Upon the completion of a diagnosis regarding mood disorders, the clinician gathers further information about the condition and diagnosis through the use of specifiers. Specifiers act as indicators to mental health professionals and other clinical experts regarding an individual’s condition, allowing the clinician the ability to decide which treatments will be most useful and where the prognosis will lead, as well as the goals and the course of the treatment. Consider specifiers acting as sub-dividisions of a greater category of your disposition/disorder — bipolar disorder, major depressive disorder, etc…

Let us review two diagnostic categories, it may shed light on what I explained above:

Major Depressive Disorder, Single Episode, Moderate, With Atypical Features
Major Depressive Disorder, Single Episode, Moderate, With Melancholic Features

Major Depressive Diagnostic Symptoms DSM-IV

Each diagnostic reveals the existence of a mood disorder, in this example–major depressive disorder. These specifiers reveal the existence of a single episode, or the first stage of depressive symptoms that provide severity clues. Although these appear similar, they are not due to its differential stages and intensity of their depression. If there are two people sitting beside each other with depressive symptoms, the only difference between them is the intensity of that depression, even if these are subtle–they may reveal something very important, this difference is significant for successfully diagnosing severe depression. Melancholic and Atypical Features describe differences important throughout the diagnostic process.

To get a better understanding, let’s have a look at other mood disorders based on their respective associated specifiers:

1. Mild: This reveals that patients have the capability of going through their lives normally, just with more effort required. With a few symptoms present, a clinician is able to make an adequate diagnosis and proper medication.
2. Moderate: Between mild and severe, individuals at this level would show increased signs of impaired judgement and an inability to proceed with their regular activities and responsibilities.
3. Severe and no Present Psychotic Features: Categorically, this individual is absolutely unable to function in normal life situations, and most symptoms of severe depression are present. Furthermore, if the patient also displays manic symptoms or episodes, he/she will require supervision in order to avoid inflicting harm on others and those around the patient.
4. Severe and Present Psychotic Features: At this state, a patient describes hallucinatory and delusional situations or images. Research has shown that psychoses may impact 15% of those inflicted with major depressive disorder. These delusional experiences conflict with a patient’s ability to make rational choices and decisions as well as judgements and may even lead to inflicting harm on others and themselves–in this scenario, the only other options are immediate medical attention and supervision or permanent hospitalization.
5. Single/Recurrent Episodes: If your condition happens frequently, it’s considered “recurrent” and vice versa if it happens for the first time.
6. Full/Partial Remission: full remission means that the disorder is absent throughout a two month period, whereas partial remission describes depressive episodes that come and go and that the substantial basis of these symptoms have not yet passed.
7. Chronic: According to the DSM, one would have had to experience chronic major depressive episodes for at least two years.
8. Catatonic Attributes: Catatonic features consist of rapid, sudden, and unprovoked movement, often uncalled-for ranging from total immobility to purposeless excessive activity, including strange and curious posturing, mimicking both behaviors and words.
9. Melancholic Features: This state of being is characterized by total loss of pleasure in one’s activities, or hobbies, despite the encounter with pleasurable events. In addition to rapid and substantial weight loss, massive feelings of guilt follow and bodily movement and apparent agitation in their body. Their depressive symptoms were caused by some devastating event, or a tragedy related to them and their response to antidepressants are very well noted.
10. Atypical Features: Approaching the final two weeks of major depression, or bipolar disorder (i.e. a manic/depressive episode), even the final two years of dysthymia, an individual experiences heightened and positive moods when something positive or good occurs. In response, individuals experience weight gain, better sleeping patterns, normal body weight, feelings of reduced guilt. Nevertheless, these individuals often suffer from social phobias or anxieties, specifically a strong sensitivity to rejection by others in social difficulties.
11. Postpartum Depression: This occurs four weeks after giving birth and may cause a strong neglect or even the death of the born child. Often it is hard to detect such symptoms.
12. Without Full Inter-Episodal Recovery/With: This state reflects the recurrent symptoms or bipolar and depressive disorder and whether a patient has recovered from the last two episodes successfully.
13. Seasonal Affective Disorder Specifier: This specifier indicates whether an individual has recurring major depression and or bipolar disorder, these symptoms start with the winter and end through the spring.