A patient with a history of recurrent depressive episodes presents to a psychiatrist. During the diagnostic interview, they report feeling persistently sad, having lost interest in previously enjoyable activities, experiencing significant weight loss despite not dieting, and having difficulty concentrating for the past two months. They also mention feeling worthless and having recurrent thoughts of death. Which of the following DSM-5 criteria, if met, would be most critical for diagnosing Major Depressive Disorder in this scenario?
- APsychotic features such as hallucinations or delusions.
- BPresence of a manic or hypomanic episode.
- CSymptoms causing clinically significant distress or impairment in functioning.
- DDuration of symptoms for at least one week.
Show answer & explanationAnswer & explanation
Correct answer: C. Symptoms causing clinically significant distress or impairment in functioning.
While the patient's reported symptoms (sadness, anhedonia, weight loss, concentration issues, worthlessness, thoughts of death) strongly suggest MDD, a critical diagnostic criterion for any mental disorder in the DSM-5 is that the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Without this, the symptoms might be considered a normal reaction to life stressors.
Why the other options are wrong
- A. Psychotic features can occur in MDD but are not required for diagnosis and would indicate MDD with psychotic features, a specifier.
- B. The absence of a manic or hypomanic episode is a criterion for MDD, as its presence would indicate Bipolar Disorder.
- D. The duration criterion for MDD is at least two weeks, not one week.
Major Depressive Disorder (MDD) DSM-5 Criteria
A mental disorder characterized by a persistently depressed mood or loss of interest in activities, causing significant impairment in daily life, lasting for at least two weeks.
- At least 5 symptoms present during the same 2-week period
- One symptom must be depressed mood or anhedonia (loss of interest/pleasure)
- Symptoms cause clinically significant distress or impairment
- Not attributable to substance use or another medical condition
- No history of manic or hypomanic episodes
Memory trick: MDD needs 5 sad signs, for 2 weeks, causing real pain.