Today, we’ll be talking about the DSM-5, also known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, because it’s a standardized guide published by the American Psychiatric Association (APA) that outlines the criteria for diagnosing mental health disorders.

It provides detailed descriptions, symptoms, and metrics to ensure consistency in diagnosing psychological illnesses across all healthcare professionals. Think of clinicians such as psychologists, and psychiatrists.

It also categorizes mental disorders by type while specifying diagnostic criteria for each disorder. Finally, it also includes information on prevalence, development, and comorbidities.

Major depressive disorder (MDD) is one of the most extensively covered mood disorders in the DSM-5.

DSM-5 Diagnostic Criteria for major depressive disorder (MDD)

To be diagnosed with Major Depressive Disorder according to the DSM-5, an individual must exhibit five or more of the following symptoms during the same two-week period.

At least one of the symptoms must be either depressed mood or loss of interest or pleasure in most activities.

These criteria are:

1. Depressed mood
   
   
   • A person must experience a persistently low mood most of the day, nearly every day, as indicated by either a subjective report (feeling sad or empty) or observation made by others (such as appearing tearful).
     This temperament can also present itself as irritability in children and adolescents.
2. Loss of interest or pleasure
   • Another key symptom is a markedly diminished interest or pleasure in all, or almost all, activities for most of the day, nearly every day.
     This symptom is known as anhedonia and is one of the core indicators of depression. It’s detrimental to our daily lives and often reduces motivation for once enjoyable activities.
3. Significant weight change or appetite disturbance
   • There may be significant weight loss when not dieting, weight gain (a change of more than 5% of body weight in a month), or a marked change in appetite nearly daily.
     This symptom may manifest as an increase or decrease in appetite. Gaining weight can be due to stress-eating, but also because of a higher cortisol level if you’re suffering from sleep disturbances.
4. Sleep disturbances
   
   
   • This includes insomnia (difficulty falling or staying asleep) or hypersomnia (excessive sleep) nearly every day.
     Sleep issues are commonly associated with depression and can greatly affect a person’s mood and energy levels.
     It’s one of the most important difficulties to get in check if you wish to get better, since everyone needs sleep, and I notice that it profoundly impacts my mood and thoughts.
5. Psychomotor agitation or retardation
   • Symptoms include either restlessness or slowed physical movements and speech that are observable by others (not merely subjective feelings).
     This psychomotor agitation may manifest as fidgeting, pacing, or other repetitive movements, while retardation may appear as sluggishness.
6. Fatigue or loss of energy
   • Persistent tiredness or low energy for nearly every day is common in depressive episodes and can impact an individual’s ability to engage in daily activities.
     This symptom often exacerbates the sense of hopelessness and lack of motivation.
7. Feelings of worthlessness or excessive or inappropriate guilt
   • Individuals may experience feelings of worthlessness or excessive guilt nearly every day.
     These emotions are often disproportionate to the situation and may not be based on reality. This can reflect a distorted self-perception and self-blame.
8. Diminished ability to think or concentrate, or indecisiveness
   
   
   • Individuals can struggle with concentration, decision-making, or memory nearly daily.
     They may find it difficult to focus on tasks, follow through on plans, or retain information, impairing occupational and social functioning.
9. Recurrent thoughts of death, suicidal ideation, or suicide attempts
   • This includes recurrent thoughts of death (not just fear of dying), suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide.
     This symptom should be taken particularly seriously in the diagnosis and treatment of depression, since there’s a real risk of self-harm.
     If you ask me, thoughts of suicide and self-harm should always require both medication and therapy.

Additional criteria

In addition to meeting five or more of the above criteria, the DSM-5 requires that:

1. Duration and impact: Symptoms must create significant distress or impairment in social, occupational, or other important areas of functioning.
   These signs should persist nearly every day for at least two weeks.
2. Not due to substance or medical condition: The indications cannot be due to the direct physiological effects of a substance (such as drug abuse or medication) or another medical condition (e.g., hypothyroidism).
   
3. Not better explained by another mental disorder: Symptoms must not be better accounted for by another mental disorder, such as schizoaffective disorder, schizophrenia, or delusional disorder.
4. No history of manic or hypomanic episodes: The individual must not have a history of manic or hypomanic episodes to receive a diagnosis of major depressive disorder. If they do, the verdict may fall under a different mood disorder, such as bipolar disorder, for instance.

Specifiers for major depressive disorder

The DSM-5 allows for specifiers that clinicians can add to the diagnosis to provide more details about the nature of the depressive episode.

These attributes offer a more nuanced view of the disorder and include:

1. With anxious distress: Significant anxiety is present along with depressive symptoms, which can increase the risk of suicide and complicate treatment.
   
2. With mixed features: Presence of some manic/hypomanic symptoms (elevated mood, increased energy) alongside the depressive symptoms.
3. With melancholic features: This includes a severe loss of pleasure in almost all activities and a lack of emotional reactivity to positive stimuli.
   Other omens can include early morning awakening, weight loss, and profound guilt.
4. With atypical features: Consists of mood reactivity (mood brightens in response to positive events), increased appetite or weight gain, hypersomnia, and a heavy or dull feeling in arms or legs.
5. With psychotic features: Presence of delusions or hallucinations.
   This can either be mood-congruent (reflecting depressive themes, such as guilt or worthlessness) or mood-incongruent (for instance, laughing when your pet dies).
6. With sadness (catatonia): Abnormal movements, lack of response, or other symptoms of catatonia.
7. With childbirth (peripartum) onset: The depressive episode begins during pregnancy or within four weeks following delivery.
   This type is commonly referred to as postpartum depression.
   
8. With seasonal pattern (seasonal affective disorder): Happens at a specific time of year (usually fall or winter) and remits at another distinct time of year (typically spring).

The severity of major depressive disorders in DSM-5

It also categorizes depression by severity based on the number of symptoms, their intensity, and their impact on functioning:

1. Mild: Few symptoms beyond the five are required for diagnosis, causing minor impairment in social or occupational functioning.
2. Moderate: Indications or impairment levels are between mild and severe.
3. Severe: Many signs that cause significant impairment in social or occupational functioning.

Differential diagnoses in the DSM-5

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders also provides a list of differential diagnoses to help professionals distinguish between MDD and other mental health illnesses with similar symptoms.

Think of indications such as:

1. Persistent depressive disorder (dysthymia): Dysthymia is a chronic form of depression with symptoms that are less severe but persist for at least two years.
2. Bipolar disorder: Characterized by alternating episodes of depression and mania or hypomania.

   

3. Adjustment disorder with depressed mood: Consists of depressive signs that are triggered by an identifiable stressor and last for less than six months.
4. Depressive disorder due to another medical condition: Depressive signals are directly attributed to medical conditions such as a neurological disorder.

Summary

The DSM-5 outlines a thorough set of criteria for diagnosing major depressive disorder by including core symptoms and additional qualifiers, such as duration, severity, and specific symptom patterns.

This detailed approach helps mental health professionals accurately diagnose and distinguish depression from other psychological illnesses to ensure that individuals receive the most appropriate and effective treatment.

It’s not just limited to diagnosing depression, either. It can be used to identify other mental disorders as well.