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Is the distinction between adjustment disorder with depressed mood and adjustment disorder with mixed anxious and depressed mood valid?

Mark Zimmerman, MD

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA

Jennifer H. Martinez, BA

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA

Kristy Dalrymple, PhD

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA

Iwona Chelminski, PhD

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA

Diane Young, PhD

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA

BACKGROUND: In the DSM-IV, adjustment disorder is subtyped according to the predominant presenting feature. The different diagnostic code numbers assigned to each subtype suggest their significance in DSM-IV. However, little research has examined the validity of these subtypes. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the demographic and clinical profiles of patients diagnosed with adjustment disorder subtypes to determine whether there was enough empirical evidence supporting the retention of multiple adjustment disorder subtypes in future versions of the DSM.

METHODS: A total of 3,400 psychiatric patients presenting to the Rhode Island Hospital outpatient practice were evaluated with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders and measures of psychosocial morbidity.

RESULTS: Approximately 7% (224 of 3,400) of patients were diagnosed with current adjustment disorder. Adjustment disorder with depressed mood and with mixed anxious and depressed mood were the most common subtypes, accounting for 80% of the patients diagnosed with adjustment disorder. There was no significant difference between these 2 groups with regard to demographic variables, current comorbid Axis I or Axis II disorders, lifetime history of major depressive disorder or anxiety disorders, psychosocial morbidity, or family history of psychiatric disorders. The only difference between the groups was lifetime history of drug use, which was significantly higher in the patients diagnosed with adjustment disorder with depressed mood.

CONCLUSIONS: There is no evidence supporting the retention of both of these adjustment disorder subtypes, and DSM-IV previously set a precedent for eliminating adjustment disorder subtypes in the absence of any data. Therefore, in the spirit of nosologic parsimony, consideration should be given to collapsing the 2 disorders into 1: adjustment disorder with depressed mood.

KEYWORDS: adjustment disorder, diagnostic validity, subtypes

ANNALS OF CLINICAL PSYCHIATRY 2013;25(4):257-265

CORRESPONDENCE: Mark Zimmerman, MD 146 West River Street Providence, RI 02905 USA E-MAIL: mzimmerman@lifespan.org
Annals of Clinical Psychiatry ©2013 Quadrant HealthCom Inc.

 
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