Author: collabmeans

What classifies a disorder as Obsessive-Compulsive?

Obsessive-Compulsive and Related Disorders are characterized by the presence of obsessions and/or compulsions, and body-focused repetitive behaviors that preoccupy the mind.

What is the difference between an obsession and a compulsion?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (2013) describes obsessions and compulsions as follows:  “obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted”; and compulsions are “repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.”

What are body-focused repetitive behaviors?

Body-focused repetitive behaviors include, but are not limited to, skin-picking, which is known as Excoriation Disorder; Trichotillomania, which is hair pulling; and mirror checking, which is a characteristic of Body Dysmorphic Disorder.

Names of the Disorders within the Class

Each of these disorders has at least one common criterion:  “the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Specifiers

Three specifiers are used when defining an Obsessive-Compulsive and Related Disorder diagnosis.  The first specifier is “with good or fair insight.”  This specifier is used when the individual recognizes that their obsessive-compulsive beliefs are either “definitely not true, probably not true, or that they may or may not be true” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  The second specifier is “with poor insight,” which is used when the individual thinks that their beliefs are probably true.  Finally, the “with absent insight/delusional beliefs” specifier is applied with the individual is completely convinced that their obsessive-compulsive beliefs are true (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Organization of this Blog Series

The Obsessive-Compulsive and Related Disorders’ Blog Series will have three parts:  Part One will cover Obsessive-Compulsive, Excoriation, and Trichotillomania Disorders; Part Two describes Body Dysmorphic Disorder and Hoarding Disorder; and Part Three summarizes Obsessive-Compulsive and Related Disorder Due to Another Medical Condition, Other Specified Obsessive-Compulsive and Related Disorder, Substance/Medication-Induced Obsessive-Compulsive and Related Disorder, and Unspecified Obsessive-Compulsive and Related Disorder.

Click HERE to read the introduction to this blog series, Mental Health Diagnoses!, which covers how diagnosis using the Diagnostic and Statistical Manual- 5 works.

Stay Tuned for Part One!

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 8 July 2018]. dsm.psychiatryonline.org

Part Four of Anxiety Disorders describes Anxiety Disorder Due to Another Medical Condition, Substance/Medication-Induced Anxiety Disorder, Other Specified Anxiety Disorder, and Unspecified Anxiety Disorder.  Click HERE to review the symptoms of anxiety and click HERE to read the criteria for a panic attack.

Anxiety Disorder Due to Another Medical Condition

Individuals are diagnosed with Anxiety Disorder Due to Another Medical Condition when their panic attacks and/or anxiety is caused by a medical illness.  Diagnosis with Anxiety Disorder Due to Another Medical Condition means that the disturbance supersedes the symptoms of the medical condition.

Diagnosis also requires that “there is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  The symptoms of Anxiety Disorder Due to Another Medical Condition should not be better explained by the criterion for another mental disorder and the “disturbance does not occur exclusively during the course of a delirium” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  The final criterion, which is shared between most DSM-5 diagnoses, is the symptoms must disrupt the individual’s typical functioning in school, at work, or in other important settings.

Substance/Medication-Induced Anxiety Disorder

Substance/Medication-Induced Anxiety Disorder is characterized by panic attacks and/or anxiety caused by a drug of abuse or a pharmaceutical drug.  Diagnosis with Substance/Medication-Induced Anxiety Disorder requires that there is evidence of two things:  one, the individual’s “symptoms develop during or soon after substance intoxication or withdrawal, or after exposure to a medication”; and two, that “the involved substance/medication is capable of producing the symptoms” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Evidence can be acquired through medically reported client history, the results of a physical examination, or the conclusions of laboratory tests.

The symptoms of Substance/Medication-Induced Anxiety Disorder should not be better explained by the criterion for another Anxiety Disorder.  Determining whether the symptoms are due to a substance or medication requires the diagnosing professional to inquire about the presence of anxiety prior to the use of the substance or medication.

Finally, symptoms must not “occur exclusively during the course of a delirium,” which is characterized by incoherence of thought and speech, delusions, and restlessness (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Other Specified Anxiety Disorder

The Other Specified Anxiety Disorder diagnosis is applied when the diagnosing professional chooses to specify why the individual does not meet the full criterion for the disorders within this class.  There are four presentations of anxiety that can be diagnosed as Other Specified Anxiety Disorder.  Two of the presentations are considered cultural concepts:  Khyâl cap, or wind attacks; and Ataque de nervios, or attack of nerves.  These phrases are used in the Cambodian and Caribbean cultures, respectively.  Finally, individuals who experience less than four of the symptoms for panic attack and/or individuals whose generalized anxiety occurs less days than not can be diagnosed with Other Specified Anxiety Disorder.

Unspecified Anxiety Disorder

This diagnosis is applied when the diagnosing professional chooses not to specify why the individual does not meet the full criterion for the disorders within this class and/or when there is not enough information available to make a specified diagnosis.  An Unspecified Anxiety Disorder diagnosis is appropriate when an individual receives mental health care in a time-limited setting such as an emergency room.

This concludes the fifth class of Mental Health Diagnoses!  We hope you are more knowledgeable about Anxiety Disorders, that you feel inspired to share what you have learned with others, and that you will help us stop the stigma and start a conversation about mental illness and mental health!

Stay Tuned!

The Introduction to Obsessive-Compulsive and Related Disorders is up next!

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 1 July 2018]. dsm.psychiatryonline.org

Part Three of Anxiety Disorders

Part Three of Anxiety Disorders compares and contrasts Social Anxiety Disorder (Social Phobia) and Specific Phobia, and it also details Agoraphobia.  Anxiety Disorders is the fifth diagnostic class being covered in the Mental Health Diagnosis blog series.  Click HERE to read Part One of Anxiety Disorders, which describes the specific characteristics of anxiety and worry.

Do Social Phobia, Specific Phobia, and Agoraphobia have any similarities?

Yes! These disorders have several commonalities.  First, each disorder has a similar presentation when seen in children.  Children’s expression of fear and anxiety can present as “crying, tantrums, freezing, clinging, shrinking, or failing to speak” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Second, the individual either avoids the object and/or situation or they experience intense fear and anxiety while enduring the object or situation.  Third, the intense fear or anxiety is “out of proportion to the actual danger posed by the specific object or situation”; and fourth, the “fear, anxiety, or avoidance is persistent,” six months or more (Diagnostic and Statistical Manual of Mental Disorders, 2013).

What is the difference between Social Phobia and Specific Phobia?

Social Phobia involves fear and/or anxiety regarding a social situation and Specific Phobia involves fear and/or anxiety concerning an object or a situation that is not social in nature.  Details about each disorder are described below.

Social Anxiety Disorder (Social Phobia)

The Social Phobia diagnosis is reserved for fear or anxiety that almost always occurs during a social situation and it disrupts the individual’s ability to function.  This experience of fear and anxiety in social situations is not due to the effects of a drug of abuse and it is not better explained by the symptoms of “Panic Disorder, Body Dysmorphic Disorder, or Autism Spectrum Disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Specific Phobia

In addition to the previously mentioned symptoms, an individual is diagnosed with Specific Phobia when they immediately experience fear and/or anxiety when presented with a particular object, or when they are in a certain situation.  Objects and situations include, but are not limited to, “seeing blood, receiving an injection, flying [or boarding a plane], and animals” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Differential diagnosis involves the clinician distinguishing symptoms of phobia from the individual’s response to feared social situations, objects, and/or traumatic events; their fear of separation from an attachment figure; and/or their symptoms of anxiety.

 Agoraphobia

The fifth edition of the Diagnostic and Statistical Manuel describes five situations that cause some persons to experience significant fear or anxiety:

1. “Using public transportation (automobiles, buses, trains, ships, planes)
2. Being in open spaces (parking lots, marketplaces, bridges)
3. Being in enclosed places (shops, theaters, cinemas)
4. Standing in line or being in a crowd
5. Being outside of the home alone” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Diagnosis for Agoraphobia requires that an individual experience fear and/or anxiety in two or more of the above situations.  Persons with Agoraphobia avoid these situations because they develop “panic-like symptoms”, become incapacitated, and/or they experience embarrassing symptoms, such as incontinence.

The response to these situations disrupts the individual’s typical functioning in school, at work, or in other important settings; and, the intensity of their response is heightened in the presence of medical conditions, such as Parkinson’s disease or Irritable Bowel Syndrome.

Differential Diagnosis requires that the clinician rule out Specific Phobia, Social Anxiety Disorder, Obsessive-Compulsive Disorder, Body Dysmorphic Disorder, Posttraumatic Stress Disorder, and Separation Anxiety Disorder.

Up Next!

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

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 16 June 2018]. dsm.psychiatryonline.org

 

 

Part Two of Anxiety Disorders

Part Two of Anxiety Disorders describes Panic Disorder, Panic Attack Specifier, and Selective Mutism.  Anxiety Disorders is the fifth diagnostic class being covered in the Mental Health Diagnosis! blog series.  If you missed the introduction to the series click HERE to learn how the Diagnostic and Statistical Manual-5 works.  Click HERE to read the Introduction to Anxiety Disorders.

Panic Attack Specifier:  What is a Panic Attack?

A panic attack is not a mental disorder; they are symptoms that can occur within or outside the context of mental disorders.  The Diagnostic and Statistical Manual 5 (2013) defines a panic attack as “an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes”.  It is important to note that this surge of feelings can begin while the person is in a calm or an anxious state.  An individual typically experiences four or more of the following symptoms during a panic attack:

1. “Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Paresthesias, [which are] numbness or tingling sensations
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying

(Diagnostic and Statistical Manual of Mental Disorders, 2013).  The intensity and combination of the previously mentioned symptoms can cause the person who is experiencing a panic attack to think and feel that they are about to die.

Panic Disorder

An individual is diagnosed with Panic Disorder when they meet four criteria:  one, the individual has reoccurring unexpected panic attacks; two, the individual makes maladaptive changes to avoid panic attacks and/or they are persistently worried about having additional panic attacks; three, the panic attacks are not caused by the physiological effects of a drug of abuse or another medical condition; and four the panic attacks are “not better explained by another mental disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Differential diagnosis involves the clinician distinguishing the individual’s panic attack symptoms from the individual’s response to feared social situations, phobias, obsessions, traumatic events, and separation from attachment figures.

Selective Mutism

Selective Mutism is less prevalent than Panic Disorder and panic attacks, which are more common experiences.  The Selective Mutism diagnosis is reserved for persons who consistently fail to speak in social situations, regardless of their knowledge on a topic of conversation, their level of comfort in the social setting, or their spoken language skills.  Individuals with Selective Mutism are not “mute”; they use spoken language in some, but not all social situations.  These failures to speak occur in “specific social situations in which there is an expectation for speaking,” such as in school or during extracurricular activities (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Diagnosis with Selective Mutism requires that the failure to speak disturbance last at least one month; that the disturbance interferes with the individual’s “educational or occupational achievement or with social communication”; and, that the disturbance is “not better explained by a communication disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Although Selective Mutism is most often seen in children, both adolescents and adults can experience the symptoms and subsequent diagnosis.

Differential diagnosis involves the clinician ruling out Autism Spectrum Disorder, Schizophrenia, and/or another psychotic disorder.

Up Next!

Part Three of Anxiety Disorders, which details Agoraphobia, Social Anxiety Disorder (Social Phobia), and Specific Phobia.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 16 June 2018]. dsm.psychiatryonline.org

 

 

Part One of Anxiety Disorders

Part One of Anxiety Disorders details Generalized Anxiety Disorder and Separation Anxiety Disorder.  Anxiety Disorders is the fifth diagnostic class being covered in the Mental Health Diagnosis! blog series.  If you missed the introduction to the blog series click HERE to learn how the Diagnostic and Statistical Manual-5 works.  Click HERE to read the Introduction to Anxiety Disorders.

What are the specific characteristics of anxiety and worry?

The Diagnostic and Statistical Manual of Mental Disorders (2013) lists the following characteristics of anxiety and worry:

1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

Are there Any Similarities between Generalized Anxiety Disorder and Separation Anxiety Disorder?

Yes!  Both disorders are characterized by symptoms of anxiety and worry, however, they differ in the typical age of onset, the duration of symptoms, and the cause of the symptoms.

As with each disorder within the Diagnostic and Statistical Manuel of Mental Disorders 5, the symptoms and characteristics of the disorder must disrupt the individual’s typical functioning in school, at work, or in other important settings; and, the symptoms of the disorder are not due to the physiological effects of a substance, nor to an abuse of a drug, nor any other medical condition.

Generalized Anxiety Disorder

Generalized Anxiety Disorder is characterized by excessive worry and trouble controlling the worry.  Diagnosis requires that the individual experience at least three of the above characteristics of anxiety and worry for “more days than not for at least six months” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Topics or scenarios that cause some persons to experience excessive anxiety and worry include work, school, social activities, presentations, and so forth.

There are several disorders that must be ruled out prior to diagnosing an individual with Generalized Anxiety Disorder.  These disorders, which we will cover throughout the Mental Health Diagnosis! Blog series, cause the individual to worry and/or experience anxiety that is better explained by a more specific set of criteria.  Disorders that include excessive worry and anxiety include, but are not limited to, Social Anxiety Disorder, Obsessive-Compulsive Disorder, Separation Anxiety Disorder, Post-Traumatic Stress Disorder, Anorexia Nervosa, and Body Dysmorphic Disorder.

Separation Anxiety Disorder

Separation Anxiety Disorder is characterized by fear and anxiousness “about separation from attachment figures to a degree that is developmentally inappropriate” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  It is developmentally appropriate for a toddler to physically cling to a parent or to cry when the parent exits the room; however, these behaviors would be considered developmentally inappropriate if the person were a teenager or an adult.

The onset of symptoms typically begins during an individual’s childhood, but they can continue into adulthood.  Diagnosis requires that the feelings of fear, anxiety, and/or avoidance are persistent:  lasting at least four weeks in children and adolescents and lasting approximately 6 months or more in adults (Diagnostic and Statistical Manual of Mental Disorders, 2013).

An individual can be diagnosed with Separation Anxiety Disorder when they experience three or more of the following developmentally inappropriate types of “excessive fear or anxiety concerning separation from those to whom [they are] attached:

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures;
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death;
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure;
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation;
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings;
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure;
7. Repeated nightmares involving the theme of separation;
8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated adults” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Disorders that must be ruled out prior to diagnosing an individual with Separation Anxiety Disorder include, but are not limited to, “excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Up Next!

Part Two of Anxiety Disorders which describes Panic Disorder, Panic Attack Specifiers, and Selective Mutism.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 6 June 2018]. dsm.psychiatryonline.org

 

 

What classifies a disorder as an Anxiety Disorder?

Feelings of excessive fear and/or extreme anxiety that subsequently cause behavioral disturbances are classified as Anxiety Disorders.  Anxiety disorders differ from another in the following three ways:  objects or situations that induce fear, encourage anxiety, and/or incite avoidance behavior (Diagnostic and Statistical Manual of Mental Disorders, 2013).

What is the difference between anxiety and fear?

While feelings of anxiety and fear can overlap, they have distinct definitions.  Anxiety is the feeling that arises when anticipating a future threat.  Symptoms of anxiety are associated with muscle tension.  Fear is “the emotional response to a real or perceived imminent threat,” and its symptoms are associated with the fight, flight, or freeze response (Diagnostic and Statistical Manual of Mental Disorders, 2013).

What are avoidance behaviors?

Types of avoidance behaviors include avoiding, escaping, and partial avoidance.  Avoiding involves dodging an object, subject, or situation in its entirety.  When unable to fully avoid, some persons escape.  Examples of escaping including leaving a gathering early or ending a presentation prior to its intended finish.  Finally, partial avoidance, which is sometimes referred to as safety behaviors, is used when avoiding and escaping are not possible.  Partial avoidance includes avoiding eye contact in social settings, daydreaming, and sitting away from groups (Cuncic, 2017).  Persons employ avoidance behaviors to reduce or prevent feelings of fear and/or anxiety.

Names of the Disorders within the Class

Each of these disorders has one common criteria, that the “fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Organization of this Blog Series

The Depressive Disorders’ Blog Series has four parts:  Part One will cover Generalized Anxiety Disorder and Separation Anxiety Disorder; Part Two describes Panic Disorder, Panic Attack Specifier, and Selective Mutism; Part Three details Agoraphobia, Social Anxiety Disorder (Social Phobia), and Specific Phobia; and Part Four describes Substance/Medication Induced Anxiety Disorder, Anxiety Disorder Due to Another Medical Condition, Other Specified Anxiety Disorder, and Unspecified Anxiety Disorder.

Click HERE to read the introduction to this blog series, Mental Health Diagnoses!, which covers how diagnosis using the Diagnostic and Statistical Manual- 5 works.

Stay Tuned for Part One!

References

Cuncic, A. (2017, July 13). 3 Coping Strategies That Actually Make Anxiety Worse. Retrieved June 1, 2018,from https://www.verywellmind.com/what-are-avoidance-behaviors-3024312

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 31 May 2018]. dsm.psychiatryonline.org

 

 

 

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

Depressive Disorder Due to Another Medical Condition

Depressive Disorder Due to Another Medical Condition is characterized by noticeable and continuous periods of depressed mood, noticeable decreased interest in activities, and a noticeable decrease in pleasure during activities.  (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Diagnosis with this disorder means that the disturbance supersedes the symptoms of the medical condition.

Diagnosis also requires that “there is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition”.  The symptoms of Depressive Disorder Due to Another Medical Condition should not be better explained by the criterion for another mental disorder and the “disturbance does not occur exclusively during the course of a delirium” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  The final criterion, which is shared between most DSM-5 diagnoses, is the symptoms must disrupt the individual’s typical functioning in school, at work, or in other important settings.

Substance/Medication-Induced Depressive Disorder

Substance/Medication-Induced Depressive Disorder is characterized by noticeable and continuous disturbance in mood, specifically the presence of depressive symptoms and/or a decreased interest in or pleasure during activities.

Diagnosis with Substance/Medication-Induced Depressive Disorder requires that there is evidence of two things:  one, the individual’s “symptoms develop during or soon after substance intoxication or withdrawal, or after exposure to a medication”; and two, that “the involved substance/medication is capable of producing the symptoms” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Evidence can be acquired through medically reported client history, the results of a physical examination, or the conclusions of laboratory tests.

The symptoms of Substance/Medication-Induced Depressive Disorder should not be better explained by the criterion for another Depressive Disorder.  Determining whether the symptoms are due to a substance or medication requires the diagnosing professional to inquire about the presence of depression prior to the use of the substance or medication.

Finally, symptoms must not “occur exclusively during the course of a delirium,” which is characterized by incoherence of thought and speech, delusions, and restlessness (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Other Specified Depressive Disorder

The Other Specified Depressive Disorder diagnosis is applied when the diagnosing professional chooses to specify why the individual does not meet the full criterion for the disorders within this class.  There are three specifications:  recurrent brief depression, short duration depressive episode, and depressive episode with insufficient symptoms.  It is important to note that diagnosis with these specifiers are not appropriate for an individual who has ever met the criteria for a psychotic, bipolar, or another depressive disorder.

Both the ‘recurrent brief depression’ and ‘short-duration depressive episode’ specifiers are used when an individual has a depressed mood and a minimum of four other symptoms of depression.  The ‘recurrent brief depression’ specifier is specific to individual’s whose symptoms occur “for two to thirteen days [within a month] for at least 12 consecutive months” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  If the symptoms only last four to thirteen days the ‘short-duration depressive episode’ is used.

‘Depressive episode with insufficient symptoms’ is appropriate for individuals who have at least one depressive symptom and it persists for at least two weeks.

Unspecified Depressive Disorder

This diagnosis is applied when the diagnosing professional chooses not to specify why the individual does not meet the full criterion for the disorders within this class and/or when there is not enough information available to make a specified diagnosis.  An Unspecified Depressive Disorder diagnosis is appropriate when an individual receives mental health care in a time-limited setting such as an emergency room.

This concludes the fourth class of Mental Health Diagnoses!  We hope you are more knowledgeable about Depressive Disorders, that you feel inspired to share what you have learned with others, and that you will help us stop the stigma and start a conversation about mental illness and mental health!

Stay Tuned!

The Introduction to Anxiety Disorders is up next!

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 6 May 2018]. dsm.psychiatryonline.org

 

 

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

Part Two of Depressive Disorders differentiates Major Depressive Disorder and Persistent Depressive Disorder.  Depressive Disorders is the fourth diagnostic class being covered in the Mental Health Diagnosis! blog series.  If you missed the introduction to the series click HERE to learn how the Diagnostic and Statistical Manual-5 works.  Click HERE to read the Introduction to Depressive Disorders.

Similarities between Major Depressive Disorder and Persistent Depressive Disorder?

Major Depressive Disorder and Persistent Depressive Disorder have four common criterion:  one, the minimum conditions for meeting a manic or hypomanic episode have never been met; two, the depressive symptoms are not due to the physiological effects of a substance, the abuse of a drug, nor any other medical condition; three, the depressive symptoms are not better explained by a Schizophrenia Spectrum Disorder; and four, the depressive symptoms must disrupt the individual’s typical functioning in school, at work, or in other important settings.

Major Depressive Disorder

Diagnosis with Major Depressive Disorder requires that an individual meet all five of the criteria outlined in the Diagnostic and Statistical Manuel of Mental Disorders.  Four of the five criteria for Major Depressive Disorder are described above as they are also requirements for Persistent Depressive Disorder.

In addition to the previously mentioned criterion, diagnosis also requires that the individual experience five or more of the nine depressive characteristics for most of the day and nearly every day for at least two weeks; it is required that either ‘depressed mood’ or ‘loss of interest or pleasure’ is one of the symptoms; and the presence of the symptoms of depression must represent a change in previous functioning.

The Diagnostic and Statistical Manual of Mental Disorders (2013) lists the following characteristics of depression:

1. “Depressed mood
2. Markedly diminished interest or pleasure in all, or almost all, activities
3. Significant weight loss when not dieting, weight gain, or decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or [delay]
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan for committing suicide”.

Persistent Depressive Disorder

One of the criteria that differentiates Persistent Depressive Disorder from Major Depressive Disorder is the length of time that symptoms have been present.  Diagnosis with Persistent Depressive Disorder requires the presence of a depressed mood for most of the day and nearly every day for at least two years in adults and at least one year in children and adolescents.

In addition to the symptoms of depression, the individual also experiences two or more of the following additional symptoms:

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”

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

Finally, the symptoms for Major Depressive Disorder must be present for two consecutive years, and there is no more than a two-month period where symptoms subside; and the individual must not have ever met the criteria for cyclothymic disorder.  Click HERE to review the characteristics of cyclothymia!

 Up Next!

Part Three of Depressive Disorders which details Disruptive Mood Dysregulation Disorder and Premenstrual Dysphoric 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

Part One of Depressive Disorders covers specifiers.  Specifiers are used to further define the characteristics that accompany a mental health diagnosis.  These specifiers are important because diagnosis determines the course of treatment.  The following specifiers are defined below:  anxious distress, mixed features, melancholic features, atypical features, psychotic features, mood-congruent psychotic features, mood-incongruent psychotic features, catatonia, peripartum onset, and seasonal pattern.  Some of these specifiers may sound familiar to you because they are also used when specifying Bipolar and Related Disorders.

Specifiers for Depressive Disorders

Mixed Features

There are four criterion for the “with mixed features” specifier.  Criterion A states that the individual must experience three or more symptoms of mania or hypomania almost every day during most of the depressive episode.  A detailed description of mania and hypomania can be found in the Part Two of Bipolar and Related Disorders.

Criterion B requires that the symptoms of depression, mania and/or hypomania are a change from the person’s typical behavior and that the changes are observable by others.  Criterion C is specifically for individuals whose symptoms meet full criteria for either mania or hypomania. In these cases, the individual’s diagnosis should be either Bipolar I or Bipolar II Disorder.  Criterion D states that the “symptoms are not attributable to the physiological effects of a substance” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Catatonia

Catatonia or catatonic behavior is a noticeable decrease in the level and intensity of which an individual interacts with or responds to their environment.  The catatonia specifier is applied to Depressive Disorders diagnosis when catatonic features are present during the majority of the individual’s depressive episode.  Details about catatonia can be found in Part Three of Schizophrenia Spectrum and Other Psychotic Disorders. 

 Melancholia Features

This specifier is applied when its features are present at the most severe stage of the individual’s depressive episode.  There are two criteria for meeting the melancholia features specifier.  Criterion A requires that the individual experience either loss of pleasure in the majority of their activities or a “lack of reactivity to usually pleasurable stimuli” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Criterion B requires that the individual experience three or more of the following features:

1. “A distinct quality of depressed mood or so-called empty mood
2. Depression that is regularly worse in the morning
3. Early-morning awakening (i.e., at least 2 hours before usual awakening)
4. [Noticeable] psychomotor agitation or [delay]
5. Significant anorexia or weight loss
6. Excessive or inappropriate guilt”

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

Psychotic Features

The psychotic features specifier is added to a diagnosis when the individual experiences delusions and hallucinations during a depressive episode.  Delusions are beliefs that remain even when there is evidence that is contrary.  Hallucinations occur when an individual involuntarily perceives an experience without any external stimuli.  Details regarding delusions and hallucinations are described in the Introduction to Schizophrenia Spectrum and Other Psychotic Disorders.

Seasonal Pattern

The seasonal pattern specifier is used for individuals with recurrent major depressive episodes.  The seasonal pattern specifier is added to a diagnosis when the depressive episode occurs during the same time of year and subsides during another time of year.  The DSM-5 outlines four criteria that qualify symptoms for the seasonal pattern specifier.

One, the relationship between the change of the season and the change in mood from euthymic (‘normal’ mood) to a depressive mood or the reverse occurs regularly and during the same time of year.  Two, the individual goes into full remission with the change of the season or at a particular time of year.  An example of this is when depression lifts in the spring.  Three, the individual’s mood episodes do not have non-seasonal changes.  Four, seasonal mood episodes significantly outnumber any non-seasonal mood episodes during the individual’s lifetime.

Peripartum Onset

The peripartum onset specifier is reserved for describing the symptoms of depression that began during pregnancy or within four weeks of delivery (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Mood-Congruent Psychotic Features

This specifier is applied when the individual experiences delusions and hallucinations.  It is important to note that these psychotic features must align with the “typical depressive themes of personal inadequacy, guilt, disease, death, nihilism [rejection of religious principles], or deserved punishment (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Mood-Incongruent Psychotic Features

The “mood-incongruent psychotic features” specifier is used when the “content of the delusions or hallucinations [that the individual experiences] does not involve typical depressive themes” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Specifiers for Major Depressive Disorder and Persistent Depressive Disorder

The following specifiers are only used for either Major Depressive or Persistent Depressive Disorder.

 Anxious Distress

The anxious distress specifier is added to a diagnosis if the individual experiences two or more ‘anxious’ features during a major depressive episode or when also experiencing the symptoms of persistent depressive disorder.  The number of symptoms experienced determines the severity of the distress.  Experiencing two symptoms is considered mild; three symptoms is moderate; four or five symptoms is moderate to severe; and, experiencing four to five symptoms with motor agitation (involuntary and meaningless movement) is classified as severe.  The Fifth Edition of the Diagnostic and Statistical Manual (DSM-5) outlines anxious features as follows:  tension, restlessness, worry that makes concentration difficult, fear something horrible will occur, and feeling as though they may lose control.

Atypical Features

The atypical features specifier is added to a diagnosis when the following features are prevalent during a major depressive episode or when also experiencing the symptoms of persistent depressive disorder.  The first necessary feature is mood reactivity which describes how an individual’s “mood brightens in response to actual or potential positive events” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Secondly, the individual experiences two or more of the following features:  “significant weight gain or increase in appetite; hypersomnia; leaden paralysis, [or a heavy feeling in the limbs]; and a long-standing pattern of [sensitivity to] interpersonal rejection that results in significant social or occupational impairment” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  Finally, the individual must not meet the criteria for the “with melancholic features” or “with catatonia” specifiers, which are described above, during the same depressive episode.

Stay Tuned for Part Two which differentiates Major Depressive Disorder and Persistent 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