Adjustment Disorders

1. 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 person’s
job, schoolwork, or social life.

4. Should we consider such reactions
normal?

5. No!
says the DSM-IV-TR

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

7. 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.

8. DSM-IV-TR lists
six types
of Adjustment Disorders
1. 309.0 With Depressed Mood:
Depressed mood, tearfulness,
feelings of hopelessness
2. 309.24 With Anxiety:
Nervousness, worry, jitteriness, or
(in children) fears of separation from
attachment figures.

9. 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.

10. 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.

11. 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

12. DSM-IV-TR lists
six types
of Adjustment Disorders
6. 309.9 Unspecified
Maladaptive reactions (e.g.,
physical complaints, social
withdrawal) that is not one of the
subtypes.

13. Adjustment Disorder (con’t.)
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

14. 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.

15. 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.
e. Diagnosis is not used when symptoms represent
Bereavement.
f. Adjustment Disorder must be resolved within 6
months of termination of the stressor (or its
consequences).
g. May persist longer than 6 months if it occurs in
response to a chronic stressor

16. 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

17. 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.

18. 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

19. 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)

20. 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.

21. 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.