Sadness can be all encompassing. How do you know when it's just a sad spell versus when it's a serious problem or even a disorder?
Major Depressive Disorder
Duration – minimum 2 weeks
Symptoms: Depressed mood or loss of interest or pleasure and five or more of the following present during the same two-week period:
Significant weight loss
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Diminished ability to think or concentrate
Recurrent thoughts of death/suicide
Diagnostic Codes:
Mild F32.0
Moderate F32.1
Severe F32.2
With Psychotic F32.3
In partial remission (single episode – F32.4, recurrent episode – F32.41)
In full remission (single episode – F32.5, recurrent episode – F32.42)
Unspecified F32.9
Differential:
Manic Episodes with Irritable Mood or Mixed Episodes – (mania)
Attention-Deficit/Hyperactivity Disorder – (inattention/hyperactivity)
Adjustment Disorder with Depressed Mood – (5 or more criteria met in 2 weeks)
Postpartum Depression OR MDD with Peripartum Onset:
This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
Persistent Depressive Disorder F34.1
Duration: 2 years, with symptoms continuous; in children, 1 year
Onset:
Early – before age 21
Late – after age 21
Symptoms: Depressed mood and at least 2 of the following
Decreased appetite or overeating
Insomnia or hypersomnia
Fatigue/low energy
Low self-worth
Difficulty concentrating or making decisions
Hopelessness
The individual is never without symptoms for more than 2 months. Major Depressive Disorder criteria may be present for the 2 years. The individual has never experienced a manic or hypomanic episode.
Differential:
Major Depressive Disorder – (criteria met for 2 years or more)
Psychotic Disorders – (psychosis)
Personality Disorders – (can coexist, criteria makes the decision)
Premenstrual Dysphoric Disorder
Timing of symptoms
In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses
Symptoms: One or more of the following symptoms must be present:
Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
Marked irritability or anger or increased interpersonal conflicts
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, and/or feelings of being keyed up or on edge
One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms above:
Decreased interest in usual activities
Subjective difficulty in concentration
Lethargy, easy fatigability, or marked lack of energy
Marked change in appetite; overeating or specific food cravings
Hypersomnia or insomnia
A sense of being overwhelmed or out of control
Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain
Differential:
Major Depressive Disorder (cause is PMS)
Panic Disorder (cause is PMS, depressive episodes present)
Persistent Depressive Disorder (cause is PMS)
Personality Disorders (can be comorbid)
Also determine if symptoms are a result of the physiological effects of a substance (e.g., drug abuse, medication or other treatment) or another medical condition (e.g., hyperthyroidism).
Gender Dysphoria in Adolescents and Adults F64.1
Duration – 6 months
Symptoms: Belief one has been born in the wrong gender's body. Individual has at least two of these issues:
Belief one is or should be a different gender
Wants to be divested of one's sexual organs and associated physical anatomy due to gender dissonance
Longs for the sexual organs and associated anatomy of desired gender
Longs to experience life as the desired gender
Longs to become and be treated as gender other than one assigned
Sense that one experiences life as desired gender state in terms of thoughts, feelings, actions, and interactions
Types:
With a disorder of sexual development E25.0
Differential:
Body Dysmorphic Disorder – (not about identity as much as physical body)
Transvestic Disorder – (wearing clothes for pleasure-not identity)
Nonconformity to Gender Roles – (identity)
Schizophrenia and Other Psychotic Disorders – (psychotic symptoms)
Gender Dysphoria (in Children) F64.2
Duration: 6 months
Symptoms: At least six of the following:
Desire to be the other gender or that one is the other gender or an alternative gender
In boys, a strong preference for cross-dressing or simulating female attire; in girls, a strong preference for wearing masculine clothing and resistance to typically feminine clothing
Strong preference for cross-gender roles in make-believe or fantasy play
Strong preference for toys, games, or activities stereo-typically used for engaged in by other gender
Strong preference for playmates of other gender
Boys rejection of typically masculine items and rough/tumble play; girls rejection of typically feminine items and activities
Strong dislike of one's sexual anatomy
Strong desire for primary and/or secondary sex characteristics that match experienced gender
Types:
With a disorder of sexual development E34.50
Other Specified Gender Dysphoria F64.8
Unspecified Gender Dysphoria F64.9
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