Adjustment Disorder DSM 5 Criteria
Explore our Adjustment Disorder DSM-5 Criteria Template for mental health professionals, and provide accurate assessments for your patients.
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What is adjustment disorder?
Adjustment Disorder, also known as situational depression or stress response syndrome, is a mental health condition characterized by emotional or behavioral symptoms that arise in response to a specific stressor or life event. The disorder typically develops within three months of the stressor's onset and can manifest in various forms, depending on the predominant symptoms.
The types of Adjustment Disorder include:
- Adjustment disorder with depressed mood: Symptoms primarily involve feelings of sadness, hopelessness, and a lack of enjoyment in life.
- Adjustment disorder with anxiety: Symptoms are primarily characterized by nervousness, worry, and jitteriness.
- Adjustment disorder with mixed anxiety and depressed mood: This type includes both anxiety and depressive symptoms.
- Adjustment disorder with disturbance of conduct: Symptoms mainly involve behavioral issues, such as impulsivity, recklessness, or defiance.
- Adjustment disorder with mixed disturbance of emotions and conduct: This type includes both emotional symptoms (anxiety or depression) and disturbances in conduct.
- Adjustment disorder unspecified: Used for reactions to stress that don't fit neatly into the other categories, often involving physical complaints or social withdrawal.
Symptoms for each type of adjustment disorder
Each type of adjustment disorder presents distinct symptoms:
- Depressed mood: Persistent feelings of sadness, tearfulness, and hopelessness.
- Anxiety: Excessive worry, nervousness, and fear about everyday situations.
- Mixed anxiety and depressed mood: A combination of depressive and anxious symptoms.
- Disturbance of conduct: Disruptive behaviors, such as vandalism, reckless driving, or fighting.
- Mixed disturbance of emotions and conduct: Emotional symptoms accompanied by behavioral issues.
- Unspecified: Various symptoms that don't align with the specific categories, such as physical complaints or social withdrawal.
Adjustment disorder causes
Adjustment disorder is triggered by significant life changes or stressors, which can be positive or negative. Here are some common triggers:
- Relationship issues: Divorce, breakups, or conflicts with family or friends.
- Job-related stress: Job loss, workplace conflicts, or starting a new job.
- Relocation: Moving to a new home, city, or country.
- Health problems: Chronic illnesses, injuries, or surgeries.
- Financial difficulties: Debt, bankruptcy, or changes in financial status.
- Major life events: Bereavement, becoming a parent, or retirement.
The disorder arises when an individual's ability to cope with these stressors is overwhelmed, leading to emotional or behavioral symptoms. Genetic, biological, and environmental factors can also contribute to the development of adjustment disorder, influencing an individual's resilience and coping mechanisms.
Printable Adjustment Disorder DSM 5 Criteria
Download this Adjustment Disorder DSM 5 Criteria form mental health professionals to diagnose mental disorders.
How do healthcare professionals diagnose adjustment disorder?
Diagnosing adjustment disorder involves a comprehensive assessment process to rule out other mental health conditions and confirm that the symptoms are directly related to a specific stressor. Here are the steps and assessments involved:
- Clinical interview: A detailed discussion with the patient about their symptoms, the stressors they've experienced, and their coping mechanisms.
- Medical history review: Examination of the patient's medical history to identify any physical health issues that could be contributing to their symptoms.
- Psychological evaluation: Standardized questionnaires or psychological tests may be used to assess the patient's emotional state and behavior.
- Observation of behavior: Healthcare professionals may observe the patient's behavior and interactions to gather more information about their condition.
- Application of DSM-5 criteria: The healthcare professional uses the DSM-5 criteria to determine if the patient's symptoms and the context of their occurrence meet the standards for Adjustment Disorder.
What is the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the standard classification system used by mental health professionals to diagnose mental disorders. Developed by the American Psychiatric Association, the DSM-5 provides a common language and standard criteria for the classification of mental disorders, ensuring consistency and reliability in diagnosis.
Without the DSM-5, diagnosis of adjustment disorder would be impossible.
DSM 5 criteria for adjustment disorder
The DSM-5 outlines specific criteria for diagnosing Adjustment Disorder:
- Criterion A: The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
- Criterion B: These symptoms or behaviours are clinically significant, as evidenced by 1 or both of the following:some text
- Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
- Significant impairment in social, occupational, or other important areas of functioning.
- Criterion C: The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
- Criterion D: The symptoms do not represent normal bereavement.
- Criterion E: Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional six months.
Differences between the DSM 4 and DSM 5 criteria for adjustment disorder
The transition from DSM-IV to DSM-5 brought several changes to the criteria for Adjustment Disorder:
- Criterion B (Clinical significance): In DSM-5, the wording was changed to "marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation." This addition emphasizes the importance of considering the context and cultural factors when assessing the severity of distress.
- Criterion C (Exclusion of other disorders): The language was simplified in DSM-5 to "the stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder," removing the reference to specific Axis I and Axis II disorders.
- Criterion D (Bereavement): DSM-5 specifies "the symptoms do not represent normal bereavement," clarifying that the symptoms should be distinguished from the normal grieving process.
- Acute and Chronic Specifiers: DSM-IV included specifiers for acute (less than 6 months) and chronic (6 months or longer) adjustment disorders. DSM-5 does not specify these durations.
- Subtypes: Both DSM-IV and DSM-5 include subtypes based on predominant symptoms. However, DSM-5 provides updated codes and descriptions for these subtypes, aligning with the ICD-10 coding system:some text
- 309.0 (F43.21) With depressed mood
- 309.24 (F43.22) With anxiety
- 309.28 (F43.23) With mixed anxiety and depressed mood
- 309.3 (F43.24) With disturbance of conduct
- 309.4 (F43.25) With mixed disturbance of emotions and conduct
- 309.9 (F43.20) Unspecified
Adjustment Disorder DSM 5 Criteria example (sample)
To assist mental health professionals in understanding the DSM 5 criteria for Adjustment Disorder, Carepatron has created a sample template filled with fictitious information. This template includes the DSM 5 criteria verbatim, along with fields for healthcare professionals to input their contact details for easy access by patients and clients.
Download our free Adjustment Disorder DSM 5 Criteria example here.
Research on adjustment disorder
Recent studies have significantly advanced our understanding of adjustment disorder and its prognosis. Key findings include the potential for symptoms to increase over time in some subpopulations and the risk of progression to more severe disorders like major depressive disorder or generalized anxiety disorder.
A systematic review by Morgan et al. (2022) highlighted the importance of comprehending the course and trajectory of adjustment disorder over time. This review suggested that many patients retain an AjD diagnosis or are diagnosed with another mental health disorder months to years after the initial diagnosis.
Additionally, patients with adjustment disorder tended to show higher rates of symptom improvement and utilized less treatment compared to patients with other disorders. However, there was a noted increase in the development of physical conditions such as infections, cancers, Parkinson's disease, and cardiovascular events in adjustment disorder-diagnosed groups compared to control groups.
Another significant contribution to adjustment disorder research is the development of the Adjustment Disorder–New Module 20 (ADNM-20) as a screening instrument. Lorenz, Bachem, and Maercker (2016) identified a threshold value for people at high risk for adjustment disorder using cluster analysis and Receiver Operating Characteristic (ROC) analysis. The recommended cut-off score of 47.5 on the ADNM-20 facilitates distinguishing between individuals at high and low risk for AjD, thereby aiding in research and clinical practice.
The ADNM-20's ability to differentiate between low, moderate, and high symptomatology levels provides a valuable tool for screening and assessing AjD. This advancement in screening instruments underscores the ongoing efforts to improve the diagnosis and understanding of AjD.
Overall, recent research on Adjustment Disorder emphasizes the need for continued investigation into its prognosis and the development of effective screening tools.
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Carepatron is a comprehensive software solution designed specifically for mental health and therapy professionals. Here are some reasons why Carepatron is an excellent choice for your practice:
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By choosing Carepatron as your mental health and therapy software, you'll have access to tools designed to streamline your practice, improve client care, and increase efficiency. With ongoing support and updates, Carepatron is committed to evolving with the needs of mental health professionals.
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References
Adjustment disorder. (2021, May 17). PsychDB. https://www.psychdb.com/trauma-and-stressors/adjustment
John Hopkins Medicine. (2019). Adjustment disorders. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adjustment-disorders
Lorenz, L., Bachem, R., & Maercker, A. (2016). The adjustment disorder–new module 20 as a screening instrument: Cluster analysis and cut-off values. The International Journal of Occupational and Environmental Medicine, 7(4), 215–220. https://doi.org/10.15171/ijoem.2016.775
Morgan, M. A., Kelber, M. S., Bellanti, D. M., Beech, E. H., Boyd, C., Galloway, L., Ojha, S., Garvey Wilson, A. L., Otto, J., & Belsher, B. E. (2022). Outcomes and prognosis of adjustment disorder in adults: A systematic review. Journal of Psychiatric Research, 156, 498–510. https://doi.org/10.1016/j.jpsychires.2022.10.052
Substance Abuse and Mental Health Services Administration. (2016, June). Table 3.19, DSM-IV to DSM-5 adjustment disorders comparison. National Library of Medicine; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t19/
Commonly asked questions
F43.22 is the ICD-10 code for Adjustment Disorder with anxiety, a subtype of Adjustment Disorder characterized by nervousness, worry, and jitteriness as predominant symptoms.
F43.20 is the ICD-10 code for Unspecified Adjustment Disorder, a category for maladaptive reactions to stressors that don't fit into specific subtypes of Adjustment Disorder.
F43.25 is the ICD-10 code for Adjustment Disorder with mixed disturbance of emotions and conduct, where both emotional symptoms (like depression or anxiety) and behavioral disturbances are predominant.
