Depression Diagnosis in the DSM: Different Types and What They Mean

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Apr 21, 2022

✨POV✨: There are so many types of depression known today. You're wondering what makes them different from each other. Isn't depression just feeling low and sad for a long period of time?

Just as mental illness is not about being crazy (or delusional or all those outdated stereotypes), depression is not just about depressed mood (which is a depression symptom). It's just the tip of the iceberg.

So what is the go-to reference for all things mental disorders?

The Bible of Clinical Depression Diagnosis 🔖

Clinical here means that it is medically diagnosable.

The Diagnostic and Statistical Manual (DSM) is the most important guidebook for mental disorders and their diagnoses. It is a comprehensive and exhaustive list of mental disorders with their diagnostic criteria (the minimum criteria that need to be met for the diagnosis of a specific mental disorder). It was first authored in 1952 by the American Psychiatric Association (APA) to standardize efforts in treating mental health conditions. It is regularly updated to include any new symptoms or disorders discovered through research.

The different types of depression are listed under 'Depressive Disorders' in the DSM. There are over 8 different types of depression that can be diagnosed.

Diagnostic Criteria for Depressive Disorders 🗒️

The reason why the DSM is considered the bible of mental disorders.

The diagnostic criteria for each disorder include a list of symptoms, prevalence of the disorder, information on its development, risk factors, functional consequences of the disorder, differential diagnoses, comorbidity, and specifiers.

A lot of this is jargony mumbo-jumbo, which in reality is quite simple and intuitive. Imagine each category of disorders as having a long list of FAQs that are answered under each section. This (extensive) level of coverage on each category of disorders helps mental health professionals all over the world be on the same page and provide the best approach to treat depression.

Here's a basic introduction to these subsections:

📄 List of Symptoms: There are 5 sections (A to E). Section A lists the range of depression symptoms that may be present in the specific disorder, how many need to be present, and for how long. Section B necessitates disturbances in day-to-day life due to the disorder. Section C necessitates the absence of a physical or substance-use issue as the cause. Section D necessitates that other mental disorders are not better diagnoses of the conditions. Section E necessitates that the condition is not bipolar depression (because they can be easily confused).

🔍 Specifiers: These mention the severity, stage, and nature of the disorder. This section goes hand-in-hand with Section A by outlining the link between the range of symptoms present and severity.

🔣 Prevalence: This section explores how common or uncommon the disorder is in certain age groups in the United States.

📈 Development: This section outlines the general course of development of the disorder - when it first sets in, how it develops, the time it takes for recovery, and if/how relapses occur.

🤕 Risk Factors: This section lists the factors that may make an individual more vulnerable to developing the specific mental disorder. This section reinforces Section C.

⏩ Functional Consequences: This section explores the negative impact that the disorder can have on the regular day-to-day life of an individual - in their emotions, physical health, relationships, behavior, and work. This section is an extension of Section B.

❌ Differential Diagnoses: This section mentions the other disorders that this specific disorder may be confused with. This section is very very important to make sure that the right diagnosis is being made and is the reference for Section D and E.

🤝 Comorbidity: This section lists the other disorders which commonly occur along with this specific disorder. Like having a common cold with fever.

Types of Clinical Depression Diagnosis 📃

There are over eight different types of depression. These are the most known ones:

🔞 Disruptive Mood Dysregulation Disorder (DMDD)

This type of depression only occurs in children and teenagers. The common symptoms of DMDD are violent outbursts, aggressive behavior, and irritability, which are easy to recognize by parents and teachers. These symptoms must be present on more than 3 days a week and should begin showing up before the age of 10.

This diagnosis means that the child struggling with DMDD is at a higher risk of developing other forms of clinical depression and needs immediate support.

1️⃣ Major Depressive Disorder (MDD)

MDD is also known as major depression or severe depression. It is the most common type of depression and arguably, the poster child. It has severe symptoms which include emotional, physical, cognitive and behavioral issues. It is diagnosed on the basis of depressive episodes that last for 2 weeks or longer. The depressive episode must have 5 or more symptoms, out of which at least one is ‘depressed mood’ or ‘loss of interest’.

As the name suggests, this type of disorder is generally more severe than the others, which makes the diagnosis easier.

2️⃣ Persistent Depressive Disorder (PDD)

PDD is also known as mild depression because unlike MDD it does not have physical symptoms. It is also diagnosed on the basis of depressive episodes, but the kinds that last for the majority of two years. Like MDD, at least 5 symptoms of depression must be present. It is harder to diagnose than MDD because its milder symptoms may not be as noticeable.

3️⃣ Premenstrual Dysphoric Disorder (PMDD)

PMDD was recently added to the DSM in 2013. Remember all the stereotypes of PMS?

Well, some of the stereotypes might be better understood as PMDD, as it is a severe extension of PMS (Pre-Menstrual Syndrome). Even though the symptoms are present only for a week or so, they are severe enough to disrupt relationships, workflow and mental health. 5 or more symptoms must be present for most menstrual cycles in a year.

4️⃣ Bipolar Disorder (BD)

This disorder is no longer listed under Depressive Disorders in the DSM. It is present under a different category 'Bipolar and Related Disorders'.

This distinction is important because clinical depression (aka unipolar depression) only has one set of bipolar disorder (aka bipolar depression) symptoms. Let us explain.

Bipolar disorder has a series of alternating manic episodes (periods of very high energy) and depressive episodes (periods of very low energy). Because half the disorder is the same as clinical depression, Section E of the diagnostic criteria emphasizes on the absence of manic episodes for a depression diagnosis.

5️⃣ Seasonal Affective Disorder (SAD)

This type of depression is also known as seasonal depression. It is MDD with the specifier of 'seasonal pattern' - which means SAD is basically severe depression that only occurs during a particular season every year. The symptoms present for SAD vary based on the trigger season. To know more, click here.

6️⃣ Treatment-Resistant Depression (TRD)

This type of depression is also a version of severe depression (MDD with a specifier). TRD does not respond to therapy or antidepressants and needs specialized brain-stimulation therapies like electroconvulsive therapy.

Last Word on Mental Health 🤍

The DSM as we might have noticed is very thorough about the listed mental disorders. This extreme attention to detail is what makes it synonymous with mental disorder diagnosis.

It's been a lot of information, some heavy textbook-sounding type. The hope here is that we know a lot more about depression diagnosis than before, which means that we will not be falling for pop-psych quips on depression.

Our building awareness of the inside-out is exactly what we need to decimate any stigma about mental health and depression. Because it is what it is.

Click here to read about the way after forward after a depression diagnosis.

Note on Mental Disorders 🚩

Clinical Depression is never clear cut, making it harder to diagnose and treat. It is not unheard of for people with depression to self-harm or have suicidal thoughts. If you have such depressive symptoms, please use the national suicide prevention lifeline or contact a mental health professional to seek treatment options.