Adjustment disorder

[medstudent234]

What do you generally diagnose when someone's symptoms feel like an adjustment d/o (i.e. abrupt onset of depression/ anxiety in the context of a divorce/breakup, job loss, deployment, etc without prior psych history), however you technically can't dx adjustment disorder because they meet the lower end of the criteria for another diagnosis (MDE, panic disorder, etc)? I feel like we are overdiagnosing those latter diagnoses when it is more characteristic of an adjustment d/o, and I'm torn on how strictly to interpret DSM-5 "rules." I asked my attending about this, and he recommended still diagnosing adjustment disorder because it can greatly affect eligibility for service connection later on if they are Tricare and somewhat misrepresents what is going on in other cases. Curious what others think. Thanks!

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[michaelrack]

If they have a prior dx of MDD, I would dx it as MDD, recurrent- especially if inpt care was required or if the patient was suicidal

 

[wolfvgang22]

We all know the DSM-V isn't perfect. Just diagnose with the criteria that best describe the patient, keeping in mind it is generally better to go with the more severe diagnosis of they are an edge case.

 

[WisNeuro]

Ah, the VA/military. Where clinical decisions are made primarily on service connection.

 

[medstudent234]

WisNeuro: yes and no, since we still offer them all the same treatment either way (group and individual therapy, medications).

 

[WisNeuro]

WisNeuro: yes and no, since we still offer them all the same treatment either way (group and individual therapy, medications).

I was slightly kidding, only slightly though. I spent a good chunk of my early career in the VA before leaving for greener pastures, I know the system wide issues.

 

[bisell26]

Ah, the VA/military. Where clinical decisions are made primarily on service connection.

OMG yes, it's always about the service connection.

 

[ryerica22]

We all know the DSM-V isn't perfect. Just diagnose with the criteria that best describe the patient, keeping in mind it is generally better to go with the more severe diagnosis of they are an edge case.

DSM V is there just to make $$$ it's far from perfect.

 

[NickNaylor]

DSM V is there just to make $$$ it's far from perfect.

That's a tad cynical - I think the DSM offers a bit more value to our profession than money for the APA.

 

[Mass Effect]

If it's acute and you can link the onset to a specific stressor, I'd go with adjustment.