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Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun.

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DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].

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Table 9DSM-IV to DSM-5 Major Depressive Episode/Disorder Comparison

Class: Mood Disorders
Class: Depressive Disorders
Five or more of the following A Criteria (at least one includes A1 or A2)
 A1 Depressed mood—indicated by subjective report or observation by others (in children and adolescents, can be irritable mood).
 A2 Loss of interest or pleasure in almost all activities—indicated by subjective report or observation by others.
 A3 Significant (more than 5 percent in a month) unintentional weight loss/gain or decrease/increase in appetite (in children, failure to make expected weight gains).
 A4 Sleep disturbance (insomnia or hypersomnia).
 A5 Psychomotor changes (agitation or retardation) severe enough to be observable by others.
 A6 Tiredness, fatigue, or low energy, or decreased efficiency with which routine tasks are completed.
 A7 A sense of worthlessness or excessive, inappropriate, or delusional guilt (not merely self-reproach or guilt about being sick).
 A8 Impaired ability to think, concentrate, or make decisions—indicated by subjective report or observation by others.
 A9 Recurrent thoughts of death (not just fear of dying), suicidal ideation, or suicide attempts.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The symptoms are not due to the direct physiological effects of a substance (e.g., drug abuse, a prescribed medication’s side effects) or a medical condition (e.g., hypothyroidism).
The symptoms do not meet criteria for a mixed episode3
There has never been a manic episode or hypomanic episode.
MDE is not better explained by schizophrenia spectrum or other psychotic disorders.
The symptoms are not better accounted for by bereavement (i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).4

The symptom must either be new or must have clearly worsened compared with the person’s pre-episode status and must persist most of the day, daily, for at least 2 weeks in a row. Exclude symptoms that are clearly due to a general medical condition, mood-incongruent delusions, or mood-incongruent hallucinations.


Symptom must persist most of the day, daily, for at least 2 weeks in a row, excluding A3 and A9.


A mixed episode is characterized by the symptoms of both a major depressive episode and a manic episode occurring almost daily for at least a 1-week period. This exclusion does not include episodes that are substance induced (e.g., caffeine) or the side effects of a medication.


This differentiation requires clinical judgment based on cultural norms and the individual’s history.

From: 3, DSM-5 Child Mental Disorder Classification

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