Updated May-20-2010

Adjustment Disorder

The work group is recommending that this disorder be included in a grouping of Trauma and Stress-Related 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 one of the following:

1. Marked distress that is in excess of what would be proportionate to the stressor, taking account of the external context and the cultural factors that might influence symptom severity and presentation.

2. Significant impairment in social, occupational, or other important areas of functioning

C.  The stress-related disturbance does not meet the criteria for another specific mental disorder and is not merely an exacerbation of a preexisting mental disorder.

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

Specify if: *

With Depressed Mood: when the predominant manifestations are symptoms such as depressed mood, tearfulness, or feelings of hopelessness

With Anxiety: when the predominant manifestations are symptoms such as nervousness, worry, or jitteriness, or, in children, fears of separation from major attachment figures

With Mixed Anxiety and Depressed Mood: when the predominant manifestation is a combination of depression and anxiety

With Disturbance of Conduct: 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)

With Mixed Disturbance of Emotions and Conduct: when the predominant manifestations are both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct (see above subtype)

With PTSD-Like or ASD-Like symptoms: when the predominant manifestation is PTSD-like or ASD-like symptoms, but the PTSD/ASD stressor and/or symptom criteria are not met)**

Unspecified: 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 Coding note: In a multiaxial assessment, the nature of the stressor can be indicated by listing it on Axis IV (e.g., Divorce).

* Subtypes will be further discussed.

** It is unclear whether this subtype should be included in DSM-5; its potential inclusion is undergoing further consideration.

These criteria are very close to DSM-IV.  They provide a residual diagnosis for individuals who have exhibited marked distress and functional impairment following exposure to stressful (but not traumatic) events.  They also provide a diagnosis when the predominant manifestation is PTSD-like or ASD-like symptoms, but the PTSD/ASD stressor and/or symptom criteria are not met)

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. 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.

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: when the predominant manifestations are symptoms such as depressed mood, tearfulness, or feelings of hopelessness

309.24 With Anxiety: when the predominant manifestations are symptoms such as nervousness, worry, or jitteriness, or, in children, fears of separation from major attachment figures

309.28 With Mixed Anxiety and Depressed Mood: when the predominant manifestation is a combination of depression and anxiety

309.3 With Disturbance of Conduct: 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)

309.4 With Mixed Disturbance of Emotions and Conduct: when the predominant manifestations are both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct (see above subtype)

309.9 Unspecified: 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 Coding note: In a multiaxial assessment, the nature of the stressor can be indicated by listing it on Axis IV (e.g., Divorce).