168 Depressive Disorders
Adjustment disorder with depressed mood. A major depressive episode that occurs in
response to a psychosocial stressor is distin guished from adjustment  disorder with de-
pressed mood by the fact that the full criteria  for a major depressive episode are not met in
adjustment disorder.
Sadness. Finally, periods of sadness are inhere nt aspects of the human experience.
These periods should not be diagnosed as a major depressive episod e unless criteria are
met for severity (i.e., five out of nine symptoms), duration (i.e., most of the day, nearly ev-
ery day for at least 2 weeks), and clinically significant distress or impairment. The diagno-
sis other specified depressive disorder may be appropriate for presentations of depressed
mood with clinically significant impairment that do not meet criteria  for duration or se-
verity.
Comorbidity
Other disorders with which majo r depressive disorder frequently co-occurs are substance-
related disorders, panic diso rder, obsessive-compulsive diso rder, anorexia nervosa, buli-
mia nervosa, and borderlin e personality disorder.
Persistent Depressive Disorder (Dysthymia)
Diagnostic Criteria 300.4 (F34.1)
This disorder represents a consolidation of  DSM-IV-defined chronic major depressive dis-
order and dysthymic disorder.
A. Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years.
Note:  In children and adolescents, mood can be irritable and duration must be at least
1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.