Adjustment Disorder

Adjustment disorder with depressed mood or with mixed anxiety and depressed mood is diagnosed when the depression is clearly a response to an external stress. This is not the same as grief.

Grief is a state that looks and feels a lot like depression, but people normally recover from grief without formal help. There is also some question of degree. Most people who are grieving are still able to feel that life will go on and hold some future rewards for them, and are able to experience enjoyment when the occasion merits. They don't feel decreased self-esteem or traditional guilt.

But people with an adjustment disorder with depression are in worse shape than this. They feel hopeless and helpless, empty and joyless. They can point to exactly what made them feel this way-a setback, a loss, an illness, a narcissistic injury of some sort-and they don't yet meet the criteria for dysthymia or major depression. This may be the first episode in what will turn out to be a lifetime struggle with depression, but many people recover from an adjustment disorder with no permanent effects.

The diagnostic criteria for adjustment disorder are:

A. The development of emotional or behavioral symptoms in response to an identifiable stressor, within three months of the onset of the stressor.

B. Symptoms are clinically significant, such as:

1. There is marked distress that is in excess of what would be expected from exposure to the stressor, or 
2. There is significant impairment in social, occupational, or academic functioning. 

C. The symptoms do not meet the criteria for another psychiatric diagnosis and are not merely an exacerbation of a preexisting condition.

D. The symptoms do not represent bereavement.

E. The symptoms do not persist for more than six months once the stressor or its consequences have terminated.

On the next page we will examine SAD and Mood Disorders.