Hello, Let's look at this diagnosis more closely. It seems to me that a diagnosis of Adjustment Disorder, Chronic Type, in the case of a person going through a divorce and child custody hearing would be entirely justified UNLESS there is evidence that another Axis I or Axis II disorder is present (such as Major Deprressive Disorder--Axis I--or Borderline Personality Disorder--Axis II). Here is the definition and criteria. ==================== From www.psywe.com "Adjustment disorders are defined as an inability or maladaptive reaction to an identifiable stressful life event(s) / stressor(s). ( e.g., divorce, family crises, ... ) Symptoms must occur within three months of the event(s) / stressor(s) and persisted for no longer than six months Diagnostic Criteria ( DSM-IV™ ) made easy. 1. Behavioral or emotional symptoms must develop in response to an identifiable event(s) and occur within three months of the onset of that event(s) / stressor(s). 2. These behaviors or symptoms must be clinically significant as evidenced by at least one of the following: 3. The disturbance does not meet the criteria for another specific Axis I disorder or is not part of a preexisting Axis I or Axis II disorder. 4. The behavioral or emotional symptoms do not represent Bereavement. 5. Once the event(s) / stressor(s) has terminated, the symptoms do not last more than an additional six months. Acute: Last less than six months. Chronic: Last for six months or longer. By definition the disturbance can not last longer then six months. Only use the chronic specifier if the disturbance is in response to a chronic event(s) / stressor(s). Specifiers and Subtypes With Anxiety ================= I wonder if the therapist actually said "I am just marking this so your insurance will pay, but I don't think it is accurate." Why would a therapist tell a client that? Was the client quizzing the therapist and making assumptions about the answers he/she received? If a client asked what the Adjustment Disorder diagnosis meant, the therapist might explain that it is used in cases where the person needs therapy but does not meet the criteria for those conditions usually considered more serious. Did the therapist really say he/she marked Adjustment Disorder to prevent an opposing attorny from using another diagnosis in future child custody hearings? I wonder if the client had that concern instead of the therapist. The therapist may have tried to allay client concerns in that area by explaining the nature of the Adjustment Disorder diagnosis. Fraudulently marking the wrong diagnosis is likely to backfire on the client and therapist. If the therapist is compelled to give testimony in a court hearing in the future (and this could easily happen in a child custody case; hopefully the limits of confidentiality were explained thoroughly to the client), therapy notes could still be read by the opposing attorney in discovery procedures. If there is evidence that a different diagnosis was warranted, this will damage the client's claim for fitness as a parent. This could be more damaging than the actual alternative diagnosis by an objective therapist. Evidence of the effectiveness of treatment will be documented in case notes when it occurs. It can be argued that effective treatment cannot occur when the client is misdiagnosed. My chief concern here is for the welfare of the children. If the client DOES have another mental disorder that would make him/her an unfit parent, then custody SHOULD be given to the other parent or some other party if the other parent is also unfit. That is the purpose of hearings like this--to protect the children. And this client must have awfully good insurance. Most insurance companies or managed care organizations would only pay for 12 visits, even for a client with a severe case of Major Depressive Disorder. A lot of providers would balk at paying for Adjustment Disorder at all. Not right or fair, but it happens. Comments? Don H. Morris< Ed.D. --------------- Note: I am not a psychiatrist and could not serve as an expert witness in most situations. I do not claim expertise in forensics. Dr. Reid may have some coments or clarifications on my post.
A. After exposure to the event(s) / stressor(s), the behavioral or emotional symptoms seem in excess of what would be normally expected.
B. Significant social, functioning, or occupational impairment..
With Depressed Mood
With Disturbance of Conduct
With Mixed Anxiety and Depressed Mood
With Mixed Disturbance of Emotions and Conduct
Unspecified"
Licensed professional Counselor
Littel Rock, Arkansas
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