Mood Disorders
Specifiers for Mood Disorders. DSM-5 includes multiple specifiers to describe the Bipolar and Depressive Disorders.
- Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymic Disorder
- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
Depressive disorders:
- Major depressive disorder (MDD), often called major depression
- Persistent depressive disorder (dysthymia)
- Other specified or unspecified depressive disorder
Others are classified by etiology:
- Premenstrual dysphoric disorder
- Depressive disorder due to another medical condition
- Substance-/medication-induced depressive disorder
Major depressive disorder (MDD), often called major depression
According to DSM-5, for diagnosis of major depressive disorder, 5 or more of the following must have been present nearly every day during the same 2-week period, and one of them must be depressed mood or loss of interest or pleasure:
- Depressed mood most of the day
- Markedly diminished interest or pleasure in all or almost all activities for most of the day
- Significant (> 5%) weight gain or loss or decreased or increased appetite
- Insomnia (often sleep-maintenance insomnia) or hypersomnia
- Psychomotor agitation or retardation observed by others (not self-reported)
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate or indecisiveness
- Recurrent thoughts of death or suicide, a suicide attempt, or a specific plan for committing suicide
Persistent depressive disorder (dysthymia)
According to DSM-5, for diagnosis of persistent depressive disorder, patients must have had a depressed mood for most of the day for more days than not for 2 or more years plus 2 or more of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
In addition, 1 or more of the following must be present:
- Decreased interest in usual activities
- Difficulty concentrating
- Low energy or fatigue
- Marked change in appetite, overeating, or specific food cravings
- Hypersomnia or insomnia
- Feeling overwhelmed or out of control
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a feeling of being bloated, and weight gain
Other specified or unspecified depressive disorder
Major depressive disorder and persistent depressive disorder may include one or more specifiers that describe additional manifestations during a depressive episode:
Specify – “mixed features” specifier for bipolar and depressive disorders: Patients also have 3 or more manic or hypomanic symptoms (e.g., elevated mood, grandiosity, greater talkativeness than usual, flight of ideas, decreased sleep, distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences). Patients who have this type of depression are at increased risk of developing bipolar disorder.
Specify – “anxious distress”: Patients feel tense and unusually restless; they have difficulty concentrating because they worry or fear that something awful may happen, or they feel that they may lose control of themselves.
Melancholic: Patients have lost pleasure in nearly all activities or do not respond to usually pleasurable stimuli. They may be despondent and despairing, feel excessive or inappropriate guilt, or have early morning awakenings, marked psychomotor retardation or agitation, and significant anorexia or weight loss.
Atypical: Patients’ mood temporarily brightens in response to positive events (e.g., a visit from children). They also have 2 or more of the following: overreaction to perceived criticism or rejection, feelings of leaden paralysis (a heavy or weighted-down feeling, usually in the extremities), weight gain or increased appetite, and hypersomnia.
Psychotic: Patients have delusions and/or hallucinations. Delusions often involve having committed unpardonable sins or crimes, harboring incurable or shameful disorders, or being persecuted. Hallucinations may be auditory (e.g., hearing accusatory or condemning voices) or visual. If only voices are described, careful consideration should be given to whether the voices represent true hallucinations.
Catatonic: Patients have severe psychomotor retardation, engage in excessive purposeless activity, and/or withdraw; some patients grimace and mimic speech (echolalia) or movement (echopraxia).
Peripartum onset: Onset is during pregnancy or in the 4 weeks after delivery. Psychotic features may be present; infanticide is often associated with psychotic episodes involving command hallucinations to kill the infant or delusions that the infant is possessed.
Seasonal pattern: Episodes occur at a particular time of year, most often fall or winter.
Classified by etiology:
Premenstrual dysphoric disorder
For diagnosis of premenstrual dysphoric disorder, patients must have 5 or more symptoms during the week before menstruation. Symptoms must begin to remit within a few days after onset of menses and become minimal or absent in the week after menstruation. Symptoms must include 1 or more of the following:
- Marked mood swings (e.g., suddenly feeling sad or tearful)
- Marked irritability or anger or increased interpersonal conflicts
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, or an on-edge feeling
Depressive disorder due to another medical condition (thyroid gland etc.)
Substance-/medication-induced depressive disorder
Generally, substance-induced mood disorders will only present either during intoxication from the substance or on withdrawal from the substance and therefore do not have as lengthy a course as other depressive illnesses.
There are many risks factors: from biology, personality to environmental risks. Prolonged grief disorder is separate category.
Prolonged grief disorder
According to DSM-5, for diagnosis of prolonged grief, the grief response (typified by persistent longing or yearning for and/or preoccupation with the deceased) lasts a year or longer and is persistent, pervasive, and exceeding cultural norms. It also must be accompanied by 3 or more of the following for the last month to a degree that causes distress or disability:
- Feeling of identity disruption (e.g., feeling as though part of oneself has died)
- Marked disbelief about the death
- Avoidance of reminders of the loss
- Intense emotional pain (e.g., sorrow) related to the death
- Difficulty engaging in ongoing life
- Emotional numbness
- Feelings of meaninglessness
- Intense loneliness
Specify – disruptive mood dysregulation disorder (DMDD)
The criteria for disruptive mood dysregulation disorder DMDD are primarily based on those developed for severe mental disorder (SMD), with some modifications. Criteria for disruptive mood dysregulation (DMDD) include the following: (1) severe, recurrent (3 or more times/week) temper outbursts (verbally and/or behaviorally) that are grossly out of proportion in intensity or duration to the situation, and inconsistent with the developmental level; (2) the mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and observable by others; (3) the symptoms must be present for 12 or more months, with no more than 3 consecutive months of symptom-free period; (4) the symptoms/behaviors must be present at least in two of three settings (i.e., at home, at school, with peers), and to a severe degree at least in one setting; (5) the diagnosis should not be made for the first time before age 6 years or after 18 years; and (6) by history or observation, the age at onset is before 10 years. Certain exclusion criteria are included: (1) 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, persistent depressive disorder/dysthymia, posttraumatic stress disorder, separation anxiety disorder); and (2) DMDD cannot co-exist with bipolar disorder, intermittent explosive disorder or oppositional defiant disorder – ODD (individuals whose symptoms meet criteria for both disruptive mood dysregulation (DMDD) and oppositional defiant disorder (ODD) should only be given the diagnosis of disruptive mood dysregulation – DMDD).
The development of disruptive mood dysregulation disorder (DMDD) has been controversial, in part, because there are no published data using the proposed diagnostic criteria for youth. The scientific support for disruptive mood dysregulation disorder (DMDD) comes primarily from studies of severe mental disorder (SMD) which, as described above, is related but not identical to disruptive mood dysregulation disorder DMDD.
Depression is present in other disorders and personality disorders.