Adjustment Disorder With Depressed Mood Essay, Research Paper

Running Head: ADJUSTMENT DISORDER WITH DEPRESSED MOOD CAUSE

Adjustment Disorder

with Depressed Mood, Cause and Affect

Abstract

Research was conducted to investigate Adjustment Disorder with Depressed Mood, and some causes, affects, and treatment approaches. Not all individuals manifest or demonstrate the same depressive symptoms, which can make it difficult for clinicians to diagnose and treat. The American Psychiatric Association has categorized various depressive disorders in the Diagnostic and Statistical Manual for Mental Disorders fourth edition (DSM-IV, 1994). Researchers have investigated the validity of the DSM diagnostic criteria over the years, and have studied various treatment approaches. The treatment approach found to be most effective and used most often for treating depression is Cognitive and Behavior therapy.

Adjustment Disorder

with Depressed Mood, Cause and Affect

Depression is not unique to our culture it is found throughout the world. Mezzich and Raab (1980), report that they found comparable depressive severity’s in samples from Austria, Czechoslovakia, England, Germany, Japan, Switzerland and the United States.

Depression is a term that covers a wide range of emotional states. Klerman (cited in Marsella, Hirschfeld & Katz, 1987) said that “as a normal mood, depression is almost universal in human experience; for example, not to grieve after the loss of a loved one is somehow less than human” (p.3). Depression can range in severity from normal everyday moods of sadness, to psychotic episodes with increased risk of suicide (Gotlib & Colby, 1987).

Depression has been identified as the most common psychiatric symptoms found in hospital settings (Rodin & Voshart, 1986). It is estimated that depression accounts for 75% of all hospitalizations, and more than 100 million people in the world develop clinically recognizable depression (Gotlib & Colby, 1987). The Diagnostic and Statistical Manual of Mental Disorders (DSM), helps clinicians identify the various depressive disorders (Snyder, Strain & Wolf, 1990).

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM IV), identifies clinical depressive disorders by diagnostic categories. Adjustment Disorder with Depressed Mood is the diagnostic term used in the DSM IV, to identify a relatively mild form of depression (DSM-IV; American Psychiatric Association, 1994).

The focus of this research paper is on Adjustment Disorder with Depressed Mood, and the treatment approach found to be the most effective. This research will include: (a) DSM-IV: validity of diagnostic criteria, (b) Adjustment Disorder with Depressed Mood: cause & affect, and (c) treatment approaches: effective methods.

DSM-IV: validity of diagnostic criteria

Clinicians need to be able to differentiate between various depressive disorders in order to properly diagnose and treat them. The information in the DSM-IV allows clinicians to differentiate between the normal depressive mood state and those abnormal states that merit clinical intervention (DSM-IV; American Psychiatric Association, 1994). How valid are the criteria in the DSM-IV? Over the years there have been several studies conducted that have validated the DSM classification system and the diagnostic criteria for adjustment disorders, which includes Adjustment Disorder with Depressed Mood (Snyder, Strain & Wolf, 1990; Andresen & Wasek, 1980; Andresen & Hoenk, 1982). The DSM-IV not only specifies the criterion that assists clinicians differentiate between various depressive states, it helps identify some of the cause and affects of the disorders.

Adjustment Disorder with Depressed Mood: cause & affect

The cause and affects of Adjustment Disorder with Depressed Mood are essentially described within the diagnostic features. The DSM-IV states that:

The essential feature of an Adjustment Disorder is the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychological stressor or stressors . . . The stressor may be a single event (e.g., termination of a romantic relationship), or there may be multiple stressors (e.g., marked business difficulties and marital problems). Stressors may be recurrent (e.g., associated with seasonal business crises) or continuous (e.g., living in a crime-ridden neighborhood). Stressors may affect a single individual, an entire family, or a larger group or community (e.g., as in a natural disaster). Some stressors may accompany specific developmental events (e.g., going to school, leaving the parental home, getting married, becoming a parent, failing to attain occupational goals, retirement). The symptoms must develop within 3 months after the onset of the stressors . . . and must resolve within 6 months of the termination of the stressor (p.623).

Research studies support the DSM-IV information on some of the causes of Adjustment Disorder with Depressed Mood (Snyder, Strain, & Wolf, 1990; Roden & Voshart, 1986). Roden and Voshart (1986) stated in their study “Adjustment Disorders . . . are maladaptive reactions to an identifiable psychosocial stressor occurring within 3 months after the onset of the stressor. Physical illness is a common precipitant of an Adjustment Disorder with Depressed Mood” (p.700).

The DSM-IV provides clinicians with a wealth of information on Adjustment Disorder with Depressed Mood. It describes the causes as psychosocial stressors, and the parameters they must meet. It also describes the affect as “the predominant manifestation of symptoms such as depressed mood, tearfulness or feelings of hopelessness” (p.623). Once clinicians have decided a client meets the criteria for the diagnosis, they only need to identify the best treatment approach.

Treatment approaches: effective methods

Aaron T. Beck (cited in Corsini & Wedding, 1989) developed cognitive therapy during his research of depression. He defined three fundamental concepts in cognitive therapy; collaborative empiricism, socratic dialogue and guided discovery. These fundamental concepts have proven to be successful for Beck, in his treatment of depression (p.302).

Since Beck’s development of cognitive therapy, hundreds of research studies have been conducted comparing the various treatment approaches used for treating depression, including pharmacotherapy. In two studies pharmacotherapy was compared to cognitive therapy. In one study the results indicated that pharmacotherapy was as effective as cognitive therapy (Murphy, Simons, Wetzel & Lustman, 1984), while in the other study results showed that cognitive therapy was more effective (Kovacs, Rush, Beck & Hollon, 1981).

In conducting their review of various treatment methods, researchers even looked at gender differences. What they found was more women pursue therapy than men (Frank, Capenter & Kupfer, 1988). However, both men and women respond similarly to cognitive behavior therapy (Thase, Reynolds III, Frank, Simons, McGeary, Fasiczka, Garamoni, Jennings & Kupfer, 1994).

To date cognitive and behavioral therapies are the methods identified as the most effective in treating various depressive states including Adjustment Disorder with Depressed Mood (Gotlib & Colby, 1987; Marsella, Hirschfeld & Katz, 1987; Shaffer, Shapiro, Sank & Coghlan, 1981; Thase & Wright, 1991; Paykel, 1988; Thase, Reynolds III, Frank, Simons, McGeary, Fasiczka, Garamoni, Jennings & Kupfer, 1994).

Conclusion

Research studies have shown that the degree of depression demonstrated by individuals can vary from normal moods of sadness, To extreme psychotic episodes that involve suicidal behavior. Adjustment Disorder with Depressed Mood as identified in the DSM-IV, is a mild depressive reaction to stress (DSM-IV; American Psychiatric Association, 1994). The DSM-IV not only provides clinicians with the necessary information to identify and properly diagnose Adjustment Disorder with Depressed Mood, it also provides incite into the causes and affects of the disorder. Research studies have compared various treatment methods for treating depression. The results indicate that cognitive behavior therapy is the most effective in treating depressive disorders including Adjustment disorder with Depressed Mood.

References

American Psychiatric Association, Diagnostic And Statistical

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Gotlib, I.H., & Colby, C. A., Treatment of Depression An Interpersonal Systems Approach. New York: Pergamon Press, 1987.

Kovacs, M., Rush, A.J., Beck, A.T., & Hollon, S.D.,(1981) Depressed outpatients treated with cognitive therapy or pharmacotherapy a one-year follow-up. Archives of General Psychiatry. 38 33-39

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Rodin, G., & Voshart, K., (1986) Depression in the medically ill. American Journal of Psychiatry. 143 696-705.

Shaffer, C. S., Shapiro, J., Sank, L.I., & Coghlan, D.J., (1981) Positive changes in depression, anxiety, and assertion following individual and group cognitive behavior therapy intervention. Cognitive Therapy and Research. 3(2) 149-157.

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Thase, M.E., Reynolds III, C.F., Frank, E., Simons, A.D., McGeary, J., Fasiczka, A.l., Garamoni, G.G., Jennings, J.R., & Kupfer, D.J.,(1994) Do depressed men and women respond similarly to cognitive behavior therapy? American Journal of Psychiatry. 155 500-505.

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