can be inferred from the pers on’s facial expression and de meanor. Some individuals em-
phasize somatic complaints (e.g., bodily aches and pains) rather than reporting feelings of
sadness. Many individuals report or exhibit in creased irritability (e.g.,  persistent anger, a
tendency to respond to events with angry outbursts or blaming ot hers, an exaggerated
sense of frustration over minor matters). In ch ildren and adolescents, an irritable or cranky
mood may develop rather than a sad or dejected mood. This presenta tion should be dif-
ferentiated from a pattern of irritability when frustrated.
Loss of interest or pleasure is nearly always  present, at least to some degree. Individ-
uals may report feeling less interested in hobb ies, “not caring anymore,” or not feeling any
enjoyment in activities that were previously considered pleasurable (Criterion A2). Family
members often notice social withdrawal or ne glect of pleasurable avocations (e.g., a for-
merly avid golfer no longer plays, a child who used to enjoy soccer finds excuses not to
practice). In some individuals,  there is a significant reduction from previous levels of sex-
ual interest or desire.
Appetite change may involve either a redu ction or increase. Some depressed individ-
uals report that they have to force themselv es to eat. Others may eat more and may crave
specific foods (e.g., sweets or other carbohydrates). When appetite changes are severe (in
either direction), there may be a significant loss  or gain in weight, or , in children, a failure
to make expected weight gains may be noted (Criterion A3).
Sleep disturbance may take the form of either difficulty sleepin g or sleeping exces-