After careful scientific review of the evidence, premenstrual dysphoric disorder has been moved from an appendix of DSM-IV (“Criteria Sets and Axes Provided for Further
Study”) to Section II of DSM-S. Almost 20 years of additional of research on this condition has confirmed a specific and treatment-responsive form of depressive disorder that begins sometime following ovulation and remits within a few days of menses and has a marked impact on functioning.
A large number of substances of abuse, some prescribed medications, and several medical conditions can be associated with depression—like phenomena. This fact is recog- nized in the diagnoses of substance/medication-induced depressive disorder and depres- sive disorder due to another medical condition.
Diagnostic Criteria 296.99 (F34.8)
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or be- haviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
. The temper outbursts are inconsistent with developmental level.
. The temper outbursts occur, on average, three or more times per week.
. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
E. Criteria A—D have been present for 12 or more months. Throughout that time, the indi- vidual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A—D.
F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 18 years.
H. By history or observation, the age at onset of Criteria A—E is before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria. except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of ma- nia or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disor- der, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent ex- plosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive diagnosis of disruptive mood dysregulation disorder. If an individual has ever experi- enced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.
K. The symptoms are not attributable to the physiological effects of a substance or to an- other medical or neurological condition.
The core feature of disruptive mood dysregulation disorder is chronic, severe persistent ir- ritability. This severe irritability has two prominent clinical manifestations, the first of which is frequent temper outbursts. These outbursts typically occur in response to frus- tration and can be verbal or behavioral (the latter in the form of aggression against prop- erty, self, or others). They must occur frequently (i.e., on average, three or more times per week) (Criterion C) over at least 1 year in at least two settings (Criteria E and F), such as in the home and at school, and they must be developmentally inappropriate (Criterion B).