9.1 Mood and Anxiety Disorder Indicators (DSM-5-TR)
Key Takeaways
- Major depressive disorder requires 5+ symptoms for at least 2 weeks, including either depressed mood or anhedonia; the SIGECAPS mnemonic (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality) tracks the remaining criterion-B symptoms.
- Persistent depressive disorder (dysthymia) demands a depressed mood for at least 2 years in adults (1 year in children/adolescents) with symptom-free intervals of no more than 2 months.
- DSM-5-TR Prolonged Grief Disorder requires intense longing or preoccupation with the deceased for at least 12 months in adults (6 months in children) plus 3+ of 8 symptoms and functional impairment, distinguishing it from normal bereavement and MDD.
- Generalized anxiety disorder requires excessive worry across multiple domains for at least 6 months; panic disorder requires recurrent unexpected panic attacks followed by persistent concern or behavioral change.
- Bipolar I mania requires at least 7 days (or hospitalization), hypomania at least 4 days, and cyclothymic disorder at least 2 years of fluctuating subthreshold mood symptoms.
9.1 Mood and Anxiety Disorder Indicators (DSM-5-TR)
Quick Answer: The ASWB Clinical exam repeatedly tests duration thresholds and differential rule-outs for mood and anxiety disorders. Know the number of symptoms, the time windows, and the conditions you must exclude before assigning a diagnosis—especially bereavement vs. MDD vs. Prolonged Grief Disorder, and bipolar depression vs. unipolar MDD.
Why This Matters for the ASWB Clinical Exam
Assessment and Planning accounts for roughly 32% of the ASWB Clinical blueprint, and within that area the exam loves duration thresholds and differential diagnoses. A vignette will present a client with sad mood, sleep disturbance, and fatigue; the correct answer hinges on whether symptoms have lasted 10 days or 4 weeks, whether the person has had a hypomanic episode, and whether the trigger was a death. Memorize the thresholds precisely—two weeks, six months, two years—and the rule-outs become predictable.
Major Depressive Disorder (MDD)
Major depressive disorder (MDD) requires at least five of the following nine symptoms during the same 2-week period, representing a change from prior functioning, with at least one symptom being either (1) depressed mood or (2) loss of interest or pleasure (anhedonia):
| SIGECAPS Symptom | DSM-5-TR Indicator |
|---|---|
| Sleep | Insomnia or hypersomnia |
| Interest | Markedly diminished interest or pleasure (anhedonia) |
| Guilt | Feelings of worthlessness or excessive/inappropriate guilt |
| Energy | Fatigue or loss of energy |
| Concentration | Diminished ability to think or concentrate, or indecisiveness |
| Appetite | Significant weight change or appetite change |
| Psychomotor | Psychomotor agitation or retardation (observable by others) |
| Suicidality | Recurrent thoughts of death, suicidal ideation, or attempt |
Symptoms must cause clinically significant distress or impairment and must not be better explained by another medical condition, substance, or schizoaffective/schizophrenia spectrum disorder. The clinician must also rule out a hypomanic or manic episode—if one has ever occurred, the diagnosis shifts to bipolar disorder.
Bereavement vs. MDD vs. Prolonged Grief Disorder
DSM-5-TR removed the bereavement exclusion entirely; grief and MDD can coexist, and a diagnosis of MDD is appropriate in a grieving person who meets full criteria. The differentiator is Prolonged Grief Disorder (PGD), newly added to DSM-5-TR in the Trauma- and Stressor-Related Disorders chapter. PGD requires intense yearning/longing for or preoccupation with the deceased, nearly every day for at least the last month, beginning after a death at least 12 months ago (adults) or 6 months ago (children/adolescents), plus at least 3 of 8 symptoms (identity disruption, disbelief, avoidance of reminders, emotional pain, difficulty reintegration, emotional numbness, meaninglessness, loneliness), with impairment exceeding cultural norms.
Persistent Depressive Disorder (Dysthymia)
Persistent depressive disorder requires a depressed mood for most of the day, more days than not, for at least 2 years in adults (or 1 year in children/adolescents), with at least two additional symptoms (poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, hopelessness). Symptom-free intervals cannot exceed 2 months during the 2-year period. MDD and persistent depressive disorder can be comorbid—sometimes called "double depression."
Bipolar Disorders (Assessment Indicators)
Although treatment belongs to Chapter 12, the exam tests the diagnostic thresholds here because missing bipolar disorder has direct safety consequences (antidepressant monotherapy can precipitate mixed states and suicidality).
| Episode | DSM-5-TR Duration Threshold |
|---|---|
| Manic episode (Bipolar I) | ≥7 days, or any duration if hospitalization is required |
| Hypomanic episode | ≥4 days; observable change in function; not severe enough to cause marked impairment or hospitalization; no psychotic features |
| Major depressive episode | ≥2 weeks (same criteria as MDD) |
| Cyclothymic disorder | ≥2 years (1 year in adolescents) of numerous hypomanic and depressive periods that do not meet full episode criteria, symptom-free intervals <2 months |
The cardinal assessment task is screening for prior hypomania/mania using a tool such as the Mood Disorder Questionnaire (MDQ) before assuming a depression is unipolar.
Anxiety Disorders
Generalized anxiety disorder (GAD) requires excessive anxiety and worry across a number of events or activities, occurring more days than not for at least 6 months, with at least three of six associated symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance). The worry is difficult to control and causes impairment.
Panic attacks are discrete episodes of intense fear with abrupt peak and physical/cognitive symptoms (palpitations, sweating, trembling, dyspnea, choking, chest pain, nausea, dizziness, derealization/depersonalization, fear of losing control, fear of dying). Panic disorder requires recurrent, unexpected panic attacks followed by at least one month of persistent concern about additional attacks or maladaptive behavioral change.
Specific phobia is marked fear or anxiety about a specific object or situation lasting at least 6 months, with avoidance or intense distress. Social anxiety disorder is fear of social situations in which scrutiny is possible, also ≥6 months. Agoraphobia is fear of situations where escape might be difficult or help unavailable (public transport, open spaces, enclosed spaces, crowds, being outside alone), ≥6 months. Separation anxiety disorder—now diagnosable in adults in DSM-5-TR—requires developmentally inappropriate, excessive fear or anxiety about separation from attachment figures for at least 4 weeks in children (a typical 6-month threshold is applied in adults), with impairment.
Obsessive-Compulsive and Related Disorders
DSM-5-TR moved obsessive-compulsive and related disorders (OCRDs) into their own chapter, separate from anxiety disorders—an exam-relevant restructuring. Obsessive-compulsive disorder (OCD) is defined by obsessions (recurrent, intrusive thoughts, urges, or images causing anxiety) and/or compulsions (repetitive behaviors or mental acts aimed at reducing anxiety), which are time-consuming (more than 1 hour per day) or cause clinically significant distress or impairment. Insight is specified: good/fair, poor, or absent (delusional beliefs).
Related disorders share a preoccupation and repetitive behavior pattern:
- Body dysmorphic disorder—preoccupation with perceived defects or flaws in appearance, with repetitive behaviors (mirror checking, grooming, skin picking) or mental acts.
- Hoarding disorder—persistent difficulty discarding possessions regardless of value, due to perceived need, causing clutter that compromises living space and function.
- Trichotillomania (hair-pulling disorder)—recurrent hair pulling causing hair loss, with repeated attempts to stop.
- Excoriation (skin-picking) disorder—recurrent picking causing skin lesions, with repeated attempts to stop.
These are body-focused repetitive behaviors; the common thread is failed resistance and impairment, not a desire for the behavior itself.
A 24-year-old graduate student reports 3 weeks of sad mood, insomnia, loss of interest in her research, fatigue, difficulty concentrating, and a 5-pound weight loss. She denies suicidal ideation. Her mother died 10 months ago. The correct assessment-based diagnosis on current information is major depressive disorder, because five symptoms have been present for more than 2 weeks and the death occurred less than 12 months ago (so PGD is not yet diagnosable). The worker should still screen for prior hypomania and substance use as rule-outs.
A 52-year-old widower presents 14 months after his wife's death. For the past 6 weeks he has felt, nearly every day, intense longing for her, disbelief that she is gone, avoidance of her belongings, intense emotional pain, feeling that life is meaningless, and isolation from friends. He has insomnia and poor appetite. He meets full MDD criteria. What is the most accurate DSM-5-TR assessment?
A 38-year-old reports 4 days of elevated mood, decreased need for sleep, rapid speech, and increased goal-directed activity after starting a new job. He is still functioning at work and has no psychotic features. He has never had a manic episode requiring hospitalization. Which DSM-5-TR indicator is the decisive threshold for distinguishing this as a hypomanic episode rather than mania?
A 19-year-old describes intrusive thoughts that her hands are contaminated, followed by 2-3 hours of handwashing daily, which she recognizes as excessive but cannot stop. The thoughts and behaviors cause distress and interfere with class attendance. Which DSM-5-TR feature most specifically distinguishes OCD from the anxiety disorders it was previously grouped with?