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Depressive Symptoms

Sadness can be all encompassing. How do you know when it's just a sad spell versus when it's a serious problem or even a disorder?

Major Depressive Disorder

  • Duration – minimum 2 weeks

  • Symptoms: Depressed mood or loss of interest or pleasure and five or more of the following present during the same two-week period:

  • Significant weight loss

  • Insomnia or hypersomnia

  • Psychomotor agitation or retardation

  • Fatigue or loss of energy

  • Feelings of worthlessness or inappropriate guilt

  • Diminished ability to think or concentrate

  • Recurrent thoughts of death/suicide

  • Diagnostic Codes:

  • Mild F32.0

  • Moderate F32.1

  • Severe F32.2

  • With Psychotic F32.3

  • In partial remission (single episode – F32.4, recurrent episode – F32.41)

  • In full remission (single episode – F32.5, recurrent episode – F32.42)

  • Unspecified F32.9

  • Differential:

  • Manic Episodes with Irritable Mood or Mixed Episodes – (mania)

  • Attention-Deficit/Hyperactivity Disorder – (inattention/hyperactivity)

  • Adjustment Disorder with Depressed Mood – (5 or more criteria met in 2 weeks)

  • Postpartum Depression OR MDD with Peripartum Onset:

  • This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.

Persistent Depressive Disorder F34.1

  • Duration: 2 years, with symptoms continuous; in children, 1 year

  • Onset:

  • Early – before age 21

  • Late – after age 21

  • Symptoms: Depressed mood and at least 2 of the following

  • Decreased appetite or overeating

  • Insomnia or hypersomnia

  • Fatigue/low energy

  • Low self-worth

  • Difficulty concentrating or making decisions

  • Hopelessness

  • The individual is never without symptoms for more than 2 months. Major Depressive Disorder criteria may be present for the 2 years. The individual has never experienced a manic or hypomanic episode.

  • Differential:

  • Major Depressive Disorder – (criteria met for 2 years or more)

  • Psychotic Disorders – (psychosis)

  • Personality Disorders – (can coexist, criteria makes the decision)

Premenstrual Dysphoric Disorder

  • Timing of symptoms

  • In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses

  • Symptoms: One or more of the following symptoms must be present:

    • Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)

    • Marked irritability or anger or increased interpersonal conflicts

    • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

    • Marked anxiety, tension, and/or feelings of being keyed up or on edge

  • One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms above:

    • Decreased interest in usual activities

    • Subjective difficulty in concentration

    • Lethargy, easy fatigability, or marked lack of energy

    • Marked change in appetite; overeating or specific food cravings

    • Hypersomnia or insomnia

    • A sense of being overwhelmed or out of control

    • Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain

  • Differential:

  • Major Depressive Disorder (cause is PMS)

  • Panic Disorder (cause is PMS, depressive episodes present)

  • Persistent Depressive Disorder (cause is PMS)

  • Personality Disorders (can be comorbid)

  • Also determine if symptoms are a result of the physiological effects of a substance (e.g., drug abuse, medication or other treatment) or another medical condition (e.g., hyperthyroidism).

Gender Dysphoria in Adolescents and Adults F64.1

  • Duration – 6 months

  • Symptoms: Belief one has been born in the wrong gender's body. Individual has at least two of these issues:

    • Belief one is or should be a different gender

    • Wants to be divested of one's sexual organs and associated physical anatomy due to gender dissonance

    • Longs for the sexual organs and associated anatomy of desired gender

    • Longs to experience life as the desired gender

    • Longs to become and be treated as gender other than one assigned

    • Sense that one experiences life as desired gender state in terms of thoughts, feelings, actions, and interactions

  • Types:

    • With a disorder of sexual development E25.0

  • Differential:

    • Body Dysmorphic Disorder – (not about identity as much as physical body)

    • Transvestic Disorder – (wearing clothes for pleasure-not identity)

    • Nonconformity to Gender Roles – (identity)

    • Schizophrenia and Other Psychotic Disorders – (psychotic symptoms)

Gender Dysphoria (in Children) F64.2

  • Duration: 6 months

  • Symptoms: At least six of the following:

    • Desire to be the other gender or that one is the other gender or an alternative gender

    • In boys, a strong preference for cross-dressing or simulating female attire; in girls, a strong preference for wearing masculine clothing and resistance to typically feminine clothing

    • Strong preference for cross-gender roles in make-believe or fantasy play

    • Strong preference for toys, games, or activities stereo-typically used for engaged in by other gender

    • Strong preference for playmates of other gender

    • Boys rejection of typically masculine items and rough/tumble play; girls rejection of typically feminine items and activities

    • Strong dislike of one's sexual anatomy

    • Strong desire for primary and/or secondary sex characteristics that match experienced gender

  • Types:

    • With a disorder of sexual development E34.50

Other Specified Gender Dysphoria F64.8

Unspecified Gender Dysphoria F64.9


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