Depressive Disorders : Changes from DSM IV to DSM 5
- To address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children, a new diagnosis, disruptive mood dysregulation disorder, is included for childrenup to age 18 years who exhibit persistent irritability and frequent episodes of extreme behavioral dyscontrol.
- Premenstrual dysphoric disorder is now promoted from Appendix B, “Criteria Sets and Axes Provided for Further Study,” in DSM-IV to the main body of DSM-5. What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive disorder, which includes both chronic major depressive disorder and the previous dysthymic disorder.
- The coexistence within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed features.”
- In DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion). This exclusion is omitted in DSM-5 for several reasons, including the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable individual, generally beginning soon after the loss, and can add an additional risk for suffering, feelings of worthlessness, suicidal ideation, poorer medical health, and worse interpersonal and work functioning. It was critical to remove the implication that bereavement typically lasts only 2 months, when both physicians and grief counselors recognize that the duration is more commonly 1–2 years. A detailed footnote has replaced the more simplistic DSM-IV exclusion to aid clinicians in making thecritical distinction between the symptoms characteristic of bereavement and those of a majordepressive disorder.
- Finally, a new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders.