What Are The DSM 5 Depression Criteria?
By Julia Thomas
Updated May 19, 2020
Reviewer Aaron Dutil
Nearly everyone is sad from time to time. However, although depression is common, not everyone who experiences sadness receives a diagnosis of depression. So how does a medical professional determine whether you're depressed or not? The answer lies in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-5 lays out the criteria for clinical depression explicitly. Here's what the DSM-5 has to say about diagnosing depression.
DSM 5 Criteria For Depression
The DSM 5 definition of depression is more than a simple one-sentence description. Instead, it's a detailed and comprehensive explanation of the symptoms that are present in order that a diagnosis of depression can be determined. In addition to a listing and description of the symptoms, the DSM gives specific rules for making that diagnosis.
The DSM-5 identifies several different symptoms of depression, but there are two main criteria that must be considered. These two are depressed mood and anhedonia. Depressed mood has to do with sadness or negative emotions. Anhedonia means that you no longer feel any pleasure or interest in the things you once enjoyed. You must have one or the other of these two main criteria to be diagnosed as depressed.
If you meet one of the two main criteria, the secondary symptoms will be considered. These include somatic symptoms related to your physical body, as well as non-somatic symptoms that are related to thought and emotion.
You feel the somatic symptoms of depression in your body. And, you may notice that your body is changing while you're depressed. The following are somatic, or body-related, symptoms mentioned in the DSM-5 depression criteria.
- Sleep difficulties - If you're depressed, you may have insomnia or you may sleep more than usual. You may have trouble going to sleep or staying asleep. Sometimes people with depression wake up very early and can't go back to bed. Often, especially in young people with depression, people sleep much more than usual. Excessive sleeping is called hypersomnia.
- Changes in appetite or weight - While you're depressed, you may find that you don't have much of an appetite for any kind of food. Or you might feel like eating constantly. It's the change that's significant to the diagnosis. The same is true for weight gain or weight loss. You may lose or gain weight during depression. What clues your doctor in that you have depression is that these things are changing.
- Poor concentration - Poor concentration happens during depression because your brain isn't working as well as it usually does. You may have a hard time focusing on your work, your daily chores, or even leisure activities like watching a movie or reading a book.
- Fatigue - The DSM criteria for depression mentions physical fatigue and loss of energy. This includes decreased activity, feeling tired, having low energy, decreased endurance, feeling weak, heavy, sluggish, or slow, having to put in more effort to do the same physical tasks, or feeling sleepy.
- Psychomotor agitation or retardation - Basically, this criterion has to do with a slowing-down or speeding up of your physical and emotional reactions. In psychomotor retardation, you may find that you think and move very slowly. In psychomotor agitation, you might feel restless, anxious, irritable, and tense. You may have racing thoughts or be unable to sit still.
The non-somatic symptoms of depression include emotions. They also include the content of your thoughts. These are non-somatic symptoms of depression described in the DSM-5:
- Depressed mood - Depressed mood is about emotion. It's feeling sad or low.
- Anhedonia - This is a loss of pleasure, interest, or enjoyment.
- Feelings of worthlessness or guilt - This symptom of depression is present when you feel there's no worth or value in yourself as a person. Unwarranted feelings of guilt are also common when you're depressed.
- Thoughts of suicide or death - If you think a lot about death or have thoughts of suicide, it's not only a symptom of depression, it's critical that you get help immediately.
Diagnosing Depression with the DSM 5
Making a diagnosis is not a simple task. Mental health professionals study for years to understand how to do it accurately. That's why it's important not to try to diagnose yourself or someone else. Knowing the symptoms can help you decide whether to seek help, but once you do, the professional will make the diagnosis.
One thing you need to know is that in addition to the list and description of symptoms, the DSM-5 outlines several other criteria for making a diagnosis of depression. The following are some of the guidelines given in the DSM.
Number of Symptoms
During a consultation and interview, your medical professional will ask you about each of the symptoms outlined in the DSM-5. They note whether you have one of the two main symptoms of depression - depressed mood or anhedonia - and add to that each of the secondary symptoms you're experiencing. If you have five or more total symptoms, the DSM-5 recommends a diagnosis of depression.
Duration and Impact
While assessing your symptoms and deciding whether or not to count them, your mental health professional notes the duration of your symptoms and how great of an effect they're having on your life. To receive a diagnosis of depression, you would be experiencing five or more symptoms most of the day every day during one two-week period. Also, they'll pay attention to how distressing these symptoms are to you and whether they impair your functioning at work, in social situations, and in other aspects of your life.
Other Causes of Symptoms
Before you get a diagnosis of depression, your doctor will need to rule out other reasons you might be having them. Many medical conditions can mimic signs of depression. Also, your doctor will need to determine if the symptoms are due to substance abuse. If there's nothing else causing your symptoms, the diagnosis may be depression.
All or None Diagnosis
The depression diagnosis DSM 5 suggests is an all or none diagnosis. Each symptom is considered as either present or not present. The criteria don't specify the severity of the symptoms - only whether it's present or not. Typically, the severity of the condition could be determined by using depression scales like the Hamilton Depression Rating Scale.
However, one study suggested that the symptoms listed in the DSM-5 for depression could be used to determine the severity of the mental disorder. The researchers explained that the somatic symptoms can be used to distinguish moderate depression from non-depression. On the other hand, the non-somatic symptoms are more likely to be prominent in severe depression and can be used to separate moderate and severe depression.
DSM 5 Depression Code
The DSM-5 is used with the International Classification of Diseases (ICD-10), which gives each DSM depression code as well as codes for other medical conditions. The depression DSM 5 code from the ICD-10 is determined by the severity, which can be mild, moderate or severe, as well as the status, like depressed, in remission, or having recurrent depressive episodes. Although this is sometimes called the DSM 5 code for depression, the code is actually from the ICD-10.
Additional Specifiers in the DSM V Depression Criteria
In addition to the diagnostic information in previous versions of the DSM, the DSM-5 gives two more specifiers to consider when diagnosing depression. The first new classification is depression "with mixed features." This specifier notes symptoms of mania within a depressive episode. The second is "with anxious distress." This recognizes the presence of anxiety symptoms that occur along with depression.
Does the DSM-5 Recommend Treatments?
The DSM-5 was designed as a handbook for diagnosis. It does not recommend any treatments at all. Medical professionals uses this manual solely for determining if someone has a mental condition. They rely on other sources to determine what to do about it.
What to Do If You Think You're Depressed
It's unwise to try to diagnose yourself. So what do you do if you feel you might be depressed? The best thing to do is to talk to a mental health professional to get an expert diagnosis. Then, you'll know whether you need to do more. Treatment can involve medications, psychotherapy, or a combination of therapies.
Whether you have depression or are just feeling sad, talking to a therapist can help you understand your reactions and find better ways to deal with them. It's easy to connect with a counselor for online therapy at BetterHelp. Then, you can discuss your symptoms as well as situations and events that are troubling you. Also, you can get support from someone who understands what you're going through and will listen to you without judging you. Finally, you can explore ways to change your thoughts and behaviors to improve your mood and functioning.
Depression can make your life seem sad, dismal, distressing, and even unbearable. It can keep you from living the life you want. Yet, you don't have to accept depression as inevitable and just force yourself to live with it. Instead, you can get help to make it through your depression and beyond.