DSM-IV is the fourth version of the "Diagnostic and Statistical Manual of Mental Disorders" published by the American Psychiatric Association. Although originally derived from diagnostic criteria derived for research on mental disorders, it has come to be considered to be the "Bible" of psychiatric diagnosis. There is much criticism and controversy about DSM-IV. However, in my opinion, it is the best tool we have to clarify communication and aid in diagnosis and treatment of psychiatric and psychological problems. DSM-IV is also an excellent resource for information about the rate of occurance, charactericstic features, long-term course, and outcome of many Mental Disorders.
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning.; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others.)
(3) significant weighte loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make exected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproachor guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode (both manic and depressive symptoms at the same time)
C. The symptoms cuase clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
A. Presence of a single Major Depressive Episode
B. The major Depressive Episode is not better accounted for by Schizoaffectivd Disorder and is not superimposed on Schizophrenia, Schizohreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
C. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.(Exclusion does not apply to substance or treatment-induced manic, mixed, or hypomanic episodes).
A. Presence of two or more Major Depressive Episodes. (Must be separated by an interval of at least 2 months).
B. Same as B. for Major Depressive Disorder, Single Episode.
C. Same as C for Major Depressive Disorder, Single Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week or requiring hospitalization.
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree.
(1) inflated self-esteem or grandiosity.
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C. The symptoms do not meet criteria for a mixed episode (presence of symptoms of major depression and mania at same time)
D. The mood disturbancve is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
E. The symptoms are not do to a direct physiological effect of a substance (e.g. a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism)
A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
B. Same as criterion B for Manic Episode, above.
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. Same as criterion D for Manic Episode, above.
F. Same as criterion E for Manic Episode, above.
A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1 week period.
B. Same as criterion D for Manic Episode, above.
C. Same as criterion E for Manic Episode, above.
A. The presence of one or more current or past Manic Episodes or Mixed Episodes, with or without present or past Major Depressive Episodes.
B. The mood episode(s) are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizoaffective Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
A. Presence (or history) of one or more Major Depressive Episodes
B. Presence (or history) of at least one Hypomanic Episode.
C. There has never been a Manic Episode or a Mixed Episode
D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizoaffective Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.