F43.2 Adjustment Disorders

States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, and arising in the period of adaptation to a significant life change or to the consequences of a stressful life event (including the presence or possibility of serious physical illness). The stressor may have affected the integrity of an individual's social network (through bereavement or separation experiences) or the wider system of social supports and values (migration or refugee status). The stressor may involve only the individual or also his or her group or community.

Individual predisposition or vulnerability plays a greater role in the risk of occurrence and the shaping of the manifestations of adjustment disorders than it does in the other conditions in F43, but is nevertheless assumed that the condition would not have arisen without the stressor. The manifestations vary, and include depressed mood, anxiety, worry (or a mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, and some degree of disability in the performance of daily routine. The individual may feel liable to dramatic behaviour or outbursts of violence, but these rarely occur. However, conduct disorders (e.g. aggressive or dissocial behaviour) may be an associated feature, particularly in adolescents. None of the symptoms is of sufficient severity or prominence in its own right to justify a more specific diagnosis. In children, regressive phenomena such as return to bed-wetting, babyish speech, or thumb-sucking are frequently part of the symptom pattern.

The onset is usually within 1 month of the occurrence of the stressful event or life change, and the duration of symptoms does not usually exceed 6 months, except in the case of prolonged depressive reaction. If the symptoms persist beyond this period, the diagnosis should be changed according to the clinical picture present, and any continuing stress can be coded by means of one of the Z codes in Chapter XXI of ICD-10.

Contacts with medical and psychiatric services because of normal bereavement reactions, appropriate to the culture of the individual concerned and not usually exceeding 6 months in duration, should not be recorded by means of the codes in this book but by a code from Chapter XXI of ICD-10 such as Z63.4 (disappearance or death of family member) plus for example Z71.9 (counselling) or Z73.3 (stress not elsewhere classified). Grief reactions of any duration, considered to be abnormal because of their form or content, should be coded as F43.22, F43.23, F43.24 or F43.25, and those that are still intense and last longer than 6 months as F43.21 (prolonged depressive reaction).

Diagnostic Guidelines

Diagnosis depends on a careful evaluation of the relationship between:

(a) form, content, and severity of symptoms;
(b) previous history and personality; and
(c) stressful event, situation, or life crisis.

The presence of this third factor should be clearly established and there should be strong, though perhaps presumptive, evidence that the disorder would not have arisen without it. If the stressor is relatively minor, or if a temporal connection (less than 3 months) cannot be demonstrated, the disorder should be classified elsewhere, according to its presenting features.

Includes:
* culture shock
* grief reaction
* hospitalism in children

Excludes:
* separation anxiety disorder of childhood