and Differential Diagnosis
the diagnostic constructs required for the diagnosis of AD is difficult to
assess and measure: 1) the stressor, 2) the mal-adaptive reaction to the
stressor, and 3) the time and relationship between the stressor and the
psychological response. None of these three components has been operationalized
for a diagnostic decision tree, which consequently plagues the AD diagnosis
with limited reliability.
contrast to other DSM-IV-TR disorders, the diagnostic criteria for AD include
no clear and specific symptoms (or check-list) that collectively compose a
psychiatric (medical) syndrome or disorder.
with regard to the maladaptive reaction, it is unclear how this concept can or
should be operationalized. The social, vocational and relationship
dysfunctions, which are unspecified qualitatively or quantitatively, do not
lend themselves to reliable or to valid assessment. The elements of culture
(i.e., the expect-able reactions within a specific cultural environment),
differ-ences in gender responses, developmental level differences and differences
in the “meaning” of events and reactions to them by a specific individual
further confound it.
concepts of “average expectable environment” (e.g., the expectation of adequate
food in a household in an industrial so-ciety) and “patient’s explanatory
belief model” are examples of an attempt to weigh cultural and subjective
differences in the assess-ment of an individual’s mental state and reaction.
Such individual cultural–social considerations often require an understanding
on the part of the psychiatrist and thereby often render the assessment of
whether a reaction is excessive or maladaptive a judgment call.
criterion and predictive validity of the diagnosis of AD in 92 children who had
new onset insulin-dependent diabetes mellitus were examined. DSM-III criteria
were employed plus requiring four clinically significant signs or symptoms, and
the time frame extended to 6 months (instead of the 3 months speci-fied in the
definition) after the diagnosis of diabetes. Thirty-three percent of the cohort
developed AD (mean 29 days after the med-ical diagnosis) and the average
episode length was 3 months with a recovery rate of 100%. The five-year
cumulative probability of a new psychiatric disorder was 0.48 in comparison to
0.16 for the nonAD subjects. The findings support the criterion validity of the
AD diagnosis using the criterion of predicting the future development of