Depression in the DSM-5
04 Aug 2023The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
The DSM-5 is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association. Following are the classifications of depression in the DSM-5.
Major Depressive Disorder (MDD)
Major Depressive Disorder is characterised by persistent feelings of sadness, emptiness, or hopelessness that significantly interfere with daily functioning. Symptoms include a loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, fatigue, feelings of worthlessness, and difficulty concentrating. To be diagnosed with MDD, symptoms must persist for at least two weeks.
Persistent Depressive Disorder (PDD)
Formerly known as dysthymia, Persistent Depressive Disorder involves a chronic low mood lasting for at least two years in adults (or one year in children/adolescents). Symptoms are less severe than MDD but are long-lasting and can include changes in appetite, sleep problems, low energy, poor self-esteem, difficulty making decisions, and feelings of hopelessness.
Disruptive Mood Dysregulation Disorder (DMDD)
Primarily diagnosed in children and adolescents, DMDD is characterised by severe temper outbursts that are out of proportion to the situation. These outbursts are consistently present and occur at least three times a week. The mood between outbursts is persistently irritable or angry. DMDD was introduced to counter the potential overdiagnosis of childhood bipolar disorder.
Bipolar Disorder
Bipolar Disorder includes periods of major depressive episodes and distinct periods of mania or hypomania. In Bipolar I Disorder, manic episodes are more severe and may require hospitalisation, while Bipolar II Disorder involves less intense hypomanic episodes. During manic episodes, individuals might experience inflated self-esteem, decreased need for sleep, impulsivity, and risky behaviours.
Premenstrual Dysphoric Disorder (PMDD)
PMDD is a severe form of premenstrual syndrome (PMS) characterised by significant mood disturbances, irritability, and physical symptoms in the luteal phase of the menstrual cycle. These symptoms severely impact daily activities and relationships. Diagnosis requires that these symptoms be absent in the follicular phase of the cycle.
Substance/Medication-Induced Depressive Disorder
This type of depression is triggered by substance abuse, withdrawal from substances, or exposure to certain medications. The symptoms closely resemble those of Major Depressive Disorder. It’s crucial to distinguish whether the depression is due to the substance/medication or if it exists independently.
Depressive Disorder Due to Another Medical Condition
This type of depression arises as a result of a medical condition, such as a chronic illness, neurological disorder, or hormonal imbalance. The symptoms of depression in this case are a direct consequence of the underlying medical condition and can improve with effective management of that condition.
Other Specified and Unspecified Depressive Disorders
These categories are used when a person’s symptoms do not fit neatly into any of the specific categories mentioned earlier. Other Specified Depressive Disorder covers atypical presentations, while Unspecified Depressive Disorder is used when the symptoms do not meet the criteria for any specific subtype.
Summary for Diagnosing Depression with the DSM-5
The DSM-5 classifies several types of depression, each with distinct diagnostic criteria. Major Depressive Disorder involves persistent sadness and impaired daily functioning, while Persistent Depressive Disorder represents chronic low mood. Disruptive Mood Dysregulation Disorder pertains to children with severe temper outbursts. Bipolar Disorder encompasses manic and depressive episodes. Premenstrual Dysphoric Disorder involves severe mood disruptions related to the menstrual cycle. Substance/Medication-Induced and Medical Condition-Related Depressive Disorders are triggered by substances, medications, or medical conditions. Other Specified and Unspecified Depressive Disorders are used for cases that don’t fit well into other categories. Understanding these classifications aids in accurate diagnosis and effective treatment of individuals experiencing various forms of depression.