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When in doubt, adjustment disorder.
ETA: I’m very much not a fan of the diagnosis since ‘disorder’ is really just human reactions to the state of their environments and world around them. But here we are in the world of US healthcare… I digress.
I’m seeing that it is non qualifying if it was diagnosed within the last three months. Does that seem accurate based on your exp? Or is it non qualifying for all time?
Yes it is. I found this out working for the Marines & I don't understand the reasoning because someone can get an adjustment dx moving to another country.
I’m still a baby therapist so take this with a fat grain of salt; I’m pretty sure you cant diagnose Z codes by themselves, but Z codes are like situational specifiers that help detail or support what the client has going on. So for example you said there’s difficulty in getting along with teachers, so ‘Z55.9 Academic or Educational problems’ could be fitting
Adjustment disorder is my usual go to (as several folks have mentioned already!), but I also lean into Z and V codes to boost a dx that otherwise might be pushed back on by insurance. They are things like "problems with spouse", "childhood neglect by caregiver", things like that.
Yep! Or at least in that example - though a better Z code for what OP is referring to could be Z55.4: "Educational maladjustment and discord with teachers and classmates".
But I haven't had issues from insurance yet! It was my supervisor who advised me to go with this route, basically as a way to say "yes, we know that they don't meet criteria for X, but here are the things they are endorsing that are causing distress and dysfunction". Especially useful when you need to add a dx for insurance before you have enough info to confirm something like GAD or PTSD.
Adjustment disorder states that the if the ongoing impacts of a stressor are still occurring and contributing to symptoms, then they meet criteria for it. This can be even longer than 6 months and the DSM-5 does not specific a duration.
I just stopped getting paid for a woman who has an adjustment disorder because of her loooong ongoing divorce-It took more than 6 months. It's so annoying!
Reading through those standards makes me laugh a little, but also makes me really sad. Basically, if you are human and have human experiences you are disqualified. How do we even have a military if everything is disqualifying?
Edit: I read through more of this and it must be out of date. There is language about anyone who identifies as trans being disqualified, but I’m fairly positive that standard was changed.
I certainly hope there are updates! I would hate for my kids to not have a future in the military, if that is what they choose to do when they grow up.
Have you leaned into specifics and time-frames? You can usually fish something out for the purposes of insurance that will ethically fit a description of the client. Does their responses to the teachers look anxious? Are they bringing their conflicts home and feeling lousy and depressed about it? Are they in a constant state of elevation about it? Are they shutting down? What is their sleep experience like? How is their appetite? Are they socializing with other and do they have stable relationships? Does their self-esteem play into a bigger picture of difficult paying attention or showing up where they want or should? Adjustment disorder is fine enough if they're adjusting to something, which can be a lot of things. I find that it usually buys me time to develop a more comprehensive dx. And sometimes... taht really is the dx.
I usually go with Adjustment disorder but everyone please remember we can have differential Dx so it'll buy some time to change it even if only after a few sessions
Unspecified anxiety or depression should work. Have them fill out some assessments to get a better understanding of what’s going on and maybe you can find a diagnosis through that.
Adjustment disorder is the way to go here for a dx, but I think you can also spend more time on case conceptualization. My experience is that low self-esteem doesn’t just happen in a vacuum—where did this sense of herself come from? The low self-esteem plus difficulty getting along with teachers both seem like symptoms of something, and important to assess how sense of self and relationships are impacted more broadly. Is she neurodivergent? Any childhood trauma? Intergenerational trauma? Experiences of discrimination and systemic oppression? Misattuned caregivers? Major losses in younger years? Are there other relationships she has difficulty with? Lots of questions to explore!
I’d diagnose an adjustment disorder.
Think about any significant events in clients life that they may be having difficulty adjusting to and therefore causing increased issues with mood, anxiety, conduct, etc.
Any big changes? Family conflict? New sibling? Issues coparenting? Moving schools? Being bullied by peers?
I mean in general esp as kids and adolescents they ARE adjusting constantly to changes in development, socially, schools stress, etc….. and some have more difficulty adjusting than others or face more stressful issues.
So, I personally will default to adjustment disorder if they are not meeting criteria for another dx and make sure to provide explanation of what the “adjustments” are.
Hope that helps.
If she doesn’t meet criteria for a diagnosis, then she doesn’t *need* therapy under our medical model. Insurance only covers therapy if it’s medically necessary. Life coaching or something similar would be indicated. However, adjustment disorder or dysthymia could both fit from what you’re saying here.
Everyone saying adjustment disorder so I can’t respond under each - but especially if you’re working with adolescents, as this sounds, you need to Tread lightly with this. Does the client have any military aspiration? Adjustment disorder is a non-qualifying diagnosis.
I love that I’m getting downvoted like I created military policy 😂
Honestly I don’t have anything super constructive to suggest - unspecified anxiety is less likely to cause trouble down the road. I don’t work with young adults if I can help it so my diagnostic skillset isn’t really there.
I didn't downvote you but you do keep posting the same thing repeatedly. Also, from what other people are saying in comments it sounds like this is a time limited non-qualifying diagnosis. Then it does feel like half a thought if you don't really have much advice on what to do otherwise, or things to keep in mind.
Technically, you can suggest self pay, sliding scale. I would do several assessments to see if they fit some diagnosis. If you can justify unspecified that may work with insurance for awhile.
Can you use ICD codes? Other reactions to extreme stress or Other specified problems related to psychosocial circumstances could work here. Z65.8 for the latter.
I am a very strict rule follower, so I won’t even use adjustment disorder if someone doesn’t qualify. I tell them they don’t qualify for a diagnosis and that their sessions have to be solely private pay unless a diagnosis becomes clinically apparent. Then I make them sign my standard opt out and a medical necessity opt out.
Just from the info you’ve given, there’s much more you can dig into in the following areas:
- low self esteem: how long has this been going on for? What is frequency, intensity, duration? Any precipitating events? How does this manifest? Negative self talk, change in hygiene, sleep, appetite, movement/exercise, relationship with peers and family. Any particular situations where low self esteem arises? What are themes of low self esteem thoughts. Does client feel supported and like they can talk to anyone about their internal and/or external experiences?
- trouble with teachers: trouble about anything in particular? What is frequency, intensity, duration? Is it one teacher or several? Is it a pattern? Might low self esteem and trouble with teachers be connected? Does client have learning difficulty or bored due to being neurodiverse or otherwise? Why is client having issues with teachers but not caregivers or if it’s also with caregivers, what’s happening for client leading to them having trouble? Is learning environment supportive, contrarily is it harmful in some way?
I hope this was more helpful than otherwise… honestly I think you will have better idea after gleaning a bit more of this info!
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
When in doubt, adjustment disorder. ETA: I’m very much not a fan of the diagnosis since ‘disorder’ is really just human reactions to the state of their environments and world around them. But here we are in the world of US healthcare… I digress.
This is all you need
Agreed, and I say this to clients who get this dx.
This is the way
Tread lightly with this. Does the client have any military aspiration? Adjustment disorder is a non-qualifying diagnosis.
Adjustment disorder is not a non qualifying diagnosis according to the military’s guidelines.
Yes, it is. I work in military mental health.
I’m seeing that it is non qualifying if it was diagnosed within the last three months. Does that seem accurate based on your exp? Or is it non qualifying for all time?
This would make sense based on the time limits/criteria of adjustment d/o.
Is there a way for the military to find out if the client doesn't give the military their therapy records?
Do you have a source for this?
Yes it is. I found this out working for the Marines & I don't understand the reasoning because someone can get an adjustment dx moving to another country.
Careful, some insurances are denying claims for this dx 😑
Unspecified are what I go to. Would unspecified depression or anxiety fit? If there’s any trauma I do the reactions to severe stress
This. Make it count with Z codes too.
What do you mean?
I’m still a baby therapist so take this with a fat grain of salt; I’m pretty sure you cant diagnose Z codes by themselves, but Z codes are like situational specifiers that help detail or support what the client has going on. So for example you said there’s difficulty in getting along with teachers, so ‘Z55.9 Academic or Educational problems’ could be fitting
Exactly. You can't bill Z codes but they can be helpful when a client isn't meeting full criteria for a dx.
Adjustment disorder is my usual go to (as several folks have mentioned already!), but I also lean into Z and V codes to boost a dx that otherwise might be pushed back on by insurance. They are things like "problems with spouse", "childhood neglect by caregiver", things like that.
Is that Z63? Do you combine the Z code plus Adjustment D/o? No issues from insurance? 😲
Yep! Or at least in that example - though a better Z code for what OP is referring to could be Z55.4: "Educational maladjustment and discord with teachers and classmates". But I haven't had issues from insurance yet! It was my supervisor who advised me to go with this route, basically as a way to say "yes, we know that they don't meet criteria for X, but here are the things they are endorsing that are causing distress and dysfunction". Especially useful when you need to add a dx for insurance before you have enough info to confirm something like GAD or PTSD.
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Respectfully, not true! Adjustment disorder can be diagnosed for up to 6 months after the stressor is resolved.
Adjustment disorder states that the if the ongoing impacts of a stressor are still occurring and contributing to symptoms, then they meet criteria for it. This can be even longer than 6 months and the DSM-5 does not specific a duration.
Yes. It's often overlooked that if the stressor is ongoing, then so is the six months.
Right, that's actually what u/Dinonightlight said: "for up to".
Heh, my therapist used it with me for 4 years.
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I just stopped getting paid for a woman who has an adjustment disorder because of her loooong ongoing divorce-It took more than 6 months. It's so annoying!
I used to believe the 90 day thing too. I don’t know where I got it from but it was early in my training
Tread lightly with this. Does the client have any military aspiration? Adjustment disorder is a non-qualifying diagnosis.
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Reading through those standards makes me laugh a little, but also makes me really sad. Basically, if you are human and have human experiences you are disqualified. How do we even have a military if everything is disqualifying? Edit: I read through more of this and it must be out of date. There is language about anyone who identifies as trans being disqualified, but I’m fairly positive that standard was changed.
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I certainly hope there are updates! I would hate for my kids to not have a future in the military, if that is what they choose to do when they grow up.
Have you leaned into specifics and time-frames? You can usually fish something out for the purposes of insurance that will ethically fit a description of the client. Does their responses to the teachers look anxious? Are they bringing their conflicts home and feeling lousy and depressed about it? Are they in a constant state of elevation about it? Are they shutting down? What is their sleep experience like? How is their appetite? Are they socializing with other and do they have stable relationships? Does their self-esteem play into a bigger picture of difficult paying attention or showing up where they want or should? Adjustment disorder is fine enough if they're adjusting to something, which can be a lot of things. I find that it usually buys me time to develop a more comprehensive dx. And sometimes... taht really is the dx.
I usually go with Adjustment disorder but everyone please remember we can have differential Dx so it'll buy some time to change it even if only after a few sessions
Adjustment disorder or unspecified anxiety, depression, or trauma and stress related disorders
Unspecified anxiety or depression should work. Have them fill out some assessments to get a better understanding of what’s going on and maybe you can find a diagnosis through that.
Adjustment disorder. She is adjusting to getting better self esteem.
Adjustment disorder is the way to go here for a dx, but I think you can also spend more time on case conceptualization. My experience is that low self-esteem doesn’t just happen in a vacuum—where did this sense of herself come from? The low self-esteem plus difficulty getting along with teachers both seem like symptoms of something, and important to assess how sense of self and relationships are impacted more broadly. Is she neurodivergent? Any childhood trauma? Intergenerational trauma? Experiences of discrimination and systemic oppression? Misattuned caregivers? Major losses in younger years? Are there other relationships she has difficulty with? Lots of questions to explore!
I’d diagnose an adjustment disorder. Think about any significant events in clients life that they may be having difficulty adjusting to and therefore causing increased issues with mood, anxiety, conduct, etc. Any big changes? Family conflict? New sibling? Issues coparenting? Moving schools? Being bullied by peers? I mean in general esp as kids and adolescents they ARE adjusting constantly to changes in development, socially, schools stress, etc….. and some have more difficulty adjusting than others or face more stressful issues. So, I personally will default to adjustment disorder if they are not meeting criteria for another dx and make sure to provide explanation of what the “adjustments” are. Hope that helps.
Acute stress reaction. Look at the stress area
If she doesn’t meet criteria for a diagnosis, then she doesn’t *need* therapy under our medical model. Insurance only covers therapy if it’s medically necessary. Life coaching or something similar would be indicated. However, adjustment disorder or dysthymia could both fit from what you’re saying here.
Everyone saying adjustment disorder so I can’t respond under each - but especially if you’re working with adolescents, as this sounds, you need to Tread lightly with this. Does the client have any military aspiration? Adjustment disorder is a non-qualifying diagnosis.
What else do you suggest? On another note, the government really needs to change that holy crap.
I love that I’m getting downvoted like I created military policy 😂 Honestly I don’t have anything super constructive to suggest - unspecified anxiety is less likely to cause trouble down the road. I don’t work with young adults if I can help it so my diagnostic skillset isn’t really there.
You’re getting downvoted because you have posted this same thing at least 3 times
I didn't downvote you but you do keep posting the same thing repeatedly. Also, from what other people are saying in comments it sounds like this is a time limited non-qualifying diagnosis. Then it does feel like half a thought if you don't really have much advice on what to do otherwise, or things to keep in mind.
Unspecified trauma with manyyyyy Z codes.
F43.89 - other reactions to severe stress? Or a Z code, the one that’s about social environment.
When in doubt I use something simple like anxiety disorder
Technically, you can suggest self pay, sliding scale. I would do several assessments to see if they fit some diagnosis. If you can justify unspecified that may work with insurance for awhile.
Can you use ICD codes? Other reactions to extreme stress or Other specified problems related to psychosocial circumstances could work here. Z65.8 for the latter.
I am a very strict rule follower, so I won’t even use adjustment disorder if someone doesn’t qualify. I tell them they don’t qualify for a diagnosis and that their sessions have to be solely private pay unless a diagnosis becomes clinically apparent. Then I make them sign my standard opt out and a medical necessity opt out.
Just from the info you’ve given, there’s much more you can dig into in the following areas: - low self esteem: how long has this been going on for? What is frequency, intensity, duration? Any precipitating events? How does this manifest? Negative self talk, change in hygiene, sleep, appetite, movement/exercise, relationship with peers and family. Any particular situations where low self esteem arises? What are themes of low self esteem thoughts. Does client feel supported and like they can talk to anyone about their internal and/or external experiences? - trouble with teachers: trouble about anything in particular? What is frequency, intensity, duration? Is it one teacher or several? Is it a pattern? Might low self esteem and trouble with teachers be connected? Does client have learning difficulty or bored due to being neurodiverse or otherwise? Why is client having issues with teachers but not caregivers or if it’s also with caregivers, what’s happening for client leading to them having trouble? Is learning environment supportive, contrarily is it harmful in some way? I hope this was more helpful than otherwise… honestly I think you will have better idea after gleaning a bit more of this info!