8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (ei- ther by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with- out a specific plan, a suicide attempt, or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
Note: Criteria A—C above constitute a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a nat- ural disaster, a serious medical illness or disability) may include the feelings of intense sad- ness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion
A, which may resemble a depressive episode. Although such symptoms may be under- standable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.1
A. Criteria have been met for at least one hypomanic episode (Criteria A—F under “Hypo— “Major Depressive Episode" above).
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaftective disorder, schizophrenia, schizophreniform disor- der, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
D. The symptoms of depression or the unpredictability caused by frequent alternation be- tween periods of depression and hypomania causes clinically significant distress or im- pairment in social, occupational, or other important areas of functioning.
Bipolar |I disorder has one diagnostic code: 296.89 (F31.81). Its status with respect to cur- rent severity, presence of psychotic features, course, and other specifiers cannot be coded but should be indicated in writing (e.g., 296.89 [F3181] bipolar II disorder, current episode depressed, moderate severity, with mixed features; 296.89 [F3181] bipolar II dis- order, most recent episode depressed, in partial remission).
Specify current or most recent episode:
Specify if:
With anxious distress (p. 149)
With mixed features (pp. 149—150) 1 In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in a MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in intensity over days to weeks and occurs in waves, the so—called pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased. The depressed mood of a
MDE is more persistent and not tied to specific thoughts or preoccupations. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhap- piness and misery characteristic of a MDE. The thought content associated with grief generally fea- tures a preoccupation with thoughts and memories of the deceased, rather than the self—critical or pessimistic ruminations seen in a MDE. In grief, seIf-esteem is generally preserved, whereas in a