296 Disorders to be listed in the DSM-V

Mixed Anxiety Depression

• Proposed Diagnosed Criteria- The patient has three or four of the symptoms of major depression(which must include depressed mood and/or anhedonia), and they are accompanied by anxious distress. The symptoms must have lasted at least 2 weeks, and no other DSM diagnosis of anxiety or depression must be present, and they are both occuring at the same time.
• Anxious distress is defined as having two or more of the following symptoms:irrational worry, preoccupation with unpleasant worries, having trouble relaxing, motor tension, fear that something awful may happen.
• Mixed Features Specifier
• Draft Criteria for mixed features specifier- this applies to manic, Hypomanic, and depressive episodes.
• The “with mixed features” specifier applies in episodes where subthreshold symptoms from the opposing pole are present during a full mood episode. While these concurrent “mixed” symptoms are relatively simultaneous, they may also occur closely juxtaposed in time as a waxing and waning of individual symptoms of the opposite pole (i.e., depressive symptoms during hypo/manic episodes and vice versa)
  • A. If predominantly Manic or Hypomanic, full criteria are met for a Manic Episode (see Criteria for Manic Episode) or Hypomanic Episode (see
    • Prominent dysphoria or depressed mood as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
    • diminished interest or pleasure in all, or almost all, activities, (as indicated by either subjective account or observation made by others).
    • psychomotor retardation nearly every day (observable by others, not merely subjective feelings of being slowed down).
    • fatigue or loss of energy.
    • Feelings of worthlessness or excessive or inappropriate guilt (not merely self-reproach or guilt about being sick).
    • recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
  • B. If predominantly Depressed, full criteria are met for a Major Depressive Episode (see Criteria for
    • Elevated, expansive mood
    • Inflated self-esteem or grandiosity
    • More talkative than usual or pressure to keep talking
    • Flight of ideas or subjective experience that thoughts are racing
    • Increase in energy or goal directed activity (either socially, at work or school, or sexually)
    • Increased or excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
    • Decreased need for sleep (feeling rested despite sleeping less than usual (to be contrasted from insomnia).

• C. Mixed symptoms are observable by others and .represent a change from the person’s usual behavior.
• D. For those who meet full episode criteria for both Mania and Depression simultaneously, they should be labeled as having a Manic Episode, with mixed features, due to the marked impairment and clinical severity of full mania.
• E. The mixed symptom specifier can apply to depressive episodes experienced in Major Depressive Disorder, Bipolar I and Bipolar II disorders.
• F. The mixed symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment).

Premenstrual Dysphoric Disorder

• A. In most menstrual cycles during the past year, five(or more) of the following symptoms occurred during the final week before the onset of menses, started to improve within a few days after the onset of menses, and were minimal or absent in the week postmenses, with at least one of the symptoms being either (1), (2), (3), or (4):
  • (1): Depressed mood, feelings of hopelessness, or self-deprecating thoughts
  • (2): Anxiety, tension, feelings of being “keyed up,” or “on edge”
  • (3): Affective lability
  • (4): Irritability, anger or increased interpersonal conflicts
  • (5): Decreased interest in usual activities (e.g., work, school, friends, hobbies)
  • (6): Subjective sense of difficulty in concentration
  • (7): Lethargy, easy fatigability, or marked lack of energy
  • (8): Change in appetite, overeating, or specific food cravings
  • (9): Hypersomnia or insomnia
  • (10): Subjective sense of being overwhelmed or out of control
  • (11): Other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” and weight gain
• B. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities or relationships with others (e.g. avoidance of social activities, decreased productivity and efficiency at work, school or home).
• C. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as Major Depressive Disorder, Panic Disorder, Dysthymic Disorder, or a Personality Disorder (although it may be superimposed on any of these disorders).
• D. Criteria A, B, and C should be confirmed by prospective daily ratings during at least two symptomatic cycles. (The diagnosis may be made provisionally prior to this confirmation.)
• E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment) or a general medical condition (e.g., hyperthyroidism).
• F. In oral contraceptives users, a diagnosis of Premenstrual Dysphoric Disorder should not be made unless the premenstrual symptoms are reported to be present, and as severe, when the woman is not taking the oral contraceptive.

NOTE: The DSM-V includes the severity and rationales for the revisions of the disorders.