Adjustment disorders ICD-10 codes are used to diagnose some of the most common disorders in the world of mental health. In fact, four of the top ten most diagnosed mental health disorders are adjustment disorders. Why the popularity? Do so many people really have adjustment disorders? Could they be over-diagnosed? Let’s examine the assessment of adjustment disorders using the adjustment disorders ICD-10 codes and discover why these diagnoses are so common.
Prevalence of adjustment disorders
While the number of diagnoses appears to be considerable, the actual prevalence of adjustment disorders is more questionable. Adjustment disorders have been estimated to affect only 1% to 2% of the general population. Compare that with major depression, which impacts many more people (8%) but is diagnosed at about the same rate. The upshot is that adjustment disorders seem to be diagnosed at a much higher rate than their prevalence would suggest. So, what is going on here? By looking at the diagnostic criteria of adjustment disorders ICD-10 we can start to gather some clues.
Diagnostic criteria for adjustment disorders ICD-10
Everyone experiences stress but certain people cope with it better than others. Simply put, adjustment disorders are maladaptive reactions to a stressor. But the general criteria for adjustment disorders ICD-10 are vague at best. The following symptoms represent the general criteria for F43.2 Adjustment Disorder:
- Symptoms are in response to an identifiable stressor.
- Symptoms develop within one month of that stressor.
- Criteria for another disorder are not fulfilled.
- Once the stressor has terminated, the symptoms do not persist for more than an additional six months.
The adjustment disorders ICD-10 codes adds a little more specificity with the disorder subtypes but still leaves a lot up to the subjectivity of the clinician. In reality, one might argue that the subtypes bring about even more confusion in diagnosis.
Differential diagnosis of adjustment disorders
Because the criteria of adjustment disorders are so imprecise, it can lead to numerous problems with differential diagnoses. Here are several diagnoses that may cause diagnostic complications:
Post-traumatic stress disorder (PTSD) and acute stress reaction
PTSD and acute stress reaction also occur in response to a stressor. The difference is that PTSD is in response to a catastrophic event and has severe symptoms that focus on arousal, avoidance, and recollection of the traumatic event. Acute stress reaction is similar to PTSD, except its symptoms must abate within a month of experiencing the stressor.
Depression and anxiety disorders
One could argue that all depression and anxiety disorders are stress reactions. And adjustment disorders can share many of the same symptoms. The defining difference is that adjustment disorders can’t be diagnosed when another disorder is present. That means that if the number of symptoms needed to diagnose anxiety or a depressive disorder is present, it can’t be an adjustment disorder.
Concerns in the diagnosis of adjustment disorder ICD-10
- The adjustment disorders ICD-10 doesn’t define much of its criteria. As a result, the diagnosis is left up for interpretation. For example, what is the requirement for a stressor? What is considered an anxiety or depressive symptom? How severe does the symptom need to be to be part of this diagnosis? The lack of detail in the criteria makes it easy for clinicians to overuse the diagnosis.
- Correspondingly, because adjustment disorders ICD-10 lack measurable criteria for clinical significance, the threshold for making the diagnosis may vary widely between professionals. This means that the diagnosis lacks uniformity and, therefore, both reliability and validity suffer.
- The requirement that symptoms should arise within one month of the stressor appears unrealistic in some cases. Stressors are dynamic entities and emotional reactions may be delayed. Therefore, this criterion may cause certain clients to be misdiagnosed or not receive a proper diagnosis. Taking this into account, the
DSM-5 gives three-months from the introduction of the stressor until symptoms may appear.
Adjustment disorder is an easy and non-threatening diagnosis. Clinicians are often under pressure to make a diagnosis for insurance reasons and may choose adjustment disorder because its vague criteria make it easy to rationalize. Further, it is seen as a non-serious disorder and many professionals may want to avoid labeling a client with a severe illness. Both of these factors may lead to further over-diagnosis.
A note about the ICD-11
The ICD-11, which has yet to be adopted in the United States, makes some major alterations to adjustment disorder. First, it specifies that the failure to adapt to a stressor must cause significant impairment. This lends it a certain severity it does not possess in the ICD-10. Maybe most startling, however, is that the ICD-11 gets rid of the specific subtypes, making it much more general. Instead, it says that preoccupation related to the stressor must cause one of the following: excessive worry, distressing thoughts about the stressor, and/or rumination.
There is little doubt that adjustment disorders have their place in the world of mental health. We are constantly barraged with stress and poor coping reactions are inevitable. However, the vagueness of the adjustment disorders ICD-10 criteria threatens its validity and may lead to its over-diagnosis. All of this uncertainty makes life more difficult for clinicians who are trying to navigate the difficult world of insurance coding and assessment.
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