A 50-year-old woman presents with persistent depressed mood for most of the day, nearly every day, for 3 years, with low energy, poor concentration, and hypersomnia, but symptoms never met full criteria for major depressive episode. The DSM-5 diagnosis is:

• A Major depressive disorder, chronic specifier
• B Adjustment disorder with depressed mood
• C Persistent depressive disorder (Dysthymia) ✓
• D Cyclothymia

Explanation

Persistent Depressive Disorder (PDD/Dysthymia) in DSM-5 requires depressed mood for most of the day, more days than not, for at least 2 years (in adults), with at least 2 of: poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, hopelessness — and symptoms never meeting full MDD criteria. Adjustment disorder has an identifiable stressor and lasts <6 months after stressor removal. Cyclothymia involves hypomanic-level mood elevations.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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