DSM-IV Criteria for Major Depressive Disorder?

DSM-IV Criteria for Major Depressive Disorder
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Question: What are the DSM-IV criteria for Major Depressive Disorder?

Answer: According to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Ed.), for a person to be diagnosed with Major Depressive Disorder, they should first of all have at least one of the two core symptoms:  depressed mood and a loss of interest in activities that they once enjoyed.  In addition, they should have at least five of the following symptoms:

  • Depressed mood
  • Loss of interest in previously enjoyed activities
  • Changes in weight or appetite when not attempting to gain or lose weight
  • Having difficulty falling asleep at night or waking up in the morning
  • Psychomotor retardation or agitation
  • Loss of energy or tiredness
  • Feelings of worthlessness or excessive guilt
  • Difficulties with making decisions, thinking or concentrating
  • Recurrent thoughts about suicide and dying

To receive a Major Depressive Disorder diagnosis, these symptoms would have to have been present most of the time during the past two weeks.  These symptoms would also have to be different from the person's normal level of functioning and would have to be impairing their function in various aspects of their life, such as their work, school, and social lives.

Other causes for their symptoms would need to be ruled out, such as drugs, alcohol, medications, a general medical condition, another mental disorder (for example, bipolar disorder or schizoaffective disorder) or grief.

Any episodes of depression following the death of a loved one that last for less than two months are not classified as being a major depressive episode.

It should be noted that the DMS-IV was replaced with an updated version, the DSM-5, in May of 2013.  The DSM-5 did not make any major changes to the diagnostic criteria for depression.

  It did, however, remove the bereavement exclusion, acknowledging that depression due to grief is no different than depression caused by any other stressful event.  It also added two new specifiers to further clarify diagnoses:

  • With Mixed Features - This specifier can be given for both bipolar and depressive disorders. It serves the purpose of allowing manic symptoms to be a part of a depression diagnosis when these symptoms fall short of meeting the criteria for being a manic episode.
  • With Anxious Distress - This specifier was added to reflect the fact that anxiety can have a sigficant impact on the course of a patient's treatment.

The DSM-5 also added guidance for assessing suicidal thoughts, plans, and risk to enable clinicians to better assess how large a role that suicide prevention should play in a particular patient's treatment plan.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994.

"Highlights of Changes from DSM-IV-TR to DSM-5". American Psychiatric Association. May 17, 2013. Accessed: May 27, 2013 (page no longer exists).

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