184 Depressive Disorders
significant distress or impairment that persist for at least 2 weeks in an individual
whose presentation has never met criteria for any other depressive or bipolar disorder,
does not currently meet active or residual criteria for any psychotic disorder, and does
not meet criteria for mixed anxiety and depressive disorder symptoms.
Unspecified Depressive Disorder
311 (F32.9)
This category applies to presentations in whic h symptoms characteristic of a depressive dis-
order that cause clinically significant distress or impairment in social, occupational, or other im-
portant areas of functioning predominate but do not meet the full criteria for any of the disorders
in the depressive disorders diagnostic class. Th e unspecified depressive disorder category is
used in situations in which the clinician chooses not to specify the reason that the criteria are
not met for a specific depressive disorder, and includes presentations for which there is insuf-
ficient information to make a more specific diagnosis (e.g., in emergency room settings).
Specifiers for Depressive Disorders
Specify if:
With anxious distress:  Anxious distress is defined as the presence of at least two of
the following symptoms during the majority of days of a major depressive episode or
persistent depressive disorder (dysthymia):
1. Feeling keyed up or tense.
2. Feeling unusually restless.
3. Difficulty concentrating because of worry.
4. Fear that something awful may happen.
5. Feeling that the individual might lose control of himself or herself.
Specify current severity:
Mild:  Two symptoms.
Moderate: Three symptoms.
Moderate-severe:  Four or five symptoms.
Severe:  Four or five symptoms and with motor agitation.
Note:  Anxious distress has been noted as a prominent feature of both bipolar and ma-
jor depressive disorder in both primary care  and specialty mental health settings. High