Part Three of Depressive Disorders

Part Three of Depressive Disorders details Disruptive Mood Dysregulation Disorder and Premenstrual Dysphoric Disorder!  Both Disruptive Mood Dysregulation Disorder and Premenstrual Dysphoric Disorder are new to the Diagnostic and Statistical Manuel-5 (DSM-5).

Disruptive Mood Dysregulation Disorder was created to prevent children from being over diagnosed with a Bipolar or Related Disorder; it is specifically reserved for children twelve years old and younger.

Further, after approximately twenty years of research, investigators determined that there are depressive symptoms directly associated with menstruation.  This determination led to diagnostic criteria for Premenstrual Dysphoric Disorder.

Although these disorders are very different, the have two common criteria:  one, the depressive symptoms are not due to the physiological effects of a substance, nor to an abuse of a drug, nor any other medical condition; and two, the characteristics and/or symptoms of the respective disorder disrupt the individual’s typical functioning in school, at work, or in other important settings.

Disruptive Mood Dysregulation Disorder

Disruptive Mood Dysregulation Disorder is characterized by severe recurring verbal and/or behavioral temper outbursts that are inconsistent with the individual’s developmental level and are tremendously out of proportion in intensity to the stimulating event.

Diagnosis requires that these outbursts, which lead to the individual being irritable or angry most of the day, occur three or more times per week and in more than one setting:  at home, in school, or with peers.  The verbal and/or behavioral temper outbursts are not considered Disruptive Mood Dysregulation Disorder if they “occur exclusively during an episode of major depressive disorder or are better explained by another mental disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

There are specific time constraints associated with diagnosing Disruptive Mood Dysregulation Disorder.  The behaviors must be present for a minimum of twelve months, with no more than three consecutive months without symptoms; the behaviors must have begun prior to the individual turning ten years old; the individual has never experienced more than one day where their behaviors aligned with the criteria for a manic or hypomanic episode; and, the initial diagnosis is not made prior to the individual turning six years old, nor after they have turned 18 years old (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder is not simply an intense version of premenstrual syndrome (PMS) nor is it a heightening of the symptoms of another depressive, personality, or anxiety disorder.  Premenstrual Dysphoric Disorder involves having severe debilitating symptoms, including mood swings, that negatively affect the individual in multiple settings.

The DSM-5 (2013) outlines eleven symptoms of Premenstrual Dysphoric Disorder.  At least one of the following four characteristics must cause a noticeable change in the individual:

1. “Affective lability (mood swings; suddenly feeling sad)
2. Irritability or anger or increased interpersonal conflicts
3. Depressed mood, feelings of hopelessness, or self-deprecating thoughts
4. Anxiety, tension, and/or feelings of being keyed up or on edge”.

In addition to the previously mentioned symptoms, one or more of the following symptoms must also be present:

1. “Decreased interest in usual activities (e.g., work, school, friends, hobbies)
2. Subjective difficulty in concentration
3. Lethargy, easy fatigability, or marked lack of energy
4. Marked change in appetite; overeating; or specific food cravings
5. Hypersomnia or insomnia
6. A sense of being overwhelmed or out of control
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain”

(Diagnostic and Statistical Manual of Mental Disorders, 2013).

Diagnosing an individual with Premenstrual Dysphoric Disorder involves tracking their symptoms daily for at least two menstruation cycles.  The symptoms must be present in the week prior to menstruation; they must begin to improve after a few days of menstruation; and the symptoms must have minimal effect or be completely absent in the week after menstruation.

 Up Next!

Part Four of Depressive Disorders which describes Depressive Disorder Due to Another Medical Condition, Substance/Medication-Induced Depressive Disorder, Other Specified Depressive Disorder, and Unspecified Depressive Disorder.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 2 May 2018]. dsm.psychiatryonline.org