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Depression criteria dsm v


Depression Definition and DSM-5 Diagnostic Criteria

Depression

Depression, otherwise known as major depressive disorder or clinical depression, is a common and serious mood disorder

Jessica Truschel

Medical ReviewerFarah Fazel, PsyS

What is Depression?

Depression, otherwise known as major depressive disorder or clinical depression, is a common and serious mood disorder. Those who suffer from depression experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. Aside from the emotional problems caused by depression, individuals can also present with a physical symptom such as chronic pain or digestive issues. To be diagnosed with depression, symptoms must be present for at least two weeks.

The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

  1. Depressed mood most of the day, nearly every day.

  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

  4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

  5. Fatigue or loss of energy nearly every day.

  6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

  8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

  • Major depressive disorder is associated with high mortality, much of which is accounted for by suicide. As a result, if you think someone you care about may be suffering from depression it is important to know the warning signs of suicide and to take suicidal statements extremely seriously. An active statement by someone with suicidal ideation might be something like, “I’m going to kill myself,” but other passive statements such as, “I wish I could just go to sleep and never wake up,” are equally worrying. If someone with depression exhibits these verbal markers, encourage them to consult a mental health professional immediately.

  • Depressed individuals also present with irritability, brooding, and obsessive rumination, and report anxiety, phobias, excessive worry over physical health, and complain of pain.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses:

  • With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.

  • With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.

What is the difference between depression and sadness? Given that the primary symptom associated with depression is sadness it can be hard to know how to make a distinction between the two psychological states.

But depression is more than just sadness, and not simply by a measure of degree. The difference doesn’t lie in the extent to which a person feels down, but rather in a combination of factors relating to the duration of these negative feelings, other symptoms, bodily impact, and the effect upon the individual’s ability to function in daily life.

Sadness is a normal emotion that everyone will experience at some point in his or her life. Be it the loss of a job, the end of a relationship, or the death of a loved one, sadness is usually caused by a specific situation, person, or event. When it comes to depression, however, no such trigger is needed. A person suffering from depression feels sad or hopeless about everything. This person may have every reason in the world to be happy and yet they lose the ability to experience joy or pleasure.

With sadness, you might feel down in the dumps for a day or two, but you’re still able to enjoy simple things like your favorite TV show, food, or spending time with friends. This isn’t the case when someone is dealing with depression. Even activities that they once enjoyed are no longer interesting or pleasurable.

What’s more, when you experience sadness triggered by a certain something you’re still able to sleep as you usually would, remain motivated to do things, and maintain your desire to eat. Depression, on the other hand, is associated with serious disruption of normal eating and sleeping patterns, as well as not wanting to get out of bed all day.

In sadness, you might feel regret or remorse for something you said or did, but you won’t experience any permanent sense of worthlessness or guilt as you might with depression. One of the diagnostic features of depression is this kind of self-diminishing, negative thought patterns.

Finally, self-harm and suicidal inclinations don’t arise from non-depressive sadness. Those struggling with severe depression may have thoughts of self-harm, death, or suicide, or have a suicide plan.

If you’re feeling suicidal or just need to talk, call the National Suicide Prevention Lifeline for free at 1-800-273-8255. Or, simply call or text 988 to reach the crisis lifeline.

Although there is a clear distinction to be made between depression and sadness, it is possible for major depressive disorder to occur in addition to sadness resulting from a significant loss, such as bereavement, financial ruin, or a serious medical illness. The decision as to whether a diagnosis of depression should be made will depend on the judgment of the clinician treating the individual.

If you think you or someone you care about may be suffering from depression, we encourage you to seek help from a mental health professional. If you lack access to mental healthcare, you can find resources in Psycom's Affordable Therapy article.

The following online directories can be consulted to find a therapist in your area:

  • Psychology Today: https://therapists.psychologytoday.com/rms

  • GoodTherapy.org: http://www.goodtherapy.org/find-therapist.html

If you’re thinking about suicide, are worried about someone else, or just need emotional support, the emergency Lifeline network is available 24/7. You can call 1-800-273-8255 or go to their website for a live chat.

"Highlights of Changes from DSM-IV-TR to DSM-5". American Psychiatric Association. May 17, 2013. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.

Notes: This article was originally published July 24, 2018 and most recently updated August 26, 2022.

7 Surprising Symptoms of Depression

The essential features of depression include depressed mood (feeling sad, hopeless, empty) and loss of interest or pleasure in nearly all activities most of the day, nearly every day, for at least two weeks. ¹ Depressed mood (or irritability for kids) and diminished pleasure are the primary symptoms people are cautioned to look for when depression is suspected.

While those symptoms certainly are red flags, the truth is that depression doesn’t always look like debilitating sadness. Some symptoms of depression can be far more subtle. Those same symptoms can also mimic other medical conditions or be dismissed as normal everyday problems.

Identifying and understanding symptoms of depression are important first steps toward getting the proper supports in place to work through. Check out these less obvious symptoms of depression.

1. Physical pain

Complaints of physical pain are common in people with depression. Back pain, joint pain, and limb pain are all symptoms of depression and can result in chronic pain if left untreated.

Studies show that the link between pain and depression is a shared neurologic pathway, and that the worse the painful physical symptoms, the more severe the depression. ²

If you experience back pain, neck pain, or other sources of pain more often than not, don’t be so quick to brush it off. It just might be a red flag of depression lurking beneath the surface.

2. Grouchy is your new normal

If it feels like even the slightest trigger sends you into a rage, or you feel irritable and grouchy a lot, you might be struggling with depression.

Although symptoms of hostility, anger, and irritability are not central to the diagnosis of depression, research shows that these symptoms are highly prevalent in depressed people and associated with increased depressive severity, longer duration, a more chronic and long-term course of depression, and high co-morbidity with substance abuse and anxiety. ³

3. You drink more alcohol than usual

One drink after a long day might take the edge off, but if you find that you’re drinking a few drinks every night, it’s probably more than a hard day at the office that’s driving your behavior.

The interplay between heavy drinking and depression is complex. While some people might pick up a drink to cope with, or mask the feelings associated with, depression, heavy alcohol use can trigger a depressive episode. This is referred to as “substance- induced depression.” One long-term study found that for men with alcohol problems, almost one-third of reported depressive episodes were only seen during bouts of heavy drinking.⁴

4. Big changes in weight

Rapid weight loss or weight gain (a change of more than 5% of body weight in a month) is associated with depression.⁵ Depression can either zap your appetite to the point where you rarely feel hungry or cause you to overeat.

While it’s perfectly normal to crave comfort foods when under stress, if you experience noticeable changes in your appetite that trigger weight loss or gain, you should seek an evaluation.

5. You forgot to shower (again)

Depression can impact your daily living, including your self-care routine. If you find that you’re not showering regularly, brushing your hair, practicing proper oral hygiene, wearing clean clothes, or struggling to even get out of bed in the morning, you might be in the midst of a depressive episode.

6. You can’t make up your mind

Depression diminishes the ability to concentrate, including making decisions.⁶ Whether you struggle to make a decision about your morning coffee or find that you’re paralyzed when making important decisions at work, your depression slows your cognitive processes.

7. You feel really, really overwhelmed with guilt

Do you apologize for every little thing? Are you completely overwhelmed with feelings of guilt nearly every day? Excessive guilt is a sneaky sign of depression that might take you by surprise.

The sense of guilt associated with depression can include guilty preoccupations over perceived past or present failings. It can also include an exaggerated sense of personal responsibility for trivial matters and increased self-blame.

Depression can sneak up on you. People are conditioned to look for that feeling of overwhelming sadness as the go-to symptom of depression, but the truth is that the above symptoms can develop over time and are sometimes hard to spot. If you do find that some of these symptoms impair your social, occupational, or other areas of functioning, make that phone call to your primary care physician for a referral for treatment. The sooner you begin the treatment process, the sooner the depression lifts and you can resume your normal daily activities.

  1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Publishing, Washington, D.C., 2013: Pages 160-168.
  2. IsHak, Waguih William MD; Wen, Raymond Y. BS; Naghdechi, Lancer DO; Vanle, Brigitte PhD; Dang, Jonathan MD; Knosp, Michelle DO; Dascal, Julieta BA; Marcia, Lobsang BS; Gohar, Yasmine BA; Eskander, Lidia MD; Yadegar, Justin MS; Hanna, Sophia BS; Sadek, Antonious MD; Aguilar-Hernandez, Leslie BA; Danovitch, Itai MD; Louy, Charles MD, PhD. Pain and Depression: A Systematic Review. Harvard Review of Psychiatry: 11/12 2018 - Volume 26 - Issue 6 - p 352-363 doi: 10.1097/HRP.0000000000000198
  3. Judd, L. , Schettler, P., Coryell, W., “Overt Irritability/Anger in Unipolar Major Depressive Episodes Past and Current Characteristics and Implications for Long-term Course,” JAMA Psychiatry, Volume 70(11), 2013: Pages 1171-1180.
  4. Schuckit, M., Smith, T., Kalmijn, J., “Relationships Among Independent Major Depressions, Alcohol Use, and Other Substance Use and Related Problems Over 30 Years in 397 Families,” Journal of Studies on Alcohol and Drugs, 2013.
  5. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Publishing, Washington, D.C., 2013: Pages 160-168.
  6. Ibid.

Notes: This article was originally published June 26, 2017 and most recently updated August 24, 2022.

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