Adjustment Disorders
description
Transcript of Adjustment Disorders
![Page 1: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/1.jpg)
Adjustment Disorders
A Category of Compromise?
![Page 2: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/2.jpg)
Some people react to a major stressor in their lives
with extended and excessive feelings of anxiety,
depressed mood, or antisocial behaviors.
![Page 3: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/3.jpg)
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.
![Page 4: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/4.jpg)
Should we consider such reactions normal?
![Page 5: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/5.jpg)
No!says the DSM-IV-TR
![Page 6: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/6.jpg)
Somewhere between effective coping strategies
and stress disorders lie the Adjustment Disorders.
![Page 7: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/7.jpg)
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.
![Page 8: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/8.jpg)
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.
![Page 9: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/9.jpg)
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.
![Page 10: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/10.jpg)
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.
![Page 11: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/11.jpg)
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
![Page 12: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/12.jpg)
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.
![Page 13: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/13.jpg)
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
![Page 14: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/14.jpg)
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.
![Page 15: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/15.jpg)
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
![Page 16: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/16.jpg)
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
![Page 17: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/17.jpg)
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.
![Page 18: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/18.jpg)
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
![Page 19: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/19.jpg)
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)
![Page 20: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/20.jpg)
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.
![Page 21: Adjustment Disorders](https://reader034.fdocuments.us/reader034/viewer/2022051316/56815b11550346895dc8bb49/html5/thumbnails/21.jpg)
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.