Which pair of findings best characterises the 'with melancholic features' specifier in DSM-5 Major Depressive Disorder?
- A Hypersomnia and hyperphagia with leaden paralysis
- B Diurnal variation with mood worse in the evening
- C Anhedonia and absence of reactivity to pleasurable stimuli ✓
- D Mood reactivity with rejection sensitivity and carbohydrate craving
Correct answer: C. Anhedonia and absence of reactivity to pleasurable stimuli
Explanation
The melancholic specifier requires either loss of pleasure in all or almost all activities, or lack of reactivity to usually pleasurable stimuli, plus at least three of six features including profound despondency, early morning waking, depression worse in the morning, psychomotor retardation or agitation, anorexia or weight loss, and excessive guilt. Option A describes the atypical specifier, option B reverses the diurnal pattern, and option D lists classic atypical features, making them incorrect for melancholia.
Reference: Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
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