MDE feelings of worthlessness and self—loathing are common. If self—derogatory ideation is present in grief, it typically involves perceived failings vis-a-vis the deceased (e.g., not visiting frequently enough, not telling the deceased how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about “joining” the deceased, whereas in a MDE such thoughts are focused on ending one’s own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.
With rapid cycling (pp. 150—151)
With mood-congruent psychotic features (p. 152)
With mood-incongruent psychotic features (p. 152)
With catatonia (p. 152). Coding note: Use additional code 293.89 (F06.1).
With peripartum onset (pp. 152—153)
With seasonal pattern (pp. 153-154): Applies only to the pattern of major depressive episodes.
Specify course it full criteria for a mood episode are not currently met:
In partial remission (p. 154)
In full remission (p. 154)
Specify severity if full criteria for a mood episode are currently met:
Mild (p. 154)
Moderate (p. 154)
Severe (p. 154)
Bipolar II disorder is characterized by a clinical course of recurring mood episodes con- sisting of one or more major depressive episodes (Criteria A—C under “Major Depressive sode”). The major depressive episode must last at least 2 weeks, and the hypomanic epi- sode must last at least 4 days, to meet the diagnostic criteria. During the mood episode(s), the requisite number of symptoms must be present most of the day, nearly every day, and represent a noticeable change from usual behavior and functioning. The presence of a manic episode during the course of illness precludes the diagnosis of bipolar II disorder (Criterion B under ”Bipolar II Disorder"). Episodes of substance/medication-induced de- senting the physiological effects of a medication, other somatic treatments for depression, drugs of abuse, or toxin exposure) or of depressive and related disorder due to another medical condition or bipolar and related disorder due to another medical condition do not count toward a diagnosis of bipolar II disorder unless they persist beyond the physiolog- ical effects of the treatment or substance and then meet duration criteria for an episode. In addition, the episodes must not be better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or terion C under ”Bipolar II Disorder”). The depressive episodes or hypomanic ﬂuctuations must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion D under ”Bipolar II Disorder”); however, for hy- pomanic episodes, this requirement does not have to be met. A hypomanic episode that causes significant impairment would likely qualify for the diagnosis of manic episode and, therefore, for a lifetime diagnosis of bipolar I disorder. The recurrent major depressive ep- isodes are often more frequent and lengthier than those occurring in bipolar I disorder.
Individuals with bipolar II disorder typically present to a clinician during a major de- pressive episode and are unlikely to complain initially of hypomania. Typically, the hy- pomanic episodes themselves do not cause impairment. Instead, the impairment results from the major depressive episodes or from a persistent pattern of unpredictable mood changes and ﬂuctuating, unreliable interpersonal or occupational functioning. Individu- als with bipolar II disorder may not view the hypomanic episodes as pathological or dis- advantageous, although others may be troubled by the individual’s erratic behavior.