DSM IV
Criteria For Mood Episodes
Major Depressive Episode
- 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.
Note: Do not include symptoms that are clearly due to a general
medical condition, or mood-incongruent delusions or hallucinations.
- 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.
- 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)
- significant weight 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 expected weight gains.
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly every day (observable by
others, not merely subjective feelings of restlessness or being slowed
down)
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-reproach or guilt
about being sick)
- diminished ability to think or concentrate, or indecisiveness, nearly
every day (either by subjective account or as observed by others)
- 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
- The symptoms do not meet criteria for a
Mixed
Episode
- The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
- 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).
- 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 distinct period of abnormally and persistently elevated, expansive, or
irritable mood, lasting at least 1 week (or any duration if hospitalization
is necessary).
- 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:
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
- increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation
- 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)
- The symptoms do not meet criteria for a
Mixed
Episode
- The mood disturbance 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.
- The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication, or other treatment) or a
general medical condition (e.g., hyperthyroidism).
- 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.
- The mood disturbance 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.
- The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication, or other treatment) or a
general medical condition (e.g., hyperthyroidism).
- 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.
- 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:
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
- increase in goal-directed activity (either socially, at work or
school, or sexually) or psychomotor agitation
- excessive involvement in pleasurable activities that have a high
potential for painful consequences (e.g., the person engages in
unrestrained buying sprees, sexual indiscretions, or foolish business
investments)
- The episode is associated with an unequivocal change in functioning that
is uncharacteristic of the person when not symptomatic.
- The disturbance in mood and the change in functioning are observable by
others.
- The episode is not severe enough to cause marked impairment in social or
occupational functioning, or to necessitate hospitalization, and there are
no psychotic features.
- The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication, or other treatment) or a
general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic
antidepressant treatment (e.g., medication, electroconvulsive therapy, light
therapy) should not count toward a diagnosis of Bipolar II Disorder.
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