Adjustment Disorder With Depressed Mood: ICD-10 And Mental Health

Please note: In previous versions of the ICD manual, including ICD-10, “adjustment disorder with depressed mood” may have been diagnosed. In the most recent adaptation of the ICD, the ICD-11, adjustment disorder is separated from depressive disorders. Situational depression may be diagnosed instead. 

It can be natural to experience uncomfortable emotions after a stressful event or major life change. However, in some cases, anxiety, sadness, or stress following such an incident can start to impact everyday life adversely. When adjusting to a life change becomes significantly challenging, it may be a sign of an adjustment disorder. To understand adjustment disorder, it can be helpful to look at its definition in the International Classification of Diseases, 11th Edition (ICD-11) and its diagnostic criteria and treatment options. 

What is an adjustment disorder?

Adjustment disorders belong to a group of conditions that develop after a stressful life event. For this article, we’re going to focus on the symptoms and criteria of adjustment disorders as laid out by the International Classification of Diseases (ICD-11). Developed by the World Health Organization, the ICD-11 is one of the most important diagnostic tools for health professionals.

• Symptoms began within one month of the stressful event
• The stressor can be clearly identified 
• Symptoms cannot be attributed to another disorder
• Symptoms are not due to grief over the passing of a loved one
• Symptoms have occurred for less than six months
• Symptoms significantly affect everyday activities and social interactions

People with adjustment disorder may present with various symptoms, including fear, nervousness, preoccupation, and sadness. Listed under “Reaction to severe stress, and adjustment disorders” in the ICD-10, adjustment disorder is part of the “Disorders specifically related to stress” section in the ICD-11.

Adjustment disorders in the ICD-10

In the ICD-10, adjustment disorders were listed under the category “Reaction to severe stress, and adjustment disorders”—a section that was given the code F43. The ICD-10 code for adjustment disorders, F43.2, was reflected in the codes for each of the seven conditions in that section (for example, adjustment disorder with mixed anxiety and depressed mood had the code F43.23). Adjustment disorders (F43.20-F43.26) in the ICD-10 included:

• Adjustment disorder, unspecified (F43.20)

• Adjustment disorder with depressed mood (F43.21)

• Adjustment disorder with anxiety (F43.22)

• Adjustment disorder with mixed anxiety and depressed mood (F43.23)

• Adjustment disorder with disturbance of conduct (F43.24)

• Adjustment disorder with mixed disturbance of emotions and conduct (F43.25)

• Adjustment disorder with other symptoms (F43.29)

In the ICD-10, the adjustment disorders (F43.2) in which depressive symptoms might have been present included adjustment disorder, unspecified (F43.20); adjustment disorder with depressed mood (F43.21); adjustment disorder with mixed anxiety and depressed mood (F43.23); adjustment disorder with mixed disturbance of emotions and conduct (F43.25); and adjustment disorder with other symptoms (F43.29). For example, in someone experiencing adjustment disorder with mixed disturbance of emotions and conduct, the emotional disturbance might have been referred to as depression. (Disturbance of conduct typically refers to actions that exhibit disregard for social standards or the rights of others.)

The classification “Reaction to severe stress, and adjustment disorders” (F43) in the ICD-10 also included acute stress reaction (F43.0), post-traumatic stress disorder (F43.1), other reactions to severe stress (F43.8), and reaction to severe stress, unspecified (F43.9). 

As mentioned above, the ICD-11 removes the “Reaction to severe stress, and adjustment disorders” section. In the ICD-11, adjustment disorder is listed under the section “Disorders specifically associated with stress”, which has the codes 6B40-45. In addition to changing the codes, ICD-11 simplifies the adjustment disorder diagnosis by removing subtypes. This means that all previous diagnoses (e.g., adjustment disorder, unspecified; adjustment disorder with mixed anxiety and depressed mood) are now subsumed under one diagnosis. 

What qualifies as a stressful event?

The ICD notes that the symptoms of an adjustment disorder must not have developed without the presence of a stressor. Various life changes and experiences may fit this criterion. The ICD lists several categories of potentially stressful events, including stressors that impact an individual’s support system, lead to a significant transition in life, or could be perceived as a crisis. Some specific examples may include the following:

• Divorce
• Relationship concerns
• Illness in yourself or a loved one
• Moving to a different location
• Retirement
• Starting college
• Experiencing sudden financial duress
• Sudden job loss or job changes 

Almost any significant life change or event can be at the root of an adjustment disorder when it impacts your ability to function. The development of an adjustment disorder often depends on the individual. For example, a teenager may find certain events more stressful than an adult. For this reason, children and adolescents may be diagnosed with adjustment disorder more frequently.

Symptoms of an adjustment disorder

Previously, individuals may have received a diagnosis of adjustment disorder with depressed mood. However, the ICD-11 only lists adjustment disorder on its own, separate from depression symptoms. Symptoms of this condition may include the following:

•  Preoccupation with a stressor
• Excessive worry
• Recurrent and distressing thoughts about a stressor
• Constant rumination
• Difficulty adapting to a stressor
• Irritability
• Risk-taking behaviors (especially in adolescents)

If you experience the above symptoms alongside nervousness, tension, or worry, you may have adjustment disorder. A doctor or mental health professional can determine whether you have an adjustment disorder and guide you through treatment options. 

Adjustment disorder with depressed mood vs. depressive disorders 

Because symptoms of adjustment disorder may resemble symptoms of a depressive disorder like major depressive disorder (MDD), it can be crucial to know the difference between them. If symptoms of depression are severe or aren’t linked to a specific stressor, they may signal the presence of major depression, dysthymia, or another depressive disorder.

In some cases, those living with a depressive disorder may experience physical symptoms that could be absent in an adjustment disorder, including headaches, changes in appetite, and weight changes. However, the most significant difference is how long the conditions last. Symptoms of an adjustment disorder do not persist for more than six months. Depressive disorders can last for years. In addition, depression is not a symptom of adjustment disorder in the ICD-11.

To determine whether you’re experiencing depression, an adjustment disorder, or a similar mental health condition (e.g., an anxiety disorder), a doctor or psychologist can examine your symptoms and compare them against the diagnostic criteria in the ICD-11 or DSM-5.

Treatment for adjustment disorder with depressed mood

Because adjustment disorder is a temporary and situational disorder, medication may not be prescribed unless it offers short-term relief. Instead, combining therapy and lifestyle changes may help you manage symptoms and work through emotions arising from the stressful event you experienced. 

Psychotherapy

One of the first-line treatments for adjustment disorder is therapy. A therapist can help you identify how your thoughts relating to a stressful event may affect your emotions and behaviors. You might participate in individual, family, or group therapy, depending on your situation.

Your therapist may offer emotional support and provide you with resources to address challenges outside of sessions. As therapy progresses, they can help you understand why the stressful event has impacted your life and how you might solve problems in the future. They might also teach you coping skills and stress-management techniques to cope with future challenging emotions.

Exercise

Physical activity has proven benefits when it comes to depression. Exercise helps produce endorphins, which can boost your mood and enhance brain function. Consider going for daily walks, taking up swimming, jogging, or biking, or developing an at-home exercise routine.

Stress management

Stress-management strategies can help you moderate the effects of a past stressful event and potentially avoid similar severe effects in the future. Practical stress management techniques may include journaling, meditating, deep breathing, and muscle relaxation exercises. Consider devising a self-care routine incorporating several relaxing activities into your daily life. 

Balanced diet

There is evidence of a connection between diet and depression. Eating healthy foods can improve your mood, provide you with energy, and help you better address symptoms of an adjustment disorder. Consider incorporating elements of a Mediterranean diet, which is high in fruits, vegetables, nuts, whole grains, and beans.

Sleep

An adjustment disorder may affect your ability to get regular sleep. To maintain a healthy schedule, consider creating a nighttime routine that prepares you for sleep. For example, stay away from screens an hour before bed, make a decaf tea, or read a book before bed to get yourself ready to sleep. 

Mindfulness

Mindfulness is the process of drawing your attention to your feelings, thoughts, and surroundings. Any form of purposeful and meditative awareness and grounding can be a form of mindfulness. To practice mindfulness, find a quiet place to sit or lie down.

Breathe deeply while bringing your attention to your thoughts, allowing them to pass through your mind without judging them. Take note of how you’re feeling in the moment, physically and emotionally. Being more present and aware may help you relax, address your emotions as they surface, and mediate the effects of rumination. 

Creating a support system with family, friends, and a mental health professional

The ICD mentions disruptions in an individual’s “social network” as one potential category of stressor. If you have experienced a social stressor, having a group of people to help you cope with your adjustment disorder may make a difference. Your support system could include family, friends, and a mental health professional. You might also consider seeking a support group specific to depression or adjustment disorders, which can connect you with people who understand what you’re experiencing and provide you with a built-in network.  

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Alternative mental health support options

In some cases, individuals may not reach out to a therapist during a stressful period due to financial barriers or burnout. In these cases, it may be helpful to try online therapy through a platform like BetterHelp. 

You can work with a therapist remotely through an online platform, which can be helpful if you’re struggling to leave home. Your therapist can also provide you with valuable resources, like at-home exercises and journaling prompts. In addition, online therapy can also be more cost-effective than in-person options.

Studies suggest that online therapy can address symptoms of mental health conditions related to stress, such as depression. In one study of app-based online cognitive-behavioral therapy for depression, which included over 300 participants, researchers found that symptoms of depression were significantly improved, with results similar to those of in-person studies.