296.33 (F33.2) Major Depressive Disorder, recurrent, severe with melancholic features
A 28-year-old male government employee referred to as T. F. is displaying signs and describing symptoms that meet criteria for major depressive disorder (MDD) in the depressive disorders diagnostic class of the Diagnostic Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013). Therefore, a diagnosis of MDD is presently appropriate.
Evidence for Diagnosis
During the evaluation, T. F. displayed signs and described symptoms that allows Criterion A, which requires five or more signs and symptoms (at least one being depressed mood or loss of interest or pleasure) be present for the same two-week period that engender a change in functioning (APA, 2013), to be met. Individuals with MDD characteristically have a depressed mood (Criterion A1) or diminished interest or pleasure in all, or almost all, activities (Criterion A2) (APA, 2013). During the evaluation, T. F. was observed to have and reported, mostly indirectly, that he has a profoundly depressed mood. For instance, T. F. was observed to be extremely tearful and stated that he feels hopeless to the point that suicide is a desired option. Moreover, similar to individuals with MDD, T. F. reported markedly diminished pleasure and interest—e.g., T.F. stated, “There is nothing in my life that I enjoy.” In addition to these two major symptoms, individuals with MDD also have various accompanying symptoms such as weight and appetite disturbance (Criterion A3); sleep disturbance (Criterion A4); psychomotor changes (Criterion A5); fatigue or loss of energy (Criterion A6); feelings of worthlessness or...
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... likely that he has a comorbid disorder(s), since depressive symptoms often obscure and delay their recognition (APA, 2013). In the National Comorbidity Survey Replication, it was determined that approximately 76% of individuals with MDD have a comorbid disorder (Kessler et al., 2005). Many of these comorbid disorders include anxiety disorders (e.g., GAD and SAD), substance use disorders (e.g., alcohol), and personality disorders (e.g., borderline personality disorder) (LeMoult et al., 2014). Determining whether or not T. F. has a comorbid disorder has implications for treatment prognosis and disorder course, because poor outcomes and greater impairment, symptom severity, and suicide risk are associated with comorbidity (LeMoult et al., 2014). As it outlined in DSM5, improvement of depressive symptoms may depend on the treatment of underlying disorders (APA, 2013).
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