20 November 2016 November 2016 21 Expert guide: Psychology 2016 ICD10 F43.2 Adjustment Disorder States of subjective distress and emotional dis-turbance, usually interfering with social func-tioning and performance, arising in the period of adaptation to a significant life change or a stressful life event. The stressor may have af-fected the integrity of an individual’s social net-work (bereavement, separation experiences) or the wider system of social supports and values (migration, refugee status), or represented a major developmental transition or crisis (going to school, becoming a parent, failure to attain a cherished personal goal, retirement). Indi-vidual predisposition or vulnerability plays an important role in the risk of occurrence and the shaping of the manifestations of adjust-ment disorders, but it is nevertheless assumed that the condition would not have arisen with-out the stressor. The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the per-formance of daily routine.Unfortunately, in both the DSM 5 and ICD10 definitions, disruption to social functioning is only a possible and not an essential element Adjustment Disorder and one would have to assume that the disorder is being diagnosed too frequently and erroneously. In any research based study where patients with psychiatric diagnoses are compared then rigor-ous methods, including diagnostic interview schedules to aid diagnoses or key evidence to support a particular diagnosis is expected. Sim-ply referring to clinical experience on its own is not considered to be a sufficient basis for a diagnosis. Such rigour is not expected for ther-apy purposes in clinical contexts where clinical experience is sufficient to offer a possible diag-nosis. One would assume that in terms of diag-nostic rigour a medico-legal assessment should be more akin to a research study than an assess-ment for purposes of therapy. It is a great pity then that evidence based rigorous assessments in relation to Adjustment Disorder in medico-legal contexts often seems to be sadly lacking. Professor Edelmann is Chartered Psycholo-gist, an HCPC Registered Clinical, Forensic and Health Psychologist and a Fellow of the British Psychological Society. From 1986 until 1997 he was involved in Clinical Psychology training at the University of Surrey where he also directed a master’s programme in Health Psychology and of the disorder. This means that symptoms of marked or subjective distress can be taken as an indicator of Adjustment Disorder. How though does one assess ‘marked distress’? In essence Adjustment Disorder can be taken as simply implying that the person has not adjusted or coped well with an identifiable stressor. How-ever, such distress must be “out of proportion to the severity and intensity of the stressor” (DSM-5) and should “usually interfere with social functioning and performance” (ICD10). Interestingly, the SCID-5, a diagnostic inter-view schedule developed specifically to aid in the diagnosis of DSM5 defined psychiatric con-ditions, specifies questions “as needed” relating to any affects of symptoms on relationships, work, taking care of things at home or in re-lation to other important parts of the person’s life to facilitate the diagnosis of an Adjustment Disorder. If the person is maintaining all as-pects of their life in exactly the same manner as prior to the index event, then, although they may be upset by the index event, it would seem highly unlikely that the distress they are experi-encing is clinically significant. In such contexts one would have to assume that a diagnosis of Adjustment Disorder is inappropriate. Unfor-tunately minimal emotional or behavioural dif-ficulties often seem to be taken as indicating in 1996 established and directed one of the first master’s programmes in Forensic Psychology in the United Kingdom. He has over 100 publica-tions including six books. He is currently Pro-fessor of Forensic and Clinical Psychology on a part-time basis at the University of Roehampton as well as a Consultant Clinical Psychologist. References Casey, D., Dowrick, C. & Wilkinson, G. (2001). Adjustment Disorders: Fault lines in the psychiatric glossary. The British Journal of Psychiatry, 179, 479-481 DSM 5 (2013) Diagnostic and Statistical Manual of the Amer-ican Psychiatric Association. Washington DC: APA First, M. B., Williams, J. B.W., Karg, R. S. & Spitzer, R. L. (2016)Structured Clinical Interview for DSM-5 (SCID-5). Arling-ton, VA: American Psychiatric Association. World Health Organisation (2016). The International Statis-tical Classification of Diseases and Related Health Problems (ICD-10). 5th Edi-tion. WHO Strain, J. J. & Diefenbacher, A. (2008). The adjustment dis-order: The conundrums of the diagnoses. Comprehensive Psychiatry, 49, 121-130. United Kingdom If the person is maintaining all aspects of their life in exactly the same manner as prior to the index event, then, although they may be upset by the index event, it would seem highly unlikely that the distress they are experiencing is clinically significant