Premenstrual Dysphoric Disorder 171
criteria are sufficient for a diagnosis of a major depressive episode at any time during this pe-
riod, then the diagnosis of major depression shou ld be noted, but it is coded not as a separate
diagnosis but rather as a specifie r with the diagnosis of  persistent depressive disorder. If the
individual’s symptoms currently meet full crit eria for a major depressive episode, then the
specifier of “with intermittent major depressi ve episodes, with current episode” would be
made. If the major depressive episode has pers isted for at least a 2-year duration and re-
mains present, then the specifie r “with persistent major depressive episode” is used. When
full major depressive episode cr iteria are not currently met but there has been at least one
previous episode of major depression in the cont ext of at least 2 years of persistent depres-
sive symptoms, then the specifier of “with in termittent major depres sive episodes, without
current episode” is used. If the individual ha s not experienced an episode of major depres-
sion in the last 2 years, then the specifier “with pure dysthymic syndrome” is used.
Psychotic disorders. Depressive symptoms are a common  associated feature of chronic
psychotic disorders (e.g., schi zoaffective disorder, schizophrenia, delusional disorder). A
separate diagnosis of persistent depressive disorder is not made if the symptoms occur
only during the course of the psychoti c disorder (including residual phases).
Depressive or bipolar and related diso rder due to another medical condition. Persistent
depressive disorder must be distinguished from a depressive or bipolar and related dis-
order due to another medical co ndition. The diagnosis is depressive or bipolar and related