From the Guidelines
The DSM-5 diagnosis that most closely aligns with "adjustment reaction with mixed emotional features" is "Adjustment Disorder with mixed anxiety and depressed mood" (309.28), characterized by emotional or behavioral symptoms in response to an identifiable stressor within three months of the stressor's onset, with significant impairment in social, occupational, or other important areas of functioning, as defined in the context of anxiety and depression symptoms 1.
Key Diagnostic Criteria
- The symptoms must be clinically significant, causing marked distress exceeding what would be expected from the stressor, or significant impairment in social, occupational, or other important areas of functioning.
- The person experiences both anxiety and depression, but neither meets the full criteria for a specific anxiety or depressive disorder.
- These symptoms must not persist for more than six months after the stressor or its consequences have ended, and they cannot be better explained by another mental disorder or represent an exacerbation of a preexisting condition.
- The distress must also not be part of normal bereavement.
Treatment Approach
- Treatment typically involves psychotherapy focused on coping skills and stress management, with medication sometimes used for symptom relief, as suggested by guidelines for managing symptoms of anxiety and depression in adults with cancer 1.
- The goal of treatment is to help the individual manage their symptoms and improve their quality of life, reducing morbidity and mortality associated with untreated adjustment disorders.
Clinical Considerations
- It is essential to assess the individual's symptoms and stressors to determine the best course of treatment, considering the potential impact on their social, occupational, or other important areas of functioning.
- Clinicians should be aware of the distinction between adjustment disorders and other mental health conditions, such as post-traumatic stress symptoms (PTS symptoms), to provide accurate diagnoses and effective treatment plans 1.
From the Research
DSM Criteria for Adjustment Reaction with Mixed Emotional Features
The provided studies do not directly address the DSM criteria for "adjustment reaction with mixed emotional features". However, we can look at the characteristics of adjustment disorder and its treatment to understand the context.
- Adjustment disorder is a common psychiatric disorder that requires therapeutic intervention due to its complications, including a significant risk of suicide 2.
- The disorder is often undertreated, and cognitive behavioral therapy (CBT) is considered the first-line treatment 3.
- Adjustment disorder with anxiety (ADA) is a specific type of adjustment disorder, and internet-delivered CBT (iCBT) appears to be an effective treatment option 3.
- Combining selective serotonin reuptake inhibitors (SSRIs) and CBT can produce greater improvement than either treatment alone in youth with depression and anxiety 4.
Treatment Approaches
The studies suggest that different treatment approaches can be effective for adjustment disorder, including:
- Pharmacotherapy interventions, such as benzodiazepines, antidepressants, or etifoxine 2.
- Psychotherapy interventions, such as CBT, psychodynamic therapy, behavioral therapy, and relaxation techniques 2, 5.
- Blended CBT, which combines online intervention and therapeutic guidance provided in person 3.
- Combination treatment with SSRIs and CBT 4.