TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 235 Changes from DSM-IV-TR to DSM-5 Major Depressive Disorder The mood disorders section in the DSM-IV-TR began with criteria for mood episodes (e.g., depressive, manic, hypomanic; APA, 2000). The mood episodes were later included in the diagnostic criteria for mood disorders. The DSM-5 has a different format. The mood disorders are separated into two sections: depressive disorders, and bipolar and related disorders. In addition, the DSM-5 lists complete criteria for each disorder in one place, rather than separating the mood episodes from the rest of the criteria for each disorder (e.g., major depressive disorder). Major depressive disorder now includes a streamlined list of symptoms and examples of each so that clinicians may better understand the intended criteria. Part A of the diagnostic criteria did not change: “Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure” (APA, 2013, p. 160). The nine symptoms that follow are very similar to the symptoms listed in the DSM-IV-TR . The first symptom focuses on depressed mood and is the hallmark of the disorder. The example “hopeless” was added to increase clarity about the way clients may describe how they feel. The requirement of clinically significant distress did not change, nor did the verbiage about symptoms being caused by a medical condition or better explained by other disorders. A significant change was made to criterion E of DSM-IV-TR , often called the bereavement exclusion. The previous rule was that major depressive disorder could not be diagnosed following the death of a loved one or other loss unless the symptoms persisted for 2 months (as opposed to the typical 2-week required duration). The DSM-5 states that responses to loss may include feelings and behaviors that match those listed in the criteria for major depressive disorder. Although the reaction may be considered understandable given the recent loss, if criteria for the disorder are met, the diagnosis may be given regardless of the circumstances. Representatives from the depressive disorders work group explained their rationale for this change at the 2013 American Psychiatric Conference (Zisook, 2013). They noted that the criteria for diagnosis should be defined without regard to the cause of the symptoms. Many things can cause or exacerbate depressive symptoms. Most individuals who suffer losses (e.g., death of a loved one, divorce, unemployment) will not experience symptoms severe enough to merit diagnosis (Zisook, 2013). Severe depressive symptoms, such as those required for diagnosis of major depressive disorder, merit clinical attention regardless of external causes in the individual’s life. The DSM-5 gives the counselor the discretion to diagnose major depressive disorder in grieving clients if the symptoms have been met for 2 weeks, rather than requiring 2 months of suffering as noted in the DSM-IV- TR . Perhaps more relevant to those clients who have long been diagnosed with major depressive disorder, the DSM-5 included changes to the specifiers. Single episode , recurrent , mild , moderate and severe are again included with different numerical codes for each. One change is that psychotic features can now be added to mild, moderate or severe levels. Specifiers about seasonal pattern , catatonia , melancholia , and atypical features remain with expanded descriptors in some cases. Postpartum was changed to peripartum because symptoms often emerge during pregnancy, which would not fit the DSM-IV-TR specifier of postpartum, but is important nonetheless. The term peripartum means during the pregnancy or in the 4 weeks following delivery, so this specifier can be used in both cases. In addition, new specifiers were added: with anxious distress and with mixed features . Both are described below. The specifier with anxious distress is to be used when the client experiences two or more of the following symptoms most days: feels tense, feels unusually restless, worry disrupts concentration, fears something bad