This 53 year old man is clearly suffering from an adjustment disorder. Although he also meets the diagnostic criteria for major depression, I am reluctant to assign this diagnosis 206 Structuring and Assessmentbecause his depressive symptoms are so strongly associated with his recent life change, and he has no personal and minimal family history of a mood disorder. Mr. Smith is also experiencing numerous signi?cant anxiety symptoms, which may actually be more central than his depressive symptoms in interfering with his ability to seek new employment. Similarly, a case could also be made for assigning him an anxiety disorder diagnosis, but again, the abrupt onset of these symptoms in direct association with his job loss suggests that his current mental state is better accounted for with a less severe diagnostic label.
His provisional DSM IV TR multiaxial diagnosis follows: Axis I: 309.28 Adjustment Disorder with Features of Anxiety and Depression Rule Out 296.21 Major Depressive Disorder, Single Episode, Mild Axis II: No Diagnosis on Axis II Axis III: None Axis IV: Severe: Recent job loss after 31 years of employment Axis V: GAF = 51