All About Depression: Diagnostic Specifiers
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Specifiers used to describe mood disorders:
- Mild: A few symptoms, if any, are present beyond what is needed to make a diagnosis, and a person can function normally although with extra effort.
- Moderate: The severity of symptoms is between mild and severe. For a manic episode, a person's activity is increased or judgment is impaired.
- Severe Without Psychotic Features: Most symptoms are present and a person clearly has little or no ability to function. For a manic or mixed episode, a person needs to be supervised to protect him/her from harm to self or others.
- Severe With Psychotic Features: A person experiences hallucinations or delusions. Psychoses may develop in about 15% of those with major depressive disorder. The presence of delusions and hallucinations often interfere with a person's ability to make sound judgments about consequences of their actions and this may put them at risk for harming themselves. Psychotic symptoms are serious and a person in this condition needs immediate medical attention and possibly hospitalization.
- Single Episode/Recurrent: A first episode is considered "single," subsequent episodes are "recurrent."
- In Partial/Full Remission: There is full remission when there is an absence of symptoms for at least two months. For partial remission, full criteria for a major depressive episode are no longer met, or there are no substantial symptoms but two months have not yet passed.
- Chronic: For at least two years a person's symptoms have met criteria for a major depressive episode.
- Catatonic Features: Unusual behaviors or movements such as immobility, excessive activity that is purposeless, rigid or peculiar posturing, mimicking others' words or behaviors.
- Melancholic Features: A loss of pleasure in most activities or an inability to feel better, even for a short time when something pleasurable happens. Also, at least three of following is present: the depressed mood is distinct (i.e., unlike feelings of bereavement), it is worse in the morning, a person wakes too early in the morning, there is distinct agitation or movements are slowed down, substantial weight loss, or extreme feelings of guilt. Melancholic features are associated with a person experiencing a specific precursor to the illness and having a better response to antidepressants. Men and women may equally have these features, although they are more common in older people. They may also be more likely to occur in more severe depressive episodes, particularly ones with psychotic features.
- Atypical Features: During the last two weeks of major depression or bipolar disorder (depressive episode) or the last two years of dysthymia, a person is able to experience brightened mood when good things happen. Also, at least two of the following must be present: substantial gain in weight or appetite, sleeping too much (at nighttime or daytime napping that is at least 10 hours total or two hours beyond normal), body feels heavy or weighted down, or persistent sensitivity to rejection by others that is related to personal or social difficulties. The sensitivity to rejection tends to be a more long-standing problem. The presence of depression may increase the sensitivity, although it is often still present when the person is not depressed. Atypical features occur two to three times more often in women. They are also associated with depression beginning at an earlier age (e.g., teens) and possibly more chronic depressive episodes. Personality and anxiety disorders may also be more common.
- Postpartum Onset: The depressive episode begins within four weeks of giving birth.
- With/Without Full Interepisode Recovery: Describes a long-term course of recurrent major depression or bipolar disorder. The specifiers indicate whether a person recovered from his/her symptoms between the two latest episodes.
- Seasonal Pattern: Describes a pattern of depressive episodes in recurrent major depression or bipolar disorder. The symptoms tend to begin (usually fall or winter) and end (usually spring) at particular times of the year.
- Rapid-Cycling: Describes a recurrent pattern of depressive and manic episodes in bipolar disorder. A person has had at least four mood episodes during the last 12 months. There is either a general absence of symptoms between episodes or a clear switch from one to its opposite, such as from depression to mania. Rapid-cycling may affect 5% to 15% of those with bipolar disorder, and women account for 70%-90% of those with this pattern. Certain medical conditions may be related to rapid-cycling such as neurological problems, hypothyroidism, head injury, and mental retardation, as well as treatment with antidepressants. Those who develop a pattern of rapid-cycling may have a less favorable prognosis.
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