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A 50-year-old female executive presents 6 weeks after being unexpectedly laid off from a position she held for 18 years. She reports depressed mood, tearfulness, difficulty sleeping, worry about finances, irritability, and difficulty concentrating. She denies anhedonia, suicidal ideation, feelings of worthlessness, psychomotor changes, or persistent worry across multiple life domains beyond the job loss. She has no psychiatric history. On structured clinical interview, she does not meet full criteria for major depressive disorder or generalized anxiety disorder. Her symptoms began within 2 weeks of the layoff. Which diagnosis most accurately captures this presentation?
Explanation
Adjustment disorder is diagnosed when emotional or behavioral symptoms develop within 3 months of an identifiable stressor, cause clinically significant distress or functional impairment, do not meet criteria for another specific mental disorder, and are not simply normal bereavement. The specifiers (with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct) describe the dominant symptom presentation.
Key Takeaway
Adjustment disorder is a diagnosis of exclusion that applies when stress-related symptoms do not meet full criteria for another specific disorder; always perform a structured assessment to confirm threshold criteria are not met before assigning it.