DSM-defined syndromes appears higher than for many other pediatric mental illnesses;
the strongest overlap is with oppositional de fiant disorder. Not only  is the overall rate of
comorbidity high in disruptive mood dysregul ation disorder, but also the range of comor-
bid illnesses appears particularly diverse. These children typically present to the clinic
with a wide range of disruptive behavior , mood, anxiety, and even autism spectrum
symptoms and diagnoses. Howe ver, children with disruptive  mood dysregulation disor-
der should not have symptoms that meet criter ia for bipolar disorder, as in that context,
only the bipolar disorder di agnosis should be made. If children have symptoms that meet
criteria for oppositional defiant disorder or intermittent explosive disorder and disruptive
mood dysregulation disorder, only the diagnosis of disruptive mood dysregulation disor-
der should be assigned. Also, as noted earlier, the diagnosis of disruptive mood dysregu-
lation disorder should not be assigned if the symptoms occur only in an anxiety-
provoking context, when the routines of a ch ild with autism spectrum disorder or obses-
sive-compulsive disorder are disturbed, or in the context of  a major depressive episode.
Major Depressive Disorder
Diagnostic Criteria
A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of interest or pleasure.
Note:  Do not include symptoms that are clearly  attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjec-
tive report (e.g., feels sad, empty, hopeless) or observation made by others (e.g.,