorders are coded based on subtype

• The subtype is selected according to the predominant symptom.

• The specific stressor(s) can be specified on Axis IV

Adjustment Disorder (con’t.)Subtypes • 309.0 With Depressed Mood – Depressed mood, tearfulness,

feelings of hopelessness• 309.24 With Anxiety - Nervousness, worry, jitteriness, or (in

children) fears of separation from attachment figures• 309.28 With Mixed Anxiety and Depressed Mood -

Combination of above)• 309.3 With Disturbance of Conduct - Violation of right of

others (e.g., truancy, vandalism, reckless driving, fighting)• 309.4 With Mixed Disturbance of Emotions and Conduct -

Both emotional symptoms (e.g., depression, anxiety) and disturbance of conduct

• 309.9 Unspecified - Maladaptive reactions (e.g., physical complaints or social withdrawal) that is not one of the subtypes.

Adjustment Disorder (con’t.)Specify if:

Acute: If the disturbance lasted less than 6 months

Chronic: If the disturbance lasts for 6 months or longer

Differential Diagnosis

All of the following diagnoses are characterized by the presence of an extreme stressor:

Adjustment DisorderPosttraumatic Stress Disorder (PTSD)

Acute Stress Disorder (AST)

Differential Diagnosis

• PTSD and Acute Stress Disorder require an extreme stressor.

• Adjustment Disorder • Can be triggered by a stressor of any severity,

and • May involve a wide range of possible

symptoms.

Differential Diagnosis

With the death of a loved one:

• Bereavement is generally diagnosed instead of Adjustment Disorder.

• However, Adjustment Disorder may be used if the reaction is in excess of, or more prolonged than, what would be expected.