A 40-year-old woman with major depressive disorder reports depressed mood that consistently improves when her friends visit, but she also has increased appetite, hypersomnia, a sensation of leaden paralysis in her limbs, and a lifelong pattern of interpersonal rejection sensitivity. Which DSM-5 specifier applies?

• A With melancholic features
• B With seasonal pattern
• C With mixed features
• D With atypical features ✓

Explanation

Atypical features specifier requires mood reactivity plus two of: significant weight gain or increased appetite, hypersomnia, leaden paralysis, and longstanding interpersonal rejection sensitivity. This patient has all four. Melancholic features require non-reactive mood with psychomotor changes and early morning worsening. Mixed features require manic symptoms during depression. Seasonal pattern requires a regular seasonal onset and remission pattern.

Reference: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 11th ed.

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