Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Adjustment Disorder with Anxiety


Related Terms

  • Adjustment Disorder with Anxious Mood
  • Adjustment Reaction
  • Adjustment Reaction with Anxious Mood

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Alcohol or substance abuse disorders
  • Mental or medical disorders
  • Personality disorder

Factors Influencing Duration

Continued exposure to the stressor will often lead to continuing maladaptive behavior and symptoms in adjustment disorders. The severity of the stressor is not always predictive of the severity of adjustment disorder. The severity of the condition depends on degree, quantity, duration, and reversibility of the stressor, the overall environment, and social support structure. Underlying personality traits and characteristics, and personal context in terms of what the stressor means to the individual also affect severity. The context of the individual's cultural setting should also be taken into account in determining whether the reaction to stress is in excess of what would be expected.

Medical Codes

ICD-9-CM:
309.24 - Adjustment Reaction with Predominant Disturbance of Other Emotions; Adjustment Disorder with Anxiety or Disturbance of Conduct
309.28 - Adjustment Reaction with Predominant Disturbance of Other Emotions; Adjustment Reaction with Mixed Anxiety and Depression

Diagnosis

History: A diagnosis of adjustment disorder should only be made when the magnitude of distress exhibited in alterations in mood, anxiety, or conduct exceeds what would normally be expected given the context surrounding the stressor event(s). Adjustment disorders may be diagnosed, for example, following the death of a loved one when the intensity, quality, or persistence of grief reactions are greater than normally expected when cultural, religious, or age-appropriate norms are considered (DSM-5). Adjustment disorder may be diagnosed in the presence of another psychiatric disorder if the latter does not account for the pattern of symptoms that have occurred in response to the stressor.

It is expected for individuals with adjustment disorder to exhibit emotional or behavior symptoms to a recognizable stressor(s) within 3 months of the onset and for those symptoms to resolve no longer than 6 months after the stressor and its consequences have ceased. If the stressor is an acute event such as being fired from a job, the onset of the symptoms usually occurs within a few days and then resolve within a few months. However, if the stressor or its consequences linger, the adjustment disorder may become continuous and become the persistent form (DSM-5). Both DSM-5 and DSM-IV-TR acknowledge that if a stressor or its consequences persist, the disorder may become chronic, which DSM-IV-TR defines as lasting 6 months or longer.

Under the category of stressor-related disorders, it is necessary to specify the sub-category of adjustment disorder with anxiety by identifying a predominance of nervousness, worry, jitteriness and separation anxiety. Other sub-categories include depressed mood, or a mixed anxiety and depressed mood, disturbance of conduct, or mixed disturbance of emotions and conduct (DSM-5 and DSM-IV-TR).

Physical exam: The physical exam is important in ruling out anxiety caused by the physiological effects of a medical condition such as hyperthyroidism or chronic obstructive pulmonary disease (COPD). Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide essential signs to help diagnose adjustment disorder with anxiety. For example, there may be poor attention to grooming, or verbalizations inconsistent with emotional state (affect), such as saying, "I feel fine" while clenching the jaw and frowning. Physical manifestations of anxiety may include sweaty palms, rapid pulse, pale or flushed skin, frequent sighing, and restless behavior such as pacing or fidgeting.

Tests: Psychological testing, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) or the State-Trait Anxiety Inventory, can be a useful adjunct to diagnosing Adjustment Disorders. It is better to use objective psychological tests, such as the MMPI-2 or the Personality Assessment Inventory (PAI) or the Millon Clinical Multi-axial Inventory-III (MCMI-III), instead of subjective inventories, such as the State-Trait Anxiety Inventory. Inventories and other subjective tests may allow outcomes of the testing to be easily influenced by the test taker, resulting in exaggeration of psychological distress.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor






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