Report of the DSM-V Mood Disorders Work Group
November 2008
Jan Fawcett, M.D.
The Mood Disorders Work Group has created three subworkgroups, focused on Major Depressive Disorder (MDD), Bipolar Disorder, and Suicide. The groups began by discussing needed changes to DSM-IV criteria, and then assessing evidence for them via literature reviews and secondary data analyses.
The group and its subgroups are increasingly working with advisors and members from other work groups to assess comorbidity of mood disorders with other disorders. Some overarching issues, such as operationally defining the term “psychosis” and examining the role of anxiety in mood disorders, have been discussed, with input from liaisons from appropriate work groups. Other issues, including revising the definition of mixed states and how these present in both bipolar and unipolar disorder, addressing psychotic states within affective disorders, and melancholia are also being addressed. Secondary analysis of symptom severity and impairment in mood disorders, is currently being performed via a twin-study data re-analysis.
Subworkgroups are being formed to conduct research in the areas of pre-menstrual dysphoric disorder (PMDD) and seasonal affective disorder (SAD). Advisors to these subworkgroups will provide evidence concerning the criteria and disposition of these conditions, whether they should be classified as subtypes or dimensional constructs, and how they relate to the spectrum of bipolar disorders.
Anxious depression is being examined to determine whether it is best classified as a separate category, a separate severity dimension, or as a specifier. Comorbid anxiety appears to predict a more severe course, longer depressive episodes, poorer treatment outcome, and a greater risk of suicide and suicidal behavior across both unipolar and bipolar mood disorders.
Another subgroup has been working with the task force study group on gender and cross-cultural issues regarding possible differences in depression symptoms and functional impairment across gender and ethnic groups.
The suicide subworkgroup has focused on the possibility of a suicide risk dimension that might be applied across diagnoses, as after reviewing various diagnoses, differential risk factors across diagnoses do not appear to have significant differences. The group hopes, despite the known lack of ability to predict suicide in individual patients, to incorporate the state of knowledge concerning chronic and acute suicide risk factors to assist clinicians in making the best possible determination of suicide risk factors present in a patient. A major area of interest has been the suicide subworkgroup’s discussion of non-suicidal self injury, a behavior which seems to span across a number of diagnoses and to sometimes occur without a specific diagnosis.