Personality disorders. With regard to personality disorders, some personality features may be associated with a vulnerability to situational distress that may resemble an adjust- ment disorder. The lifetime history of personality functioning will help inform the in- terpretation of distressed behaviors to aid in distinguishing a long-standing personality disorder from an adjustment disorder. In addition to some personality disorders incurring vulnerability to distress, stressors may also exacerbate personality disorder symptoms. In the presence of a personality disorder, if the symptom criteria for an adjustment disorder are met, and the stress-related disturbance exceeds what may be attributable to maladap- tive personality disorder symptoms (i.e., Criterion C is met), then the diagnosis of an ad- justment disorder should be made.
Psychological factors affecting other medical conditions. In psychological factors af- fecting other medical conditions, specific psychological entities (e.g., psychological symp- toms, behaviors, other factors) exacerbate a medical condition. These psychological factors can precipitate, exacerbate, or put an individual at risk for medical illness, or they can worsen an existing condition. In contrast, an adjustment disorder is a reaction to the stressor (e.g., having a medical illness).
Normative stress reactions. When bad things happen, most people get upset. This is not an adjustment disorder. The diagnosis should only be made when the magnitude of the distress (e.g., alterations in mood, anxiety, or conduct) exceeds what would normally be expected (which may vary in different cultures) or when the adverse event precipitates functional impairment.
Adjustment disorders can accompany most mental disorders and any medical disorder.
Adjustment disorders can be diagnosed in addition to another mental disorder only if the latter does not explain the particular symptoms that occur in reaction to the stressor. For example, an individual may develop an adjustment disorder, with depressed mood, after losing a job and at the same time have a diagnosis of obsessive-compulsive disorder. Or, long as the criteria for both are met. Adjustment disorders are common accompaniments of medical illness and may be the major psychological response to a medical disorder.
309.89 (F43.8)
This category applies to presentations in which symptoms characteristic of a trauma- and stressor-related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the trauma- and stressor-related disorders diagnostic class. The other specified trauma- and stressor-related disorder category is used in situa- tions in which the clinician chooses to communicate the specific reason that the presenta- tion does not meet the criteria for any specific trauma- and stressor-related disorder. This the specific reason (e.g., “persistent complex bereavement disorder”).
Examples of presentations that can be specified using the “other specified" designation include the following: 1 . Adjustment-Iike disorders with delayed onset of symptoms that occur more than 3 months after the stressor.
2. Adiustment-like disorders with prolonged duration of more than 6 months with- out prolonged duration of stressor.
3. Ataque de nervios: See “Glossary of Cultural Concepts of Distress" in the Appendix.
4. Other cultural syndromes: See “Glossary of Cultural Concepts of Distress" in the Ap- pendix.
5. Persistent complex bereavement disorder: This disorder is characterized by severe and persistent grief and mourning reactions (see the chapter "Conditions for Further
Study”).
309.9 (F43.9)
This category applies to presentations in which symptoms characteristic of a trauma- and stressor-related disorder that cause clinically significant distress or impairment in social, oc- cupational, or other important areas of functioning predominate but do not meet the full cri- teria for any of the disorders in the trauma- and stressor-related disorders diagnostic class.