Major Depressive Disorder, Single Episode

  1. Presence of a single Major Depressive Episode.
  2. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
  3. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Major Depressive Disorder, Recurrent

  1. Presence of a two or more Major Depressive Episodes.
  2. The Major Depressive Episodes are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
  3. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Dysthymic Disorder

  1. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
  2. Presence, while depressed, of two (or more) of the following:
    1. poor appetite or overeating
    2. insomnia or hypersomnia
    3. low energy or fatigue
    4. low self-esteem
    5. poor concentration or difficulty making decisions
    6. feelings of hopelessness
  3. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
  4. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
    Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be give when the criteria are met for a Major Depressive Episode
  5. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
  6. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
  7. 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).
  8. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Early Onset. This specifier should be used if the onset of the dysthymic symptoms occurs before age 21 years. Such individuals are more likely to develop subsequent Major Depressive Episodes.

Late Onset. This specifier should be used if the onset of the dysthymic symptoms occurs at age 21 or older.

Cyclothymic Disorder

  1. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year.
  2. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.
  3. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.
    Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).
  4. The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
  5. 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., hyperthyroidism).
  6. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Bipolar II Disorder

  1. Presence (or history) of one or more Major Depressive Episodes.
  2. Presence (or history) of at least one Hypomanic Episode.
  3. There has never been a Manic Episode or a Mixed Episode.
  4. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
  5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Hypomanic. This specifier is used if the current (or most recent) episode is a Hypomanic Episode.

Depressed. This specifier is used if the current (or most recent) episode is a Major Depressive Episode.

Bipolar I Disorder, Single Manic Episode

  1. Presence of only one Manic Episode and no past Major Depressive Episodes.
    Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms.
  2. The Manic Episode is not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Hypomanic

  1. Currently (or most recently) in a Hypomanic Episode.
  2. There has previously been at least one Manic Episode or Mixed Episode.
  3. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Manic

  1. Currently (or most recently) in a Manic Episode.
  2. There has previously been at least one Major Depressive Episode, Manic Episode or Mixed Episode.
  3. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Mixed

  1. Currently (or most recently) in a Mixed Episode.
  2. There has previously been at least one Major Depressive Episode, Manic Episode or Mixed Episode.
  3. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Depressed

  1. Currently (or most recently) in a Major Depressive Episode.
  2. There has previously been at least one Manic Episode or Mixed Episode.
  3. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Bipolar I Disorder, Most Recent Episode Unspecified

  1. Criteria, except for duration, are currently (or most recently) met for a Manic, a Hypomanic, a Mixed, or a Major Depressive Episode.
  2. There has previously been at least one Manic Episode or Mixed Episode.
  3. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
  5. The mood symptoms in Criteria A and B 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).

Mood Disorder Due to General Medical Condition

  1. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
    1. depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
    2. elevated, expansive, or irritable mood
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Depressed Mood in response to the stress of having a general medical condition).
  4. The disturbance does not occur exclusively during the course of a delerium.
  5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important area of functioning.

With Depressive Features: if the predominant mood is depressed but the full criteria are not met for a Major Depressive Episode.

With Major Depressive-Like Episode: if the full criteria are met (except Criterion D) for a Major Depressive Episode.

With Manic Features: if the predominant mood is elevated, euphoric, or irritable.

With Mixed Features: if the symptoms of both mania and depression are present but neither predominates.

Substance-Induced Mood Disorder

  1. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
    1. depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
    2. elevated, expansive, or irritable mood
  2. There is evidence from history, physical examination, or laboratory findings of either (1) or (2):
    1. the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal
    2. medication use is etiologically related to the disturbance
  3. The disturbance is not better accounted for by a Mood Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Mood Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced Mood Disorder (e.g., a history of recurrent Major Depressive Episodes).
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.

With Depressive Features: if the predominant mood is depressed

With Manic Features: if the predominant mood is elevated, euphoric, or irritable

With Mixed Features: if symptoms of both mania and depression are present and neither predominates.

With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrome

With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome