2.1 Depressive, Bipolar, and Anxiety Disorders
Key Takeaways
- Major Depressive Disorder (MDD) requires a duration threshold of 2+ weeks, 5+ symptoms, and must include depressed mood or anhedonia.
- Bipolar I is defined by at least one Manic Episode (lasting 1+ week or requiring hospitalization) causing marked functional impairment.
- Bipolar II is characterized by at least one Hypomanic Episode (lasting 4+ days, no marked impairment) and at least one Major Depressive Episode.
- Generalized Anxiety Disorder (GAD) requires excessive, uncontrollable worry about multiple areas for at least 6 months.
- Panic Disorder is diagnosed when recurrent unexpected panic attacks are followed by 1+ month of persistent concern or behavioral changes.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is the foundational tool for diagnostic classification in social work. In the ASWB Masters Exam, questions testing these disorders require you to apply diagnostic criteria, identify duration thresholds, and distinguish between closely related clinical presentations.
Depressive Disorders
The primary depressive disorders are Major Depressive Disorder (MDD) and Persistent Depressive Disorder (dysthymia). MDD requires five or more symptoms during the same two-week period, representing a change from previous functioning. At least one symptom must be either depressed mood or loss of interest or pleasure (also known as anhedonia). The symptom profile is remembered using the mnemonic SIGECAPS:
- Sleep disturbance (insomnia or hypersomnia)
- Interest reduction (anhedonia)
- Guilt or feelings of worthlessness
- Energy loss or fatigue
- Concentration difficulties or indecisiveness
- Appetite or weight changes
- Psychomotor agitation or retardation
- Suicidal ideation
These symptoms must cause clinically significant impairment and cannot be due to a substance or medical condition.
Persistent Depressive Disorder is a chronic form of depression. The duration threshold is at least two years in adults (and one year in children and adolescents). During this period, the individual must not be symptom-free for more than two months at a time, and they must present with at least two of the following: poor appetite or overeating, insomnia or hypersomnia, low energy, low self-esteem, poor concentration, and hopelessness.
Bipolar and Related Disorders
Bipolar disorders involve severe shifts in mood and energy. Distinguishing between Bipolar I and Bipolar II is critical.
Bipolar I Disorder requires the occurrence of at least one Manic Episode. A manic episode is a distinct period of abnormally elevated, expansive, or irritable mood, and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary). The client must exhibit at least three symptoms (four if the mood is only irritable) from the mnemonic DIGFAST:
- Distractibility
- Indiscretion (excessive risky activities)
- Grandiosity or inflated self-esteem
- Flight of ideas or racing thoughts
- Activity increase (goal-directed)
- Sleep need decreased (feels rested after 3 hours)
- Talkativeness or pressured speech
Bipolar I does not require a history of major depressive episodes, though most clients experience them. The episode must cause marked impairment in social or occupational functioning or necessitate hospitalization.
Bipolar II Disorder requires at least one major depressive episode and at least one Hypomanic Episode. A hypomanic episode is a distinct period of elevated, expansive, or irritable mood, and abnormally increased activity or energy, lasting at least four consecutive days. While the symptom list is the same, the hypomanic episode is not severe enough to cause marked impairment in functioning and does not require hospitalization. If psychotic features are present, the episode is, by definition, manic, indicating Bipolar I.
Cyclothymic Disorder is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and depressive symptoms that do not meet full criteria. The duration threshold is at least two years (one year in children and adolescents), with symptoms present at least half the time and not absent for more than two months.
Anxiety Disorders
Anxiety disorders share features of excessive fear, anxiety, and behavioral disturbances.
Generalized Anxiety Disorder (GAD) involves excessive anxiety and worry about a number of events or activities. The duration threshold is at least six months, during which the worry is present more days than not. The client must find it difficult to control the worry and must experience at least three of the following six symptoms (only one for children): restlessness, fatigue, concentration difficulties, irritability, muscle tension, and sleep disturbance.
Panic Disorder requires recurrent, unexpected Panic Attacks (abrupt surges of intense fear reaching a peak within minutes). At least one attack must be followed by one month or more of:
- Persistent concern or worry about additional panic attacks or their consequences.
- A significant maladaptive change in behavior related to the attacks.
Agoraphobia involves marked fear or anxiety about two or more of the following situations: public transportation, open spaces, enclosed places, standing in line or crowds, or being outside of the home alone. The fear is driven by thoughts that escape might be difficult if panic-like symptoms occur. The duration threshold is typically six months or more.
Social Anxiety Disorder (fear of social scrutiny) and Specific Phobias (fear about a specific object or situation) also require a duration threshold of at least six months to minimize overdiagnosing transient fears.
| Disorder | Duration Threshold | Key Diagnostic Criterion |
|---|---|---|
| Major Depressive Disorder | 2+ Weeks | 5+ symptoms including depressed mood or anhedonia |
| Persistent Depressive Disorder | 2+ Years (1 Year for minors) | Depressed mood more days than not; 2+ symptoms |
| Bipolar I Disorder (Mania) | 1+ Week (or any if hospitalized) | Elevated mood, 3+ manic symptoms, marked impairment |
| Bipolar II Disorder (Hypomania) | 4+ Consecutive Days | Elevated mood, 3+ manic symptoms, no marked impairment |
| Generalized Anxiety Disorder | 6+ Months | Excessive, uncontrollable worry; 3+ symptoms |
| Panic Disorder | 1+ Month (following attack) | Recurrent unexpected panic attacks with persistent worry |
| Agoraphobia / Phobias | 6+ Months | Marked fear of specific situations or objects |
Clinical Vignette
A 28-year-old client reports feeling "anxious and on edge" since starting a new job six months ago. She describes constant muscle tension, trouble falling asleep, and persistent worry about her performance, finances, and health. She has had no panic attacks and her mood is tired but not depressed. She denies any history of elevated mood or decreased need for sleep.
Clinical Analysis: This client fits the criteria for GAD. Her symptoms of muscle tension, sleep disturbance, and excessive worry have persisted for exactly six months, meeting the duration threshold. The worries are broad rather than focused on a single object, ruling out specific phobias.
A clinical social worker is assessing a 34-year-old client who reports feeling low and sad most days. The client states, 'I've felt this way for as long as I can remember, at least the last three years.' They report poor appetite, low self-esteem, and fatigue, but deny any periods of suicidal ideation, marked psychomotor changes, or anhedonia. The client has not been without these symptoms for more than a month at a time. What is the most appropriate diagnosis?
A client presents with a history of recurrent major depressive episodes. During the assessment, the client describes a five-day period last month where they felt 'on top of the world,' needed only four hours of sleep per night, talked rapidly, and successfully completed three large home renovation projects. The client's spouse notes that while this behavior was unusual, the client did not experience any significant social or occupational impairment, and there was no need for hospitalization. What diagnosis is most indicated by this history?
A social worker is diagnosing a client who exhibits excessive anxiety and worry about their job performance, family safety, and physical health. To meet the diagnostic criteria for Generalized Anxiety Disorder (GAD) under the DSM-5-TR, these symptoms must be present for what minimum duration?