F43.23

Adjustment disorder with mixed anxiety and depressed mood

Adjustment disorder with mixed anxiety and depressed mood is a mental health condition characterized by an emotional or behavioral reaction to an identifiable life stressor. This specific subtype involves a combination of symptoms typically associated with both anxiety (such as nervousness, worry, or jitteriness) and depression (such as low mood, tearfulness, or feelings of hopelessness). The symptoms must develop within three months of the onset of the stressor and must be clinically significant, either by causing marked distress that is out of proportion to the severity of the stressor or by causing significant impairment in social, occupational, or other important areas of functioning. It is distinguished from other mood or anxiety disorders by its direct temporal relationship with a stressor and the fact that symptoms typically resolve once the stressor is removed or a new level of adaptation is achieved.

Clinical Symptoms

  • Persistent feelings of sadness and hopelessness
  • Tearfulness or frequent crying spells
  • Excessive worry or apprehension
  • Nervousness or jitteriness
  • Difficulty concentrating or 'mind going blank'
  • Social withdrawal or isolation
  • Sleep disturbances (insomnia or hypersomnia)
  • Fatigue or loss of energy
  • Physical symptoms of anxiety (palpitations, trembling)
  • Reduced ability to perform daily tasks or work duties

Common Causes

  • Major life changes (e.g., divorce, marriage, moving)
  • Occupational stressors (e.g., job loss, toxic work environment)
  • Financial difficulties or economic instability
  • Relationship conflicts or family problems
  • Chronic or acute medical illness in self or a loved one
  • Educational challenges or school-related pressure
  • History of trauma or multiple life stressors
  • Inadequate social support systems

Documentation & Coding Tips

Identify and document the specific stressor.

Example: 'Patient's symptoms began two months following a formal notification of corporate downsizing and impending job loss.'

Clarify the temporal relationship.

Example: 'Onset of emotional symptoms occurred within 60 days of the patient's primary stressor (divorce filing).'

Differentiate from Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD).

Example: 'While the patient exhibits both low mood and worry, the symptoms do not meet the full diagnostic criteria for MDD or GAD and are directly linked to the identified situational stressor.'

Document the impairment in functioning.

Example: 'The patient reports an inability to maintain focus at work and has missed three days of school due to overwhelming distress.'

Relevant CPT Codes

Related Diagnoses

Hierarchy