order due to another medical co ndition. The diagnosis is depressive or bipolar and related
disorder due to another medical condition if the mood disturbance is judged, based on his-
tory, physical examination, or laboratory findin gs, to be attributable to the direct patho-
physiological effects of a specific, usually  chronic, medical condition (e.g., multiple
sclerosis). If it is judged that the depressive  symptoms are not attrib utable to the physiolog-
ical effects of another medical condition, then the primary ment al disorder (e.g., persistent
depressive disorder) is recorded, and the medi cal condition is noted as a concomitant med-
ical condition (e.g., diabetes mellitus).
Substance/medication-induced depressive or bipolar disorder. A substance/medi-
cation-induced depressive or bipolar and rela ted disorder is distin guished from persis-
tent depressive disorder when a substance (e.g ., a drug of abuse, a medication, a toxin) is
judged to be etiologically re lated to the mood disturbance.
Personality disorders. Often, there is evidence of a co existing personality disturbance.
When an individual’s presentation meets the cr iteria for both persis tent depressive disor-
der and a personality disorder , both diagnoses are given.
Comorbidity 
In comparison to individuals with major depressive disorder, those with persistent de-
pressive disorder are at higher risk for psychiatric comorbidit y in general, and for anxiety
disorders and substance use disorders in partic ular. Early-onset persistent depressive dis-
order is strongly associated with DSM-IV  Cluster B and C personality disorders.
Premenstrual Dysphoric Disorder
Diagnostic Criteria 625.4 (N94.3)
A. In the majority of menstrual cycles, at least five symptoms must be present in the final