DEPRESSIVE

DISORDERS
Is the persistent feelings of
sadness and worthlessness
and a lack of desire to
engage in formerly
pleasurable activities.
DYSRUPTIVE MOOD DYSREGULATION
DISORDER

Disruptive mood dysregulation disorder

(DMDD) is a condition in which a child
is chronically irritable and experiences
frequent, severe temper outbursts that
seem grossly out of proportion to the
situation at hand.
 DIAGNOSTIC CRITERIA
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.
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).
 DIAGNOSTIC CRITERIA
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 (i.e., at home, at school, with peers) and are
severe in at least one of these.
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.
 DIAGNOSTIC CRITERIA
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 hypomanie episode have been
met.
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]).
MAJOR DEPRESSIVE
DISORDER

Major Depressive Disorder is a

condition characterized by one or more
Major Depressive Episodes without a
history of Manic, Mixed, or Hypomanic
Episodes.
DIAGNOSTIC CRITERIA

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.
1. Depressed mood most of the day, nearly every day, 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).
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 every day.
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 every day.

7. Feelings of worthlessness or excessive or inappropriate

guilt (which may be delusional) nearly every day (not
merely self-reproach or guilt about being sick).

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
 DIAGNOSTIC CRITERIA
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.
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 hypomanie
episode .
PERSISTENT DEPRESSIVE DISORDER
(DYSTHYMIA)

is a mild but long-term form of

depression. Symptoms usually last for
at least two years, and often for much
longer than that. Dysthymia interferes
with your ability to function and enjoy
life.
 DIAGNOSTIC FEATURE
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.
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.
 DIAGNOSTIC FEATURE
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 hypomanie episode, and criteria
have never been met for cyclothymic disorder.
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).
H. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
PREMENSTRUAL DYSPHORIC
DISORDER

Premenstrual dysphoric disorder

(PMDD) is a condition in which a
woman has severe depression
symptoms, irritability, and tension
before menstruation.
 DIAGNOSTIC FEATURE
A. In the majority of menstrual cycles, at least five symptoms
must be present in the final week before the onset of menses
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.
 DIAGNOSTIC FEATURE
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.
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.
 DIAGNOSTIC FEATURE
D. The symptoms are associated with clinically significant distress or
interference with work, school, usual social activities, or relationships
with others (e.g., avoidance of social activities; decreased productivity
and efficiency at work, school, or home).
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).
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

Substance/Medication-Induced Depressive
Disorder is the diagnostic name for alcohol or
drug induced depression. Unlike the transient
feelings of sadness that are normal and that
everyone experiences, or even the temporary
hangover or "crash" that often gets people
the morning after alcohol or drug use, when
substance induced depression hits, it feels
considerably worse for much longer.
 DIAGNOSTIC FEATURE
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
pleasure in all, or almost all, activities.
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.
 DIAGNOSTIC FEATURE

C. The disturbance is not better explained by a

depressive disorder that is not substance/medication-
induced.

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
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.
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.
 OTHER SPECIFIED DEPRESSIVE
DISORDER
This category applies to presentations in which
symptoms characteristic of a depressive disorder that
cause clinically significant distress or impairment in
social, occupational, or other important areas of
functioning predominate but 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. This is done by
recording “other specified depressive disorder”
followed by the specific reason (e.g., “short-duration
depressive episode”).
UNSPECIFIED DEPRESSIVE
DISORDER

This category applies to presentations in which

symptoms characteristic of a depressive disorder that
cause clinically significant distress or impairment in
social, occupational, or other important areas of
functioning predominate but do not meet the full criteria
for any of the disorders in the depressive disorders
diagnostic class. The unspecified depressive disorder
category is used in situations in which 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