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Depressive Disorders
Depressive Disorder
| Question | Answer |
|---|---|
| Disruptive Mood Dysregulation Disorder | The core feature of disruptive mood dysregulation disorder is chronic, severe persistent irritability. This severe irritability has two prominent clinical manifestations, the first of which is frequent temper outbursts. These outbursts typically occur in response to frustration and can be verbal or behavioral (the latter in the form of aggression against property, self, or others). |
| Disruptive Mood Dysregulation Disorder (Criterion A, B & C) | A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The temper outbursts occur, on average, three or more times per week. |
| Disruptive Mood Dysregulation Disorder (Criterion D, E & F) | D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). E. Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A–D. F. Criteria A and D are present in at least two of three settings (at home, at school, with peers) and are severe in at least one of these. |
| Disruptive Mood Dysregulation Disorder (Criterion G, H & I) | G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age at onset of Criteria A–E is before 10 years. I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. |
| Disruptive Mood Dysregulation Disorder (Criterion J) | J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]). |
| Disruptive Mood Dysregulation Disorder (Criterion J Note) | Diagnosis cannot with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, coexist major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorder. Symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should be given the diagnosis of disruptive mood dysregulation disorder. Ever experienced a hypo/manic or episode, disruptive mood dysregulation disorder should not be assigned. |
| Disruptive Mood Dysregulation Disorder (Criterion K) | K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition. |
| Major Depressive Disorder | The criterion symptoms for major depressive disorder must be present nearly every day to be considered present, with the exception of weight change and suicidal ideation. De- pressed mood must be present for most of the day, in addition to being present nearly every day. Often insomnia or fatigue is the presenting complaint, and failure to probe for accompanying depressive symptoms will result in under diagnosis. |
| Major Depressive Disorder (Criterion A) | A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. |
| Major Depressive Disorder (Criterion A: 1-2) | 1. Depressed mood most of the day, nearly everyday, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). |
| Major Depressive Disorder (Criterion A: 3-4) | 3. Significant weight loss when not dieting or weight gain(e.g.,a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) 4. Insomnia or hypersomnia nearly everyday. |
| Major Depressive Disorder (Criterion A: 5-7) | 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly everyday. 7. Feelings of worthless ness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). |
| Major Depressive Disorder (Criterion A: 8-9) | 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. |
| Major Depressive Disorder (Criterion B & C) | B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or to another medical condition. |
| Major Depressive Disorder (Criterion D & E) | D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition. |
| Major Depressive Disorder (Bereavement Note) | Responses to a significant loss; the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss. |
| Major Depressive Disorder (Specifier) | With anxious distress (p. 184) With mixed features (pp. 184–185) With melancholic features (p. 185) With atypical features (pp. 185–186) With mood-congruent psychotic features (p. 186) With mood-incongruent psychotic features (p. 186) With catatonia (p. 186). Coding note: Use additional code 293.89 (F06.1). With peripartum onset (pp. 186–187) With seasonal pattern (recurrent episode only) (pp. 187–188 |
| Persistent Depressive Disorder (Dysthymia) | The essential feature of persistent depressive disorder (dysthymia) is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years, or at least 1 year for children and adolescents. Individuals with persistent depressive disorder describe their mood as sad or “down in the dumps.” |
| Persistent Depressive Disorder (Dysthymia) (Criterion A) | A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. |
| Persistent Depressive Disorder (Dysthymia) (Criterion B) | B. Presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness. |
| Persistent Depressive Disorder (Dysthymia) (Criterion C, D & E) | C. During the 2-year period(1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. |
| Persistent Depressive Disorder (Dysthymia) (Criterion F & G) | F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism). |
| Persistent Depressive Disorder (Dysthymia) (Criterion H) | H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
| Persistent Depressive Disorder (Dysthymia) (Specifier) | With anxious distress (p. 184) With mixed features (pp. 184–185) With melancholic features (p. 185) With atypical features (pp. 185–186) With mood-congruent psychotic features (p. 186) With mood-incongruent psychotic features (p. 186) With peripartum onset (pp. 186–187) |
| Persistent Depressive Disorder (Dysthymia) (Specifier) | In partial remission (p. 188) In full remission (p. 188) Early onset: If onset is before age 21 years. Late onset: If onset is at age 21 years or older. With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years. With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period. |
| Persistent Depressive Disorder (Dysthymia) (Specifier) | With intermittent major depressive episodes, with episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode. With intermittent major depressive episodes, without current episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years. |
| Persistent Depressive Disorder (Dysthymia) (Specifier) | Mild: Few, symptoms in excess of those required to make the diagnosis are present, the intensity is distressing but manageable, and result in minor impairment functioning. Moderate: The number, intensity of symptoms, functional impairment are between those specified for “mild” and “severe.” Severe: The symptoms is substantially in excess of that required to make the diagnosis, the intensity is seriously distressing and unmanageable, markedly interfere with social and occupational functioning. |
| Premenstrual Dysphoric Disorder | The essential features of premenstrual dysphoric disorder are the expression of mood lability, irritability, dysphoria, and anxiety symptoms that occur repeatedly during the pre- menstrual phase of the cycle and remit around the onset of menses or shortly thereafter. These symptoms may be accompanied by behavioral and physical symptoms. |
| Premenstrual Dysphoric Disorder (Criterion A) | A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses. |
| Premenstrual Dysphoric Disorder (Criterion B) | B. One (or more) of the following symptoms must be present: 1. Marked affective lability(e.g.,mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection). 2. Marked irritability or anger or increased interpersonal conflicts. 3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. 4. Marked anxiety, tension, and/or feelings of being keyed up or on edge. |
| Premenstrual Dysphoric Disorder (Criterion C: 1-4) | C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above. 1. Decreased interest in usual activities (e.g.,work, school, friends, hobbies). 2. Subjective difficulty in concentration. 3. Lethargy, easy fatigability, or marked lack of energy. 4. Marked change in appetite; overeating; or specific food cravings. . |
| Premenstrual Dysphoric Disorder (Criterion C: 5-7) | 5. Hypersomnia or insomnia. 6. A sense of being overwhelmed or out of control. 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain ,a sensation of “bloating,” or weight gain. Note: The symptoms in Criteria A–C must have been met for most menstrual cycles that occurred in the preceding year. |
| Premenstrual Dysphoric Disorder (Criterion D & E) | D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others. E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders). |
| Premenstrual Dysphoric Disorder (Criterion F & G) | F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.) G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism). |
| Substance/Medication-Induced Depressive Disorder | The diagnostic features of substance/medication-induced depressive disorder include the symptoms of a depressive disorder, such as major depressive disorder; however, the depressive symptoms are associated with the ingestion, injection, or inhalation of a sub- stance. |
| Substance/Medication-Induced Depressive Disorder (Criterion A) | A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or plea- sure in all, or almost all, activities. |
| Substance/Medication-Induced Depressive Disorder (Criterion B) | B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2): 1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. 2. The involved substance/medication is capable of producing the symptoms in Criterion A. |
| Substance/Medication-Induced Depressive Disorder (Criterion C) | C. The disturbance is not better explained by a depressive disorder that is not substance/ medication-induced. Independent depressive disorder could include the following: The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced depressive disorder |
| Substance/Medication-Induced Depressive Disorder (Criterion D & E) | D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention. |
| Depressive Disorder Due to Another Medical Condition | The essential feature of depressive disorder due to another medical condition is a prominent and persistent period of depressed mood or markedly diminished interest or plea- sure in all, or almost all, activities that predominates in the clinical picture and that is thought to be related to the direct physiological effects of another medical condition |
| Depressive Disorder Due to Another Medical Condition (Criterion A & B) | A. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture. B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. |
| Depressive Disorder Due to Another Medical Condition (Criterion C, D & E) | C. The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition). D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
| Depressive Disorder Due to Another Medical Condition (Specifier) | F06.31) With depressive features: Full criteria are not met for a major depressive episode. (F06.32) With major depressive–like episode: Full criteria are met (except Criterion C) for a major depressive episode. (F06.34) With mixed features: Symptoms of mania or hypomania are also present but do not predominate in the clinical picture. |
| Other Specified Depressive Disorder | This category applies to presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment areas of functioning do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class. The other specified depressive disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific depressive disorder. |
| Other Specified Depressive Disorder (Specifier) | 1. Recurrent brief depression: Concurrent presence of depressed mood and at least four other symptoms of depression for 2–13 days at least once per month (not associated with the menstrual cycle) for at least 12 consecutive months in an individual whose presentation has never met criteria for any other depressive or bipolar disorder and does not currently meet active or residual criteria for any psychotic disorder. |
| Other Specified Depressive Disorder (Specifier) | 2. Short-duration depressive episode(4-13days): Depressed affect and at least four of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persists for more than 4 days, but less than 14 days, in an individual whose presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic dis- order, and does not meet criteria for recurrent brief depression. |
| Other Specified Depressive Disorder (Specifier) | 3. Depressive episode with insufficient symptoms: Depressed affect and at least one of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment that persist for at least 2 weeks in an individual whose presentation has never met criteria for any other depressive or bipolar disorder, does not currently meet active or residual criteria for any psychotic disorder, and does not meet criteria for mixed anxiety and depressive disorder symptoms. |
| Unspecified Depressive Disorder | This category applies symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment areas of functioning do not meet the full criteria the depressive disorders diagnostic class. The unspecified depressive disorder category is used when the clinician chooses not to specify the reason that the criteria are not met for a specific depressive disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis. |
| Specifiers for Depressive Disorders (Anxious Distress) | With anxious distress: Anxious distress is defined as the presence of at least two of the following symptoms during the majority of days of a major depressive episode or persistent depressive disorder (dysthymia): 1. Feeling keyed up or tense. 2. Feeling unusually restless. 3. Difficulty concentrating because of worry. 4. Fear that something awful may happen. 5. Feeling that the individual might lose control of himself or herself. |
| Specifiers for Depressive Disorders (Anxious Distress Specifier) | Mild: Two symptoms. Moderate: Three symptoms. Moderate-severe: Four or five symptoms. Severe: Four or five symptoms and with motor agitation. |
| Specifiers for Depressive Disorders (Mixed Features Criterion A: 1-5) | A. At least three of the following manic/hypomanic symptoms are present nearly every day during the majority of days of a major depressive episode: 1. Elevated, expansive mood. 2. Inflated self-esteem or grandiosity. 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Increase in energy or goal-directed activity(either socially, at work or school, or sexually). |
| Specifiers for Depressive Disorders (Mixed Features Criterion A: 6-7) | 6. Increased or excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual in- discretions, foolish business investments). 7. Decreased need for sleep(feeling rested despite sleeping less than usual; to be contrasted with insomnia). |
| Specifiers for Depressive Disorders (Mixed Features Criterion B & C) | B. Mixed symptoms are observable by others and represent a change from the person’s usual behavior. C. For individuals whose symptoms meet full criteria for either mania or hypomania, the diagnosis should be bipolar I or bipolar II disorder. |
| Specifiers for Depressive Disorders (Mixed Features Criterion D) | D. The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment). |
| Specifiers for Depressive Disorders (Melancholic Features Criterion A) | A. One of the following is present during the most severe period of the current episode: 1. Loss of pleasure in all, or almost all, activities. 2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens). |
| Specifiers for Depressive Disorders (Melancholic Features Criterion B) | B. Three (or more) of the following: 1. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood. 2. Depression that is regularly worse in the morning. 3. Early-morning awakening(i.e.,at least 2 hours before usual awakening). 4. Marked psychomotor agitation or retardation. 5. Significant anorexia or weight loss. 6. Excessive or inappropriate guilt. |
| Specifiers for Depressive Disorders (Atypical Features Criterion A & B) | A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events). B.Two (or more) of the following: 1. Significant weight gain or increase in appetite. 2. Hypersomnia. 3. Leaden paralysis(i.e.,heavy, leaden feelings in arms or legs). 4. A long-standing pattern of interpersonal rejection sensitivity(not limited to episodes of mood disturbance) that results in significant social or occupational impairment. |
| Specifiers for Depressive Disorders (Atypical Features Criterion C) | C. Criteria are not met for “with melancholic features” or “with catatonia” during the same episode. Atypical depression” has historical significance and today does not connote an uncommon or unusual clinical presentation as the term might imply. |
| Specifiers for Depressive Disorders (Psychotic Features: Delusions and/or hallucinations are present. ) | With mood-congruent psychotic features: The delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. With mood-incongruent psychotic features: The content of the delusions or hallucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood-incongruent and mood-congruent themes. |
| Specifiers for Depressive Disorders (Catatonia) | The catatonia specifier can apply to an episode of depression if catatonic features are present during most of the episode. See criteria for catatonia associated with a mental disorder (for a description of catatonia, see the chapter “Schizophrenia Spectrum and Other Psychotic Disorders”). |
| Specifiers for Depressive Disorders (Peripartum Onset) | This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks follow- ing delivery. |
| Specifiers for Depressive Disorders (Seasonal Pattern Criterion A & B) | A. There has been a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and a particular time of the year (e.g.,in the fall or winter). B. Full remissions (or a change from major depression to mania or hypomania) also occur at a characteristic time of the year (e.g., depression disappears in the spring). |
| Specifiers for Depressive Disorders (Seasonal Pattern Criterion C & D) | C. In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined above and no nonseasonal major depressive episodes have occurred during that same period. D. Seasonal major depressive episodes (as described above) substantially outnumber the nonseasonal major depressive episodes that may have occurred over the individual’s lifetime. |
| Specifiers for Depressive Disorders (Remission) | In partial remission: Symptoms of the immediately previous major depressive episode are present, but full criteria are not met, or there is a period lasting less than 2 months without any significant symptoms of a major depressive episode following the end of such an episode. In full remission: During the past 2 months, no significant signs or symptoms of the disturbance were present. |
| Specifiers for Depressive Disorders (Severity) | Mild: Few, symptoms in excess of those required to make the diagnosis are present, the intensity is distressing but manageable, and result in minor impairment functioning. Moderate: The number, intensity of symptoms, functional impairment are between those specified for “mild” and “severe.” Severe: The symptoms is substantially in excess of that required to make the diagnosis, the intensity is seriously distressing and unmanageable, markedly interfere with social and occupational functioning. |
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