What Should I Know About DSM V Depression?

Updated February 17, 2021

Medically Reviewed By: Lori Jones, LMHC

DSM and depression are associated with one another, but they’re two very different things. Depression is a serious medical condition, while the DSM is a handbook that serves as an authoritative guide for diagnosing mental health disorders.

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Depression is a mental health disorder that may also be called a major depressive disorder or clinical depression. While depression is a mental health disorder, it can also cause physical symptoms like chronic pain or digestive issues. Depression manifests a bit differently in everyone, even though many of their symptoms may be the same. In some people, depression is fairly mild, and in others, it can be quite serious. Depending on the circumstances that brought the depression on, it can be temporary, or it can be persistent.

What Is The DSM?

DSM is an acronym for The Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (APA). Healthcare providers in the United States, and somewhat in the world, rely on the DSM as an authoritative guide on diagnosing mental health disorders. Clinicians will find descriptions of mental health disorders, along with symptoms and other criteria to assist them in making qualified diagnoses. The other benefit to the DSM is that it uses common language for clinicians to use with their patients and with other clinicians, which provides consistency in diagnostics and research. Using a common language also helps pharmaceutical companies in the development of medications and other interventions.

I’m Struggling With Sadness, Do I Have Depression?

Everyone goes through periods of sadness for various lengths of time. If you consider that the main symptom of depression is sadness, it can be difficult to differentiate the difference between normal periods of sadness and depression that requires some type of clinical intervention.

Sadness is a healthy emotion that all people experience at one time or another. It’s common to feel sadness as a result of a situation, event, or person. When you lose a job, end a relationship, get a diagnosis of serious physical disease or ailment, or hear of a loved one’s passing, you’re bound to be sad for some time.

When we contrast normal periods of sadness with depression, there’s no situation, event, or person that triggers depression. You should be able to feel happiness and joy when good things are happening in your life. You might feel frustrated, upset, or disappointed at times, but you should still be able to enjoy watching television, playing video games, reading, or doing other favorite activities. Normal periods of sadness won’t usually keep you up at night. It won’t prevent you from going to work in the morning. You’ll probably still feel like eating. In your interactions with friends, family, or coworkers, you might feel regret your words or actions, and you might wish you could have a “do-over,” but it won’t cause you to feel major guilt or worthlessness.

If you’re feeling sad and hopeless about everything, even when you can’t attribute it to anything specific, you may have a depressive disorder. If you have a major depressive disorder, you lose interest in the activities that you used to enjoy. You may not feel like eating, and you might be sleeping too much or too little. A depressive disorder may cause you to have negative thought patterns about yourself and everyone else.

Depression isn’t just a strong degree of sadness. It has to do with a combination of factors that relate to the duration of negative feelings, the impact they have on your body, other symptoms, and the effect that depressive symptoms have on your ability to manage normal, everyday functions. One of the most important differences between general sadness and a depressive disorder is that people with a major depressive disorder may have suicidal ideations or feelings about harming themselves or others that are difficult for them to shake off.

Diagnosing A Major Depressive Disorder During Times Of Loss Or Hardship

Diagnosing a depressive disorder becomes even more complicated when someone experiences a significant loss in addition to have persistent feelings of sadness. If this sounds like you or someone that you know, don’t try to make a diagnosis on your own and don’t ignore it. This type of situation calls for getting the opinion of a licensed clinician or other mental health professional.

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Diagnostic Criteria For Depression According To the DSM-5

When you visit a mental health professional, they take a medical and mental health history from you. They will ask you a lot of questions, and they may ask you to fill out one or more questionnaires. Once they’ve done their due diligence in information gathering, they’ll compare the information with the criteria for major depressive disorder as provided by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders before making a diagnosis of a depressive disorder or something else.

The DSM-5 is the latest version of the Diagnostic and Statistical Manual of Mental Disorders. According to this guide, individuals must experience five or more of the following symptoms during the same two-week period, and the symptoms should either be related to a depressed mood or loss of interest or pleasure:

  • Experiencing a depressed mood almost every day for most of the day.
  • Having a noticeable decreased interest or pleasure in all or almost all activities that you formerly enjoyed almost every day.
  • Having a significant weight gain or loss when not consciously trying to lose or gain weight or having a noticeable decrease or increase in appetite.
  • Feeling like your thoughts are sluggish and having slower physical movements.
  • Feeling fatigued or loss of energy almost every day.
  • Having feelings of worthlessness, excessive guilt, or misdirected guilt almost every day.
  • Difficulty being able to think, concentrate or focus almost every day.
  • Having recurrent thoughts of death, having recurrent suicidal ideations, having a plan for committing suicide, or attempting suicide.

If you or someone that you know is experiencing the symptoms as described in the final bullet point, it’s important to seek emergency help. The National Suicide Prevention Lifeline 1-800-273-8255 and is available 24 hours a day, 7 days a week.

In the latest version of the DSM-5, the APA added two more specifications to help further classify diagnoses.

  1. Depression With Mixed Features. This means that for patients that don’t meet the full criteria for a manic episode, clinicians can allow for the presence of manic symptoms as part of their diagnosis for depression.
  2. Depression With Anxious Stress. Clinicians should perform an assessment of anxious distress as part of their assessment for depression and determine whether it warrants any changes in their prognosis, treatment options, or patient’s response to them.

What Are the Signs And Symptoms Of Clinical Depression?

No one is immune to the symptoms of clinical depression. It can strike anyone at any time, across genders, ethnicities, socioeconomic statuses, and other demographics.

For a clinician to accurately diagnose clinical depression, the symptoms of depression must be severe enough to cause disruption in their work, school, social life, or daily activities, and they shouldn’t be caused by substance abuse or some other medical condition.

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Here are some of the questions a licensed clinician may ask to determine a diagnosis of clinical depression. Some of these are also listed under the criteria for the DSM-5.

  • Feeling sad, teary-eyed, empty or hopeless
  • Having angry outbursts, or expressing irritability or frustration over little things
  • Losing interest or pleasure in most or all normal activities like sex, sports, or hobbies
  • Sleeping far too much or far too little
  • Being tired, lacking energy
  • Extreme weight loss or weight gain or big changes in appetite
  • Feeling anxious, agitated, or restless
  • Experiencing slowed speech or body movements
  • Feeling guilty, worthless, or fixating on past failures
  • Having difficulty thinking, concentrating and making decisions
  • Frequent or consistent thoughts of suicide or death
  • Physical problems like back pain or headaches that can’t be explained

Suicide Associated With Major Depression

According to the U.S. Department of Health and Human Services (HHS), the majority of people that have depression die due to a cause other than suicide. While that’s good news, people that have a diagnosis of depression have an increased risk of suicide when compared with people that don’t live with depression. In some cases, the risk of death by suicide may be related to the severity of the depression.

HHS has new data that shows that about 2% of the people that have been treated for depression in an outpatient setting will die by suicide. The rate for people living with depression that have been treated in an inpatient hospital setting is higher at 4%. Patients that were treated for depression on an in-patient basis following incidents of having suicidal ideations or suicide attempts are three times more likely (6%) to die by suicide as those who were treated in outpatient settings.

HHS also reports that there are significant differences in the risk of suicide connected with depression based on differences in gender. The rate for men with a lifetime history of depression that die by suicide is 7% as compared with only 1% of women that have a lifetime history of depression that die due to suicide.

As mentioned above, if you or someone you know are suicidal, you should seek immediate help. The National Suicide Prevention Lifeline is available at 1-800-273-8255 and is reachable 24 hours a day, 7 days a week.

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Clinical depression is a serious medical condition. If you suspect that you or someone that you care about has uncontrolled depression, it helps to schedule an appointment with a licensed therapist. Treatments for depression are usually quite effective. The sooner you seek help, the sooner you can begin to enjoy life again. Remember that no matter what you’re experiencing, with the right tools, you can move forward in healthy ways.

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