Psychological Disorders: Adjustment Disorder

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

B. These symptoms or behaviors are clinically significant as evidenced by either of the following:

1. marked distress that is in excess of what would be expected from exposure to the stressor

2. significant impairment in social or occupational (academic) functioning

C. The stress-related disturbance does not meet the criteria for another specific Axis I disorder (clinical disorder) and is not merely an exacerbation of a preexisting Axis I or Axis II disorder (Personality Disorder or Mental Retardation).

D. The symptoms do not represent Bereavement.

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

Specify if:
Acute: if the disturbance lasts less than 6 months
Chronic: if the disturbance lasts for 6 months or longer

Adjustment Disorders subtypes are selected according to the predominant symptoms:

With Depressed Mood
With Anxiety
With Mixed Anxiety and Depressed Mood
With Disturbance of Conduct
With Mixed Disturbance of Emotions and Conduct
Unspecified

Onset and Course
By definition, Adjustment Disorder begins within 3 months of onset of a stressor and lasts no longer than 6 months after the stressor or its consequences have ceased.

Adjustment Disorder frequently presents as occupational or social impairment.

Adjustment Disorder may increase the risk of suicide attempts and suicide.

Adjustment Disorder may actually represent an initial mild episode of what later will return as a more severe mental disorder (e.g., Major Depressive Disorder).

European Description
States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, and arising in the period of adaptation to a significant life change or to the consequences of a stressful life event (including the presence or possibility of serious physical illness). The stressor may have affected the integrity of an individual's social network (through bereavement or separation experiences) or the wider system of social supports and values (migration or refugee status). The stressor may involve only the individual or also his or her group or community.

Individual predisposition or vulnerability plays a greater role in the risk of occurrence and the shaping of the manifestations of adjustment disorders than it does in the other conditions in F43, but is nevertheless assumed that the condition would not have arisen without the stressor. The manifestations vary, and include depressed mood, anxiety, worry (or a mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, and some degree of disability in the performance of daily routine. The individual may feel liable to dramatic behaviour or outbursts of violence, but these rarely occur. However, conduct disorders (e.g. aggressive or dissocial behaviour) may be an associated feature, particularly in adolescents. None of the symptoms is of sufficient severity or prominence in its own right to justify a more specific diagnosis. In children, regressive phenomena such as return to bed-wetting, babyish speech, or thumb-sucking are frequently part of the symptom pattern.

The onset is usually within 1 month of the occurrence of the stressful event or life change, and the duration of symptoms does not usually exceed 6 months, except in the case of prolonged depressive reaction. If the symptoms persist beyond this period, the diagnosis should be changed according to the clinical picture present, and any continuing stress can be coded by means of one of the Z codes in Chapter XXI of ICD-10.

Contacts with medical and psychiatric services because of normal bereavement reactions, appropriate to the culture of the individual concerned and not usually exceeding 6 months in duration, should not be recorded by means of the codes in this book but by a code from Chapter XXI of ICD-10 such as Z63.4 (disappearance or death of family member) plus for example Z71.9 (counselling) or Z73.3 (stress not elsewhere classified). Grief reactions of any duration, considered to be abnormal because of their form or content, should be coded as F43.22, F43.23, F43.24 or F43.25, and those that are still intense and last longer than 6 months as F43.21 (prolonged depressive reaction).

Diagnostic Guidelines
Diagnosis depends on a careful evaluation of the relationship between:

(a) form, content, and severity of symptoms;
(b) previous history and personality; and
(c) stressful event, situation, or life crisis.

The presence of this third factor should be clearly established and there should be strong, though perhaps presumptive, evidence that the disorder would not have arisen without it. If the stressor is relatively minor, or if a temporal connection (less than 3 months) cannot be demonstrated, the disorder should be classified elsewhere, according to its presenting features.

Includes:
* culture shock
* grief reaction
* hospitalism in children

Excludes:
* separation anxiety disorder of childhood