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 Predominant Disturbance of Conduct


Related Terms

  • Adjustment Reaction with Predominant Disturbance of Conduct
  • Predominant Disturbance of Conduct

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Chronic medical conditions
  • Personality disorder
  • Substance abuse disorders

Factors Influencing Duration

Continued exposure to the stressor can often lead to continuing maladaptive behavior and symptoms. The severity of the stressor is not always predictive of the severity of symptoms. This depends on degree, quantity, duration, and reversibility of the stressor, work and home environment and social supports, and personal context in terms of significance of the stressor to the individual. 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
309.3 - Adjustment Reaction with Predominant Disturbance of Conduct
309.4 - Adjustment Disorder with Mixed Disturbance of Emotions and Conduct

Overview

An adjustment disorder is characterized by a psychological response to an identifiable stressor or life event that results in significant emotional or behavioral symptoms. In adjustment disorder with disturbance of conduct, the main feature is abnormal conduct violating the rights of others or going against societal norms. Examples include truancy, vandalism, reckless driving, fighting, or defaulting on legal responsibilities.

Life stressors that cause adjustment disorders may be single events such as the termination of a job, continuously stressful circumstances such as living in a crime-ridden neighborhood, prolonged circumstances such as a chronic and debilitating medical condition, or multiple simultaneous events such as business difficulties in addition to marital problems. Although a stressor will typically initiate adjustment disorder, it is less likely that predominant disturbance of conduct would be related to solely a physical concern.

Incidence and Prevalence: Adjustment disorders occur in up to 12% of hospitalized individuals referred for a mental health consultation and in 10% to 30% of mental health outpatients. Of those individuals diagnosed with adjustment disorders, the most common subtype is depressed mood followed by, in order of frequency, anxious mood, mixed anxiety and depressed mood, with disturbance of conduct being least frequent (Strain).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Adjustment disorders are fairly common depending on the population studied; as many as 50% of those who experience a specific stressor, such as cardiac surgery, will experience an adjustment disorder. Typically, adjustment disorder with predominant disturbance of conduct occurs when there are changes in the workplace (e.g., down-sizing, workplace performance issues, supervisor issues), marital problems, and other types of problems within the family or personal relationships.

Source: Medical Disability Advisor



Diagnosis

History: Diagnosis is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). Symptoms should occur within 3 months of the identifiable stressful event and not last longer than 6 months after resolution of the stressor or its consequences, unless the symptoms are in response to a chronic stressor.

The symptoms or behaviors are identified as either a marked distress in excess of what would be expected or a significant impairment in social or occupational functioning. The stress-related disturbance cannot be diagnosed as another specific psychiatric disorder or merely an exacerbation of a pre-existing psychiatric disorder. Symptoms cannot be related to bereavement. However, adjustment disorder may be diagnosed in the presence of another psychiatric disorder if the latter does not account for the pattern of symptoms occurring in response to the stressor.

Physical exam: Eliciting a description of the individual's atypical conduct in his or her customary environment is essential. The physical exam is then important in ruling out aberrant changes in behavior caused by the physiological effects of a medical condition. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide important signs to help diagnose the adjustment disorder.

Tests: Psychological testing can be helpful as an adjunct to diagnosing Adjustment Disorders and may include the Minnesota Multiphasic Personality Inventory - 2 or other personality tests. However, subjective tests, such as inventories, are not appropriate to measure psychological distress in an objective manner.

Source: Medical Disability Advisor



Treatment

Psychotherapy is the treatment of choice for adjustment disorders. Ending the stressful situation or removing the individual from the stressful situation is desirable. Group therapy has been effective, especially when individuals in the group have experienced similar stressors. Short-term problem-focused, individual psychotherapy may be helpful to explore the meaning of the stressful situation to the individual so that it may be resolved. Brief psychotherapy, when utilized in a crisis intervention, can help resolve the situation quickly through supportive techniques, suggestion, reassurance, environmental modification, and even hospitalization, if necessary. Cognitive behavioral therapy has a strong empirical base and helps correct disordered thinking and maladaptive behavior; utilization of role-playing, directive therapy, and behavioral logs can help the individual to make meaningful behavioral changes. Pharmacotherapy utilizes anti-anxiety agents and antidepressants to reduce symptoms of disordered mood that may accompany disturbed conduct. These medications should be used judiciously and for brief periods.

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Stress-related Conditions
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

Overall outcome for adjustment disorder is favorable with appropriate treatment. Adjustment disorders generally occur within a short period of time following the stressor and should last no longer than 6 months after the stressor or its consequences have ended. Individuals generally return to normal functioning within a few months.

Source: Medical Disability Advisor



Complications

Adjustment disorders may be associated with substance abuse and physical symptoms. As with other adjustment disorders, suicidal behavior and/or suicide attempts are not a part of the clinical presentation with this disorder. Typically, suicidal ideation or attempts would be indicative of a more serious psychological diagnosis than an adjustment disorder.

If an individual with a pre-existing mental or medical illness is also diagnosed with an adjustment disorder, the course of that illness may be complicated or prolonged through decreased compliance with recommended treatment or increased hospital length of stay.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are necessary only infrequently, for the most serious cases. In these instances, time-limited restrictions and work accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote timely and safe transition back to full work productivity.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual exhibit significant emotional or behavioral symptoms as a result of a stressor or life event?
  • Was diagnosis confirmed? Were other psychiatric and substance abuse disorders ruled out?
  • Were medical disorders with psychiatric presentations rule out?
  • If there is concurrent drug or alcohol abuse, to what extent are these conditions causing additional problems?

Regarding treatment:

  • Has stressor been identified?
  • Was stressful situation eliminated? Would environmental modification or hospitalization be beneficial?
  • Were anti-anxiety agents or antidepressants prescribed?
  • Are social supports adequate?
  • Is additional or extended use of group or individual therapy warranted?
  • Has psychotherapy been added to the pharmacotherapy regimen for the most effective results?
  • Is individual motivated to participate in treatment, and does individual possess the capacity to engage in psychological exploration?

Regarding prognosis:

  • How are current stresses being dealt with?
  • How were major stresses dealt with in the past? If methods of coping are maladaptive (i.e., drug or alcohol abuse), to what extent are these conditions causing additional problems?
  • Who are individual's social supports? Family? Friends? Church or other community affiliations? Are these being utilized?
  • What is happening outside of work that may be contributing to or worsening the problems experienced at work?
  • Are there incentives not to improve such as ongoing litigation, social security, or disability insurance?
  • Does individual have an underlying condition that may impact recovery?
  • Does individual have symptoms of other disorders that may be affecting recovery?
  • Does a stressor exist that has not been identified?
  • Is individual motivated to recover, or do symptoms fulfill psychological, personal, or economic factors?

Source: Medical Disability Advisor



References

Cited

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Strain, J. J. "Adjustment Disorder: A Multisite Study of its Utilization and Interventions in the Consultation-Liaison Psychiatry Setting." General Hospital Psychiatry 3 (1998): 139-149.

Source: Medical Disability Advisor






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