Specifiers for depressive disorders are to help mental health professionals narrow down subtypes of depressive disorders for a proper diagnosis. Many people do not realize that there are many different subtypes for each depressive disorder.
With Anxious Distress
Anxious distress is defined as the presence of at least two of the following symptoms during the majority of days of a major depressive episode or persistent depressive disorder (dysthymia):
- Feeling keyed up or tense.
- Feeling unusually restless.
- Difficultly concentrating because of worry.
- Fear that something awful might happen.
- Feeling that the individual might lose control.
Mild: two symptoms; Moderate: three symptoms; Moderate-severe: four or five symptoms; Severe: four or five symptoms, plus motor agitation
With Mixed Features
With Melancholic Features
- At least three of the following manic/hypomanic symptoms are present nearly every day during the majority of days of a major depressive episode:
- Elevated, expansive mood.
- Inflated self-esteem or grandiosity.
- More talkative than usual or pressure to keep talking.
- Flight of ideas of subjective experience that thoughts are racing.
- Increase in energy or goal-directed activity.
- Increased or excessive involvement in activities that have a high potential for painful consequences.
- Decreased need for sleep.
- Mixed symptoms are observable by others and represent a change from the person’s usual behavior.
- For individuals who meet full criteria for either mania or hypomania, the diagnosis [of a depressive disorder should be revoked and] should be Bipolar I or Bipolar II.
- The mixed symptoms are not attributable to the psychological affects of a substance.
With Atypical Features
- One of the following is present during the most severe period of the current episode:
- Loss of pleasure in all, or almost all, activities.
- Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens).
- Three or more of the following:
- A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
- Depression that is regularly worse in the morning.
- Early-morning awakening (at least two hours before usual awakening).
- Marked psychomotor agitation or retardation.
- Significant anorexia or weight loss.
- Excessive or inappropriate guilt.
This specifier can be applied when these features predominate during the majority of the days of the current of most recent major depressive episode or persistent depressive disorder.
With Mood-Congruent Psychotic Features
- Mood brightens in response to actual or potential positive events.
- Two or more of the following:
- Significant weight gain or increase in appetite.
- Leaden paralysis.
- A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
- Criteria are not met for “with melancholic features” or “with catatonia” during the same episode.
The content of delusions or hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment.
With Mood-Incongruent Psychotic Features
The content of delusions or hallucinations does not involve the typical depressive themes, or the content is a mixture of mood-incongruent and mood-congruent themes.
The catatonia specifier can apply to an episode of depression if catatonic features are present during most of the episode.
With Peripartum Onset
This specifier can be applied to the current or, if full criteria are not currently met for met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or the four weeks following delivery.
With Seasonal Pattern
This specifier applies to recurrent major depressive disorder (used to be called Seasonal Affective Disorder).
- There has been a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and a particular time of the year. This does not include cases where there is an obvious effect of seasonally related psychosocial stressors.
- Full remissions (or a change from major depression to (hypo-)mania) also occur at a characteristic time of year (after the “season” of depression).
- In the last two years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined above and no nonseasonal major depressive episodes have occurred during the same period.
- Seasonal major depressive episodes substantially outnumber the nonseasonal major depressive episodes that may have occurred over the individuals lifetime.
Disruptive Mood Dysregulation Disorder: includes no specifiers
Major Depressive Disorder: includes all nine specifiers
Persistent Depressive Disorder: includes all specifiers except “with catatonia” and “with seasonal pattern”
Premenstrual Dysphoric Disorder: includes no specifiers
Substance/Medication-Induced Depressive Disorder: includes specifiers not listed above (“with onset during intoxication” and “with onset during withdrawal”)
Depressive Disorder Due to Another Medical Condition: includes no specifiers
Other Specified Depressive Disorder: includes no specifiers (only subtypes)
Unspecified Depressive Disorder: includes no specifiers
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Adapted with permission. ALL RIGHTS RESERVED.
The use of this information is for informational purposes only; to guide those experiencing mental distress and to educate those who are interested in the topic. diagnostic criteria alone is not proper grounds for a diagnosis; professional evaluation and diagnosis is critical for proper treatment of mental disorders.