A diagnosis of a particular disorder may include additional specifiers. These provide additional details to a diagnosis, such as the severity of the current episode and how the person is cycling. The tables show which specifiers apply to which disorders. For example, Chronic applies to Major Depressive Disorder, but not to Dysthymic Disorder, since it only applies to Major Depressive Episodes.

Click on the name of the specifier (column titles) to jump to its criteria. Click on the name of the mood disorder (row titles) to jump to its criteria.

 

Severity/Psychotic/Remission Specifiers for current (or most recent) Major Depressive Episode

Note: Code in fifth digit. Can be applied to the most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or II Disorder only if it is the most recent type of mood episode.

.x1 -- Mild: Few, if any symptoms in excess of those required to make the diagnosis and symptoms result in only minor impairment in occupational functioning or in usual social activities or relationships with others.

.x2 -- Moderate: Symptoms or functional impairment between "mild" and "severe."

.x3 -- Severe Without Psychotic Features: Several symptoms in excess of those required to make the diagnosis, and symptoms markedly interfere with occupational functioning or with usual social activities or relationships with others.

.x4 -- Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:

Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment.

Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. Included are such symptoms as persecutory delusions (not directly related to depressive themes), thought insertion, thought broadcasting, and delusions of control.

.x5 -- In Partial Remission: Symptoms of a Major Depressive Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Major Depressive Episode lasting less than 2 months following the end of the Major Depressive Episode. (If the Major Depressive Episode was superimposed on Dysthymic Disorder, the diagnosis of Dysthymic Disorder alone is give once the full criteria for a Major Depressive Episode are no longer met.)

.x6 -- In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.

.x0 -- Unspecified.

Severity/Psychotic/Remission Specifiers for current (or most recent) Manic Episode

Note: Code in fifth digit. Can be applied to a Manic Episode in Bipolar I Disorder on if it is the most recent type of mood episode.

.x1 -- Mild: Minimum symptom criteria are met for a Manic Episode.

.x2 -- Moderate: Extreme increase in activity or impairment in judgment.

.x3 -- Severe Without Psychotic Features: Almost continual supervision required to prevent physical harm to self or others.

.x4 -- Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:

Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical manic themes of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.

Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical manic themes of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person. Included are such symptoms as persecutory delusions (not directly related to grandiose ideas or themes), thought insertion, and delusions of being controlled.

.x5 -- In Partial Remission: Symptoms of a Manic Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Manic Episode lasting less than 2 months following the end of the Manic Episode.

.x6 -- In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.

.x0 -- Unspecified.

Severity/Psychotic/Remission Specifiers for current (or most recent) Mixed Episode

Note: Code in fifth digit. Can be applied to a Mixed Episode in Bipolar I Disorder on if it is the most recent type of mood episode.

.x1 -- Mild: No more than minimum symptom criteria are met for both a Manic Episode and a Major Depressive Episode.

.x2 -- Moderate: Symptoms or functional impairment between "mild" and "severe."

.x3 -- Severe Without Psychotic Features: Almost continual supervision required to prevent physical harm to self or others.

.x4 -- Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:

Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical manic or depressive themes.

Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical manic or depressive themes. Included are such symptoms as persecutory delusions (not directly related to grandiose or depressive themes), thought insertion, and delusions of being controlled.

.x5 -- In Partial Remission: Symptoms of a Mixed Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Mixed Episode lasting less than 2 months following the end of the Mixed Episode.

.x6 -- In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.

.x0 -- Unspecified.

Chronic

Chronic (can be applied to the current or most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or II Disorder only if it is the most recent type of mood episode.)

Full criteria for a Major Depressive Episode have been met continuously for at least the past 2 years.

Catatonic Features

With Catatonic Features (can be applied to the current or most recent Major Depressive Episode, Manic Episode, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder or Bipolar II Disorder)

The clinical picture is dominated by at least two of the following:

1. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
2. excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
3. extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
4. peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
5. echolalia or echopraxia

Melancholic Features

With Melancholic Features (can be applied to the current or most recent Major Depressive Episode in Major Depressive Disorder and to a Major Depressive Episode in Bipolar I or Bipolar II Disorder only if it is the most recent type of mood episode)

1. Either of the following, occurring during the most severe period of the current episode:
   1. loss of pleasure in all, or almost all, activities
   2. lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
2. Three (or more) of the following:
   1. distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
   2. depression regularly worse in the morning
   3. early morning awakening (at least 2 hours before usual time of awakening)
   4. marked psychomotor retardation or agitation
   5. significant anorexia or weight loss
   6. excessive or inappropriate guilt

Atypical Features

With Atypical Features (can be applied when these features predominate during the most recent 2 weeks of a Major Depressive Episode in Major Depressive Disorder or in Bipolar I or Bipolar II Disorder when the Major Depressive Episode is the most recent type of mood episode, or when these features predominate during the most recent 2 years of Dysthymic Disorder)

1. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
2. Two (or more) of the following features:
   1. significant weight gain or increase in appetite
   2. hypersomnia
   3. leaden paralysis (i.e., heave, leaden feelings in arms or legs)
   4. long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
3. Criteria are not met for With Melancholic Features or With Catatonic Features during the same episode

Postpartum Onset

With Postpartum Onset (can be applied to the current or most recent Major Depressive, Manic, or Mixed Episode in Major Depressive Disorder, Bipolar I Disorder or Bipolar II Disorder; or to Brief Psychotic Disorder.)

Onset of episode within 4 weeks postpartum.

Longitudinal Course

(can be applied to Recurrent Major Depressive Disorder or Bipolar I or II Disorder):

With Full Interepisode Recovery: if full remission is attained between the two most recent Mood Episodes

Without Full Interepisode Recovery: if full remission is not attained between the two most recent Mood Episodes

Seasonal Pattern

With Seasonal Pattern (can be applied to the pattern of Major Depressive Episodes in Bipolar I Disorder, Bipolar II Disorder, or Major Depressive Disorder, Recurrent)

1. There has been a regular temporal relationship between the onset of Major Depressive Episodes in Bipolar I or Bipolar II Disorder or Major Depressive Disorder, Recurrent, and a particular time of the year (e.g., regular appearance of the Major Depressive Episode in the fall or winter).
   Note: Do not include cases in which there is an obvious effect of seasonal-related psychosocial stressors (e.g., regularly being unemployed every winter).
2. Full remissions (or a change from depression to mania or hypomania) also occur at characteristic time of the year (e.g., depression disappears in the spring).
3. In the last 2 years, two Major Depressive Episodes have occurred that demonstrate the temporal seasonal relationships defined in Criteria A and B, and no nonseasonal Major Depressive Episodes have occurred during that same period.
4. Seasonal Major Depressive Episodes (as described above) substantially outnumber the nonseasonal Major Depressive Episodes that may have occurred over the individual's lifetime.

Rapid-Cycling

With Rapid Cycling (can be applied to Bipolar I Disorder or Bipolar II Disorder)

At least four episodes of a mood disturbance in the previous 12 months that meet criteria for a Major Depressive, Manic, Mixed, or Hypomanic Episode.

Note: Episodes are demarcated either by partial or full remission for at least 2 months or a switch to an episode of opposite polarity (e.g., Major Depressive Episode to Manic Episode).