5.2 Mood, Anxiety, Trauma, Sleep, and Eating Presentations

Depressive and Bipolar Presentations

Depressive disorders are among the most common Areas of Clinical Focus. A major depressive episode requires five or more of nine symptoms during the same two-week period, representing a change from prior functioning, and at least one must be depressed mood or markedly diminished interest/pleasure (anhedonia). A useful mnemonic is SIG E CAPS plus mood: sleep change, loss of interest (anhedonia), guilt/worthlessness, energy loss, concentration problems, appetite/weight change, psychomotor change, and suicidal ideation.

Symptoms must cause clinically significant distress or impairment and not be attributable to a substance or another medical condition. Persistent depressive disorder (formerly dysthymia) is chronic depressed mood lasting two years or more (one year in children/adolescents) with fewer acute symptoms but greater chronicity. Disruptive mood dysregulation disorder applies to children with chronic irritability and frequent temper outbursts, and premenstrual dysphoric disorder ties mood symptoms to the luteal phase.

Bipolar and related disorders turn on the mood-elevation episode, and this is where careless reading costs points. Bipolar I requires at least one manic episode — abnormally and persistently elevated, expansive, or irritable mood plus increased energy or goal-directed activity, lasting at least one week (or any duration if hospitalization is needed), with three or more associated symptoms (four if mood is only irritable), such as inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, and risky pleasure-seeking.

Bipolar II requires at least one hypomanic episode (the same symptom picture lasting at least four days, observable but without marked impairment, hospitalization, or psychosis) plus at least one major depressive episode. Cyclothymic disorder involves two years of fluctuating subthreshold highs and lows. The week-versus-four-days duration and the presence or absence of psychosis or hospitalization are the classic exam discriminators between mania and hypomania.

Anxiety, OCD, and Trauma Presentations

Anxiety disorders share excessive fear and anxiety but differ by focus and duration:

• Generalized anxiety disorder (GAD): excessive, hard-to-control worry about multiple domains, more days than not, for 6+ months, with three or more of restlessness, fatigue, irritability, muscle tension, concentration difficulty, and sleep disturbance (only one symptom required in children).
• Panic disorder: recurrent unexpected panic attacks plus 1+ month of persistent concern about further attacks or a maladaptive change in behavior to avoid them. Panic disorder and agoraphobia are now separate diagnoses in DSM-5; agoraphobia requires marked fear/avoidance of two or more situations (public transit, open spaces, enclosed spaces, lines/crowds, being alone outside the home) for 6+ months.
• Social anxiety disorder (fear of scrutiny in social situations) and specific phobia both carry a 6-month duration in adults. Separation anxiety and selective mutism are also classed here in DSM-5-TR.

Obsessive-compulsive and related disorders form their own chapter — OCD is no longer an anxiety disorder. OCD requires obsessions (recurrent, intrusive, unwanted thoughts, urges, or images) and/or compulsions (repetitive behaviors or mental acts performed to reduce distress) that are time-consuming (e.g., more than one hour per day) or cause significant distress/impairment, with an insight specifier (good/fair, poor, or absent). Related disorders include body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation.

Trauma- and stressor-related disorders key on the timeline. Posttraumatic stress disorder (PTSD) requires exposure to actual or threatened death, serious injury, or sexual violence (directly, witnessed, learned of, or repeated occupational exposure), plus symptoms across four clusters — intrusion (flashbacks, nightmares), avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity (hypervigilance, startle) — lasting more than one month.

Acute stress disorder covers the same symptom territory but applies from 3 days to 1 month after exposure; once symptoms persist beyond one month, the diagnosis shifts to PTSD. Adjustment disorders involve emotional/behavioral symptoms emerging within 3 months of an identifiable stressor that are out of proportion or impairing.

Sleep and Eating Presentations

Sleep and eating changes are real clinical data, not throwaway background. In depression and anxiety cases they help establish symptom count, severity, and risk, and they sometimes point to a primary disorder. Insomnia disorder requires dissatisfaction with sleep quantity/quality at least three nights per week for three months; hypersomnolence, narcolepsy, and the breathing-related and circadian-rhythm disorders round out the sleep-wake chapter.

On the NCMHCE, a sleep complaint usually contributes to a depression, anxiety, mania, or trauma picture rather than standing alone, but you should still log it as a tracked symptom.

Eating disorders are distinguished by their core feature:

The presence or absence of compensatory behavior separates bulimia from binge-eating disorder, and significantly low body weight separates anorexia from both. ARFID (avoidant/restrictive food intake disorder) involves restriction without the weight/shape concern that defines anorexia. On the NCMHCE, eating-disorder details often feed a medical-stability decision — anorexia carries serious medical risk (electrolyte disturbance, bradycardia), so medical referral and coordinated care is often the strongest answer.

Integrating Overlapping Presentations

Real cases rarely stay in one box: a client may present with depressed mood, panic, insomnia, and restricted eating at once. When the diagnosis is not yet established, the best first use of overlapping symptoms is to gather and organize data — clarify duration, severity, impairment, and risk — rather than commit to a single label. The exam rewards the integrative response and recognizing comorbidity (e.g., GAD with major depression) over forcing one diagnosis.