Statement of Principles concerning adjustment disorder No. 57 of 1996 (Cth)
Instrument No.57 of 1996
Determination
of
Statement of Principles
concerning
ADJUSTMENT DISORDER
ICD CODES: 309.0, 309.1, 309.24, 309.28, 309.3, 309.4, 309.9
Veterans’ Entitlements Act 1986
This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act).
Kind of injury, disease or death
(a) This Statement of Principles is about adjustment disorder and death from adjustment disorder.
(b) For the purposes of this Statement of Principles, “adjustment disorder” means the development of clinically significant emotional or behavioural symptoms in response to an identifiable psychosocial stressor or stressors, which occur within the three months after the onset of the stressor(s), which do not persist for more than six months after cessation of the stressor(s) and which do not meet the diagnostic criteria for another specific clinical psychiatric disorder, attracting ICD code 309.0, 309.1, 309.24, 309.28, 309.3, 309.4 or 309.9. The specific diagnostic criteria for making a diagnosis of adjustment disorder as set out in the DSM-IV are as follows (APA 1994, p.626-627):
A. The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s).
B. These symptoms or behaviours are clinically significant as evidenced by either of the following:
(1) marked distress that is in excess of what would be expected from exposure to the stressor
(2) significant impairment in social or occupational (academic) functioning
C. The stress related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
D. The symptoms do not represent Bereavement.
E. Once the Stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional six months.
Adjustment Disorder is specified as Acute or Chronic where
(i) Acute applies if the disturbance lasts less than six months; or
(ii) Chronic applies if the disturbance lasts for six months or longer.
The symptoms may persist for a prolonged period if they occur in response to a chronic stressor (typically a chronic disabling medical condition, for example, cardiorespiratory failure, malignancy) or to a stressor that has enduring consequences;
Basis for determining the factors
The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that adjustment disorder can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
Factors that must be related to service
Subject to clause 6, the factors set out in at least one of the paragraphs in clause 5 must be related to any relevant service rendered by the person.
Factors
The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting adjustment disorder or death from adjustment disorder with the circumstances of a person’s relevant service are:
(a) experiencing an identifiable psychosocial stressor or stressors within the three months immediately before the clinical onset of adjustment disorder; or
(b) experiencing an identifiable psychosocial stressor or stressors within the three months immediately before the clinical worsening of adjustment disorder; or
(c) inability to obtain appropriate clinical management for adjustment disorder.
Factors that apply only to material contribution or aggravation
Paragraphs 5(b) to 5(c) apply only to material contribution to, or aggravation of, adjustment disorder where the person’s adjustment disorder was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Other definitions
For the purposes of this Statement of Principles:
“DSM-IV” means the fourth edition of the American Psychiatric Association’s Diagnostic and Statistic Manual of Mental Disorders;
“ICD code” means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1995, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 22235 5;
“psychosocial stressor(s)” means an injury, disease or occurrence that evokes in an individual feelings of substantial anxiety or stress (for example being shot at, being involved in a motor vehicle accident, experiencing a failure or loss such as divorce; or receiving a diagnosis of a disabling medical condition such as a malignancy or chronic cardiorespiratory disorder);
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service.
Dated this Eighteenth day of April 1996
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of )
KEN DONALD
CHAIRMAN
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