Adjustment Disorder

May 2008 // Washington, DC – Today, Citizens for Responsibility and Ethics in Washington (CREW) and released an e-mail obtained from a Veterans Affairs (VA) employee directing VA staff to refrain from diagnosing soldiers and veterans with Post Traumatic Stress Disorder (PTSD).
On March 20, 2008 a VA hospital’s PTSD program coordinator sent an e-mail to a number of VA employees, including psychologists, social workers, and a psychiatrist stating that due to an increased number of “compensation seeking veterans,” the staff should “refrain from giving a diagnosis of PTSD straight out” and they should “R/O [rule out] PTSD” and consider a diagnosis of “Adjustment Disorder” instead. The e-mail is available at

This week, CREW sent a Freedom of Information Act request to the VA asking for all records pertaining to any guidance given regarding the diagnosis of PTSD.

Some context would be useful here. The DSM IV says(the list has links to definitions):

An adjustment disorder is a debilitating reaction, usually lasting less than six months, to a stressful event or situation. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

These symptoms or behaviors are clinically significant as evidenced by either of the following:

Distress that is in excess of what would be expected from exposure to the stressor.

Significant impairment in social, occupational or educational functioning.

The symptoms are not caused by Bereavement.

The stress-related disturbance does not meet the criteria for another specific disorder. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.

Adjustment Disorders Subtypes:

309.24 Adjustment Disorder With Anxiety
309.28 Adjustment Disorder With Mixed Anxiety and Depressed Mood
309.3 Adjustment Disorder With Disturbance of Conduct
309.4 Adjustment Disorder With Mixed Disturbance of Emotions and Conduct
309.9 Adjustment Disorder Unspecified

Adjustment Disorder unspecified can be used for insurance purposes before a diagnosis is made to begin the process. Here in MA the limit is theoretically three months, but in practice can be used for much longer.

A diagnosis od adjustment disorder for this particular population, for troops coming out of the fighting environment special to the ME, can simply postpone appropriate treatment in what could be a critical time to actually make the diagnosis to implement appropriate treatments. The environment is special compared to civilian life.

Disruption of family relationships, onset of or lack of treatment for drug abuses, TBI diagnosis, or the dropping out of the system after the delay of months waiting for service are cause for concern.

Anxiety in psychological terms can be up to and including quite violent behavior. The same for Irritability.

The average waiting time is already over 1000 days for some in the system. How does the use of a very mild diagnosis category aide the process?

(Edited by rdan for readability)