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Healing Voices

The full criteria for major depressive disorders are found below.

DSM-5 Criteria for Major Depressive Disorder
A. 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.
Note: Do not include symptoms that are clearly attributable to another medical condition.
‣ Depressed mood most of the day, nearly every day, as indicated by either subjective report
(e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).
(Note: In children and adolescents, can be irritable mood.)

‣ Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly
every day (as indicated by either subjective account or observation).
‣ Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day.
(Note: In children, consider failure to make expected weight gain.)

‣ Insomnia or hypersomnia nearly every day.
‣ Psychomotor agitation or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down).

‣ Fatigue or loss of energy nearly every day.
‣ Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly
every day (not merely self-reproach or guilt about being sick).
‣ Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others).

‣ 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. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical
condition.
Note: Criteria A–C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a
serious medical illness or disability) may include the feelings of intense sadness, rumination about the
loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive
episode. Although such symptoms may be understandable or considered appropriate to the loss, the
presence of a major depressive episode in addition to the normal response to a significant loss should
also be carefully considered. This decision inevitably requires the exercise of clinical judgment based
on the individual’s history and the cultural norms for the expression of distress in the context of loss.
In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the
predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood
and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in
intensity over days to weeks and occurs in waves, the so-called pangs of grief. These waves tend
to be associated with thoughts or reminders of the deceased. The depressed mood of MDE is more
persistent and not tied to specific thoughts or preoccupations. The pain of grief may be accompanied

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