Persistent Depressive Disorder

Question 1

Persistent Depressive Disorder

Answer 1

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others for at least 2 years. NOTE: In children and adolescents, mood can be irritable and duration must be at least 1 year.

B. Presence, while depressed, of two (or more) of the following:

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

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.

D. Criteria for a major depressive disorder may be continuously persistent for 2 years.

E. There has never been a manic episode or hypomanic episode.

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse a medication) or another medical condition (e.g., hyperthyroidism).

H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

NOTE: If criteria are sufficient for a diagnosis of major depressive episode at any time during the 2-year period of depressed mood, then a separate diagnosis of major depression should be made in addition to the diagnosis of persistent depressive disorder along with the relevant specifier (e.g., with intermittent major depressive episodes, withe current episode).

Question 2

Persistent Depressive Disorder Specifiers

Answer 2

With Anxious Distress
With Atypical Features
In Partial Remission
In Full Remission
Early Onset (If onset before age 21 years)
Late Onset (If onset is at age 21 years or older)

Specify if (for most recent 2 years of persistent depressive disorder):
–With Pure Dysthymic Syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years.
–With Persistent Major Depressive Episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period.
–With Intermittent Major Depressive Episodes, With Current Episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode.
–With Intermittent Major Depressive Episodes, Without Current Episode: Full criteria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years.

Question 3

Persistent Depressive Disorder Severity Specifiers

Answer 3

Mild
Moderate
Severe