The DSM also required now that the symptoms should be associated with clinically significant distress -- there should be some kind of disturbance in work or school or social relationships -- and that symptoms and symptom severity should now be documented by keeping a daily log for at least two cycles in a row.
Menurut DSM, gejala-gejala tersebut juga harus dikaitkan dengan perasaan tertekan secara klinis -- semacam gangguan di tempat kerja, sekolah atau dalam hubungan sosial -- dan gejala-gejala serta tingkat keparahannya harus dicatat dalam catatan harian selama minimal dua siklus berturut-turut.