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Adjustment and Stress Disorder

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Adjustment and Stress Disorder
An adjustment disorder or (AD) is a psychological response to a stressor or stressors that are identifiable and result in the formation and growth of clinically significant, emotional or behavioral symptoms. The symptoms displayed by a person who suffers from this disorder share similar symptoms as depressed people. As a result this disorder is sometimes referred to as situational depression. There are five criterions that are to be met for Adjustment and Stress Disorder to be accurately diagnosed. As it pertains to the diagnostic features of this disorder, symptoms must develop within 3 months after the onset of the stressor(s) (Criterion A). The clinical significance of the reaction is indicated by marked distress (the excess that would be anticipated given the nature of the stressor or stressors) or by significant impairment in social or occupational functioning (Criterion B). What this means is a reaction to a stressor that might be considered normal or expectable can still qualify for a diagnosis of Adjustment Disorder if the reaction is sufficiently severe to cause significant impairment. This category should not be used if 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. In Criterion D the symptoms do not represent Bereavement. Finally in Criterion E, once the stressor (or its consequences) has been terminated, the symptoms do not persist for more than an additional 6 months.
According to the DSM IV, Adjustment Disorders are coded according to the subtype that best characterizes the predominant symptoms. Depressed Mood is characterized by 309.0. This subtype should be used when the predominant manifestations are symptoms such as depressed mood, tearfulness, or feelings of hopelessness. Anxiety is characterized by 309.24. This subtype should be used when the predominant manifestations are symptoms such as nervousness, worry, or jitteriness, or, in children, fears of separation from major attachment figures. Mixed Anxiety and Depressed Mood are characterized by 309.28.This subtype should be used when the predominant manifestation is a combination of depression and anxiety. Disturbance of Conduct is characterized by 309.3. This Subtype should be used when the predominant manifestation is a disturbance in conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules (e.g., truancy. vandalism, reckless driving, fighting, defaulting on legal responsibilities).
Mixed Disturbance of Emotions and Conduct is characterized by 309.4. This subtype should be used when the predominant manifestations are both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct. Unspecified is 309.9. This subtype should be used for maladaptive reactions (e.g., physical complaints, social withdrawal, or work or academic inhibition) to stressors that are not classifiable as one of the specific subtypes of Adjustment Disorder.
The duration of the symptoms of an Adjustment Disorder can be Acute. This specifier can be used to indicate persistence of symptoms for less than 6 months.
It also can be chronic. This specifier can be used to indicate persistence of symptoms for six months or longer. By definition, symptoms cannot persist for more than 6 months after the termination of the stressor or its consequences. The Chronic specifier therefore applies when the duration of the disturbance is longer than 6 months in response to a chronic stressor or to a stressor that has enduring consequences.

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