OVERVIEW OF MOOD DISORDERS 11: DISRUPTIVE MOOD DYSREGULATION DISORDER
*general emotional state (mood) is distorted or inconsistent with the
person’s circumstances and interferes with their ability to function
*it ranges from being extremely sad, empty, or irritable (depression) and
periods of depression alternating with being excessively happy (mania)
Disruptive Mood Dysregulation Disorder: chronic, severe, and
persistent irritability in children that often includes frequent temper
outbursts that are inconsistent with the child’s developmental age
Major Depressive Disorder: prolonged and persistent periods of
extreme sadness
Persistent Depressive Disorder (Dysthymia): a long-term (chronic) form of
depression
Premenstrual Dysphoric Disorder: mood disturbance and irritability that
occur during the premenstrual phases of a woman’s cycle and
disappear with the onset of menses
Bipolar Disorder: depression that includes alternation of depression
and mania (or hypomania)
Cyclothymic Disorder: causes emotional ups and downs that are less
extreme than bipolar disorder
A. severe recurrent TOs manifested verbally and/or behaviorally
that are grossly out of proportion in intensity or duration to the
situation or provocation
B. the TOs are inconsistent with the developmental level
C. the TOs occur 3/+ times per week on average
D. the mood between TOs is persistently irritable or angry for
mod, ne, & obo
E. criteria A-D have been present for 12/+ months without 3/+
consecutive months of asymptomatic period
F. criteria A&D are present in at least 2 of 3 settings and are
severe in 1 of these
G. first diagnosis should not be made -6 years old or +18 years old
H. by history or observation, the age at onset of criteria A-E is
-10 years old
I.except for duration, a distinct period of full symptom criteria for a
manic or hypomanic episode lasting for +1day has never been
met N: developmentally appropriate mood elevation should not
be considered as a symptom of mania or hypomania
J. the behaviors are not exclusive during an episode of MDD
and are not better explained by another mental disorder
N: *diagnosis has no comorbidity with oppositional defiant disorder,
intermittent explosive disorder, or bipolar disorder *it has
comorbidity with major depressive disorder,
attention-deficit/hyperactive disorder, conduct disorder, and
substance use disorder *if symptoms meet criteria for both DMDD
and oppositional defiant disorder, diagnosis is only DMDD *if there
has been manic or hypomanic episode, diagnosis of DMDD is not
assigned
K. the symptoms are not substance induced or due to another
medical or neurological condition
5: MAJOR DEPRESSIVE DISORDER
A. 5/+ of the ff. symptoms have been present for md/ne during
the same 2wk period and represent a change from previous
functioning; at least 1 of the symptoms is either (1) depressed
mood or (2) anhedonia
N: do not include symptoms that are substance induced or due to
another medical condition
1. depressed mood
2. loss of interest or pleasure in all or almost all activities;
either subjective report or observed by others
N: mood can be irritable for children and adolescents
3. significant weight loss without dieting or weight gain (for
example,
+5% change of body weight in a month) or increase or decrease in
appetite; either subjective report or observed by others
N: consider failure to make expected weight gain for children
4. insomnia or hypersomnia
5. psychomotor agitation or retardation; must be observed by
others, not just subjective report of restlessness or being slowed
down
6. fatigue or loss of energy
7. feelings of worthlessness or excessive or inappropriate guilt; it
could be delusional and not a mere self-reproach or guilt for
being sick
8. poor concentration or indecisiveness; either subjective
report or observed by others
9. recurrent thoughts of death (not just fear of dying), suicidal
ideation without a specific plan, or a suicide attempt or a specific
plan for committing suicide
B. the symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning
C. the episode is not substance induced or due to
another medical condition
N: criteria A-C represents MDE
N: *responses to a significant loss with symptoms noted in criterion
A may resemble MDE *although such event is understandable or
appropriate, the presence of MDE in addition to the grief or
bereavement should be carefully considered *this decision requires
 5: MAJOR DEPRESSIVE DISORDER 8: PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA) 7: PREMENSTRUAL DYSPHORIC DISORDER
clinical judgement based on the individual’s history and cultural norms *this disorder represents a consolidation of DSM-IV-defined chronic A. in the majority of menstrual cycles, at least 5 symptoms
of expression of distress in the context of loss MDD and dysthymic disorder must be present in the final week before the onset of menses, start
D.the episode is not better explained by another mental disorder in to improve within a few days after the onset of menses, and
schizophrenia spectrum and other psychotic disorders A. depressed mood for md, for +days than not—either subjective
become minimal or absent in the week postmenses
E. there has never been a manic or hypomanic episode report or observed by others—for at least 2yrs
B. 1/+ of the ff. symptoms must be present: these are marked…
N: this exclusion does not apply to mania or hypomania that are N: mood can be irritable and duration must be at least 1yr for 1. affective lability
substance induced or due to another medical condition children and adolescents 2. irritability or anger or increased interpersonal conflicts
B. 2/+ of the ff. symptoms are present while depressed:
3. depressed mood, feelings of hopelessness, or self-depreciating
Distinguishing Grief and MDE 1. poor appetite or overeating
thoughts
Dimension MDE Grief 2. insomnia or hypersomnia
4. anxiety, tension, and/or feelings of being keyed up or on edge
Predominant affect depressed mood emptiness and loss 3. low energy or fatigue
and anhedonia C. 1/+ of the ff. symptoms must additionally be present, to reach
4. low self-esteem
Duration persistent and likely to decline a total of 5 symptoms when combined with symptoms from
5. poor concentration or indecisiveness
not tied to in intensity criterion B
6. feelings of hopelessness 1. decreased interest in usual activities
specific
C. during the 2yr period—or 1yr for children and adolescents— 2. subjective difficulty in concentration
thoughts
Severity of pain pervasive may be of disturbance, there has been no asymptomatic period for 3. lethargy, easy fatigability, or marked lack of energy
unhappiness and accompanied by symptoms in criteria A&B for +2 months at a time
4. marked change in appetite, overeating, or specific food cravings
misery positive emotions D. criteria for MDD may be continuously present for 2yrs
5. hypersomnia or insomnia
and humor E. there has never been a manic or hypomanic episode and
6. sense of being overwhelmed or out of control
Thought content self-critical or preoccupied with criteria have never been met for cyclothymic disorder
7. physical symptoms such as breasts tenderness or swelling,
pessimistic thoughts and F. the disturbance is not better explained by another mental
joint or muscle pain, a sensation of bloating, or weight gain
ruminations memories of the disorder in
deceased schizophrenia spectrum and other psychotic disorders N: the symptoms in criteria A-C must have been met for most menstrual
Self-esteem feelings of generally preserved G. the symptoms are not substance induced or due to another cycles that occurred in the preceding year
worthlessness and medical condition
self-loathing H. the symptoms cause clinically significant distress or D. the symptoms cause clinically significant distress or
*self-derogatory ideation typically involves perceived failings in relation to impairment in social, occupational, or other important areas of impairment in social, occupational, or other important areas of
the deceased functioning functioning
*death ideation in grief typically focus on the deceased unlike MDE E. the disturbance is not merely an exacerbation of the symptoms of
that focus on the individual itself N: *because the criteria for MDD include 4 symptoms excluded from another disorder
PDD, a very few will have depressive symptoms persisting for +2yrs F. criterion A should be confirmed by prospective daily ratings
without meeting criteria for PDD *if full criteria for MDD have been met at during at least 2 symptomatic cycles
some point during the current episode of illness, diagnosis should be N: the diagnosis may be made provisionally prior to this
MDD *otherwise, diagnosis of other specified or unspecified depressive confirmation
disorder is warranted G. the symptoms are not substance induced or due to another medical
condition
 2: BIPOLAR I DISORDER
A. criteria have been met for at least one ME
B. the occurrence of the M and MD episodes are not better
explained by another mental disorders in schizophrenia spectrum
and other psychotic disorder
4: MANIC EPISODE
*for a diagnosis of B1D, it is necessary to meet the ff. criteria for a manic
episode *the ME may have been preceded by and may be followed by
H or MD episodes
A. for at least 1wk, there is a distinct period of abnormal and
persistent elevated, expansive, or irritable mood and abnormal and
persistent increased activity or energy that are present for md,
ne, or any duration if hospitalized
B. 3/+ of the ff. symptoms are present to a significant degree—or
4 if the mood is only irritable—during the mood disturbance and
represent a marked change from usual behavior:
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressured speech
4. flight of ideas
5. distractibility, as reported or observed
6. increased in goal-oriented activity or psychomotor agitation
7. excessive pursuit of potentially self-destructive activities
C. the mood disturbance is severe enough to cause marked
impairment in social or occupational functioning, require
hospitalization to prevent harm to self or others, or involve
psychotic features
D. the episode is not substance induced or due to
another medical condition
N: a full ME due to antidepressant treatment but persists at a fully
syndromal level beyond the treatment’s physiological effects is
enough to diagnose ME and qualify for B1D
4: BIPOLAR II DISORDER 4: BIPOLAR II DISORDER
A. criteria have been met for at least 1 HE and at least 1 MDE A. the episode is not substance induced or due to another
B. there has never been a ME medical condition
C. the occurrence of the H and MD episodes are not better N: *a full HE due to antidepressant treatment but persists at a fully
explained by another mental disorders in schizophrenia spectrum syndromal level beyond the treatment’s physiological effects is
and other psychotic disorder enough to diagnose HE and qualify for B2D *however, caution is
D. the depressive symptoms or the unpredictability caused by indicated so 1 or 2 symptoms (particularly those ff. antidepressant
frequent alternation between depression and hypomania cause use) are not taken as sufficient for diagnosis of HE nor indicate a
clinically significant distress or impairment in social, occupational, bipolar diathesis
or other important areas of functioning
6: HYPOMANIC EPISODE
*for a diagnosis of B2D, it is necessary to meet the ff. criteria for a
current or past HE and the ff. criteria for a current or past MDE
A. for at least 4 consecutive days, there is a distinct period of
abnormal and persistent elevated, expansive, or irritable mood and
abnormal and persistent increased activity or energy that are
present for md/ne
B. 3/+ of the ff. symptoms are present to a significant degree—or
4 if the mood is only irritable—during the mood disturbance and
represent a marked change from usual behavior:
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressured speech
4. flight of ideas
5. distractibility, as reported or observed
6. increased in goal-oriented activity or psychomotor agitation
7. excessive pursuit of potentially self-destructive activities
C. the episode is associated with a definite change in
functioning that is unlikely of the individual when asymptomatic
D. the mood disturbance and the change in functioning are obo
E. the episode is not severe enough to cause marked
impairment in social or occupational functioning, or require
hospitalization—if there are psychotic features, the episode is
manic
6: CYCLOTHYMIC DISORDER

for at least 2yrs—or 1yr in children and adolescents

—there have been many hypomanic and depressive
symptoms that fall short for meeting the criteria
for either H and MD episode
during the 2yr period—or 1 year in children and
adolescents—the periods of hypomania and
depression have been present for at least half the
time without an asymptomatic period for +2
months at a time
criteria for MD, M, or H episodes has never been
met
the symptoms in criterion A are not better
explained by another mental disorders in
schizophrenia spectrum and other psychotic
disorder
the symptoms are not substance induced or due to
another medical condition
the symptoms cause clinically significant distress
or impairment in social, occupational, or other
important areas of functioning