Adjustment Disorders

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Adjustment Disorders

• A Category of Compromise?

2

• Some people react
• to a major stressor in their lives
• with extended and excessive feelings of anxiety,
• depressed mood, or antisocial behaviors.

3

• 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 persons job, schoolwork, or
  social life.

4

• Should we consider such reactions normal?

5

• No!
• says the DSM-IV-TR

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• Somewhere between
• effective coping strategies
• and stress disorders
• lie the Adjustment Disorders.

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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.

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DSM-IV-TR lists six types of Adjustment
Disorders

• 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.

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DSM-IV-TR lists six types of Adjustment
Disorders

• 3. 309.28 With Mixed Anxiety and Depressed
  Mood
• Combination of depressed mood, tearfulness,
  feelings of hopelessness
• and nervousness, worry, jitteriness, or
• (in children) fears of separation from
• attachment figures.

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DSM-IV-TR lists six types of Adjustment
Disorders

• 4. 309.3 With Disturbance of Conduct
• Violation of rights of others e.g., truancy,
  vandalism, reckless driving, fighting.

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DSM-IV-TR lists six types of Adjustment
Disorders

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

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DSM-IV-TR lists six types of Adjustment
Disorders

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

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Adjustment Disorder (cont.)

• Adjustment Disorder should not be diagnosed if
  the reaction to stress is
• What might be expected, given the situation
• and
• Does not cause significant impairment in social
  or occupation functioning

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Adjustment Disorder (cont.)

• Characteristics
• Symptoms must develop within 3 months after the
  onset of the stressor
• Client must have marked distress in excess of
  what would be expected given the nature of the
  stressor
• 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.

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Adjustment Disorder (cont.)

• 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.
• Diagnosis is not used when symptoms represent
  Bereavement.
• Adjustment Disorder must be resolved within 6
  months of termination of the stressor (or its
  consequences).
• May persist longer than 6 months if it occurs in
  response to a chronic stressor

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Adjustment Disorder (cont.)

• 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

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Adjustment Disorder (cont.)

• 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.

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Adjustment Disorder (cont.)

• Specify if
• Acute If the disturbance lasted less than 6
  months
• Chronic If the disturbance lasts for 6 months
• or longer

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Differential Diagnosis

• All of the following diagnoses are characterized
  by the presence of an extreme stressor
• Adjustment Disorder
• Posttraumatic Stress Disorder (PTSD)
• Acute Stress Disorder (AST)

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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.

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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.