ICD 10 Adjustment Disorder With Depressed Mood – Symptoms, Causes, And Treatment
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 referred to 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 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 healthful 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
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.
Alternative 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.
Takeaway
What is adjustment disorder with depressed mood?
Adjustment disorders belong to a group of conditions that can develop after a stressful life event. According to the ICD-11, adjustment disorders are conditions of “subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change.”
The development of an adjustment disorder often depends on the individual. For example, experiencing certain events in childhood may feel more stressful. For this reason, children and adolescents may be diagnosed with adjustment disorder more frequently. Children with an existing condition such as neurodevelopmental disorders may be at higher risk of adjustment disorder following a big life change.
What is F43 25 adjustment disorder?
F43.25 is an adjustment disorder subtype whose predominant symptoms are mixed disturbances of emotions and conduct. It includes emotional symptoms such as depression and anxiety and is accompanied by behavioral changes.
What is F43 20 adjustment disorder unspecified?
F43.20 is an adjustment disorder subtype with unspecified symptoms. It typically involves maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
Is adjustment disorder a serious mental illness?
Adjustment disorders appear in response to a specific stressor and typically disappear once the stressor has been removed. However, if adjustment disorders do not resolve, they can lead to more serious conditions such as severe stress, anxiety, or depression.
What happens when you have adjustment disorder?
Almost any significant life change or event can be at the root of an adjustment reaction. Symptoms of adjustment disorder may include the following, particularly if they impact day-to-day functioning:
- 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)
Is adjustment disorder with depressed mood the same as depression?
No, there is no longer a specific diagnosis for adjustment order with depressed mood. ICD-10 criteria listed the condition, but the ICD-11 does not.. In the most recent adaptation of the International Classification of Diseases (ICD 11), adjustment disorder is separated from depressive disorders. However, people with adjustment disorder may present with various symptoms, including fear, nervousness, preoccupation, and sadness. In some cases, depression may be diagnosed alongside adjustment disorder.
How long can you be diagnosed with adjustment disorder?
The symptoms of an adjustment disorder are most commonly a reaction to severe stress due to a specific event. To meet the ICD criteria for adjustment disorder, symptoms must have begun within one month of a stressful event and occurred for less than six months. Various life changes and experiences may fit this criterion including divorce, illness, relocation, retirement, financial distress, and relationship concerns.
Is adjustment disorder considered depression?
Symptoms of adjustment disorder may resemble symptoms of a depressive disorder like major depressive disorder (MDD), but the conditions are different.
In some cases, those living with a depressive disorder may experience physical symptoms absent in an adjustment disorder, including headaches, changes in appetite, and weight changes. They may also experience symptoms regardless of the presence of a specific stressor. However, the most significant difference is how long the conditions last. Symptoms of an adjustment disorder do not persist for more than six months, while depressive disorders can last for years.
Is adjustment disorder a mental breakdown?
“Mental breakdown” is not a clinical term. It is used to describe a person who is experiencing an acute mental health crisis that affects their ability to complete daily tasks and function normally. An adjustment disorder is not a mental breakdown. However, certain symptoms of adjustment disorder such as nervousness, tension, or worry can worsen over time and put a person at risk of experiencing a mental breakdown.
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