Cindy has suffered from a depressed mood for two years.

In the last six months, she has lost

interest in normal activities, feels tired all the time, and is experiencing sleep disturbances. In

the past three weeks, she has experienced disassociation, hallucinations, and thoughts of

suicide and self-harm. From these symptoms, it appears that Cindy has Early-Onset Persistent

Depressive Disorder (PDD).

The first criteria for PDD is a depressed mood which lasts for two years or more in adults or one

year or more in minors. As Cindy is a minor and she stated that she has been feeling depressed

for two years, she meets this first criteria. The second criteria is two or more of the following:

poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, poor concentration

or difficulty making decisions, or feelings of hopelessness. She has stated that she has trouble

falling asleep and waking up, which falls under insomnia. She also stated that she is tired all the

time, demonstrating low energy and fatigue. Therefore she has at least two of the symptoms in

the second criteria and successfully meets this criteria. The third criteria states that the

individual must have had these symptoms continually and any breaks in symptoms must have

been 2 months or less. There were no mentions of pauses in her symptoms for two years

straight, so she meets this criteria. The fourth criteria states that an individual may meet the

criteria for a major depressive episode for over two years, which will be addressed in a following

section. Criteria 5-7 address differential diagnoses, essentially stating that the individual’s

condition must not be better explained by Cyclothymic Disorder, a psychotic disorder, substance

abuse, or other medical condition. She does not experience waxing and waning in her

symptoms, and since her psychotic symptoms have always been accompanied by depressive

symptoms, psychotic disorder can be ruled out as well. Finally, the last criteria states that it has

to cause distress or impair function. She has stated that she was worried that she would hurt
herself, and her grades have dropped and she has lost interest in social activities. Both of these

show distress and impaired function.

The first diagnosis I considered when looking at this case was Major Depressive Disorder

(MDD) as she reported feeling depressed, loss of interest in activities, insomnia, feelings of

excessive and inappropriate guilt with delusions and hallucinations, and recurrent thoughts of

death and suicide, meeting the first criteria for MDD. However, as her symptoms have lasted for

two years, PDD fit her symptoms better and PDD allows for the individual to meet the criteria for

MDD. Another diagnosis I considered was Post-Traumatic Stress Disorder (PTSD) as a result of

her mother’s attack. She experienced significant harm at the hand of her mother, and then

avoided her mother, the instigator of the attack. She also suffered from feelings of negativity

towards herself and loss of interest in activities as well as sleep disturbance and difficulty

concentrating. However, we do not know if she had intrusive thoughts regarding her experience,

and therefore cannot fully state that she is suffering from PTSD since she does not clearly meet

all of the criteria.

In the end, to come to a more firm conclusion, we would need to know if she suffers from

intrusive thoughts about her experience with her mother, and if her psychotic symptoms occur

without depressive symptoms, and if she drinks alcohol or takes drugs. If she suffers from

intrusive thoughts (other than her guilt) regarding her mother, a diagnosis of PTSD may be

better suited. If her psychotic symptoms occur without depressive symptoms, a diagnosis of

schizoaffective disorder may be better suited. Finally, if she has substance abuse issues, those

could be the cause of her symptoms.