Adjustment Disorders

Some children with a diagnosis of physical illness will go on to have maladaptive reactions and impairments in function that exceed the typical reaction to illness. Individuals identified as having depressive symptoms in response to an identifiable stressor and within 3 months of the onset of the stressor meet criteria for an adjustment disorder with depressed mood (see Table 6-5). The diagnostic criteria for adjustment disorders specify that the symptoms must be clinically significant but not meet threshold criteria for a depressive disorder or bereavement. Adjustment disorders are accompanied by dysphoria that tends to be milder in form and responsive to distraction and to differ from normal grief and demoralization based on the severity of impairment. Currently, because no absolute criteria will help the mental health clinician distinguish this disorder, the clinician must use clinical judgment to make the diagnosis.

Adjustment disorders are among the most common psychiatric diagnoses. Prevalence estimates for adjustment disorders range from 12% in general hospital inpatients referred for mental health consulta-

Table 6-5. DSM-IV-TR diagnostic criteria for adjustment disorders

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 and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

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 are coded based on the subtype, which is selected according to the predominant symptoms. The specific stressor(s) can be specified on Axis IV

309.0 With Depressed Mood

309.24 With Anxiety

309.28 With Mixed Anxiety and Depressed Mood

309.3 With Disturbance of Conduct

309.4 With Mixed Disturbance of Emotions and Conduct 309.9 Unspecified tion to 50% among adults with specific medical problems and stressors (Newcorn et al. 2000). Studies in children and adolescents with diabetes found rates as high as 36%-60% (LeBlanc et al. 2003). Prior depressive episodes and family and genetic factors may increase the risk for the development of an adjustment disorder. Adolescents with adjustment disorders with depressed mood are at increased risk for the development of major depression.

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