| Diagnostic symptom | Frequency/intensity to meet diagnostic criteria | Examples of symptom manifestation |
| Dysphoria (depressed mood) | Most of the day, nearly every day | - Can be indicated by subjective self-report or third-party observations
- Feel sad, hopeless, empty, discouraged, "blue," or "down in the dumps"
- Appear tearful
- Can manifest as irritable mood
|
| Anhedonia (loss of interest or pleasure in almost all activities) | Most of the day, nearly every day | - Can be indicated by subjective self-report or third-party observations
- Find events, hobbies, and activities less interesting or fun than previously
- Report "I don't care anymore"
- Withdraw from friends
- Have decreased libido or interest in sex
|
| Unintentional change in appetite or weight | Appetite change nearly every day | - Have significant weight change (eg, more than 5% of body weight in a month)
- Need to force self to eat
- Overeat or crave specific foods
|
| Insomnia or hypersomnia | Nearly every day | - Have difficulty falling asleep
- Wake up in the middle of the night with difficulty returning to sleep
- Wake up earlier than usual and remain awake
- Have prolonged nighttime sleep or nonrestorative sleep or sleep during the day
- Have difficulty getting out of bed in the morning
|
| Psychomotor agitation or retardation | Nearly every day | - Indicated by third-party observations (not just subjective feelings)
- Manifest excessive motor activity that is usually nonproductive and repetitious (eg, hand-wringing)
- Manifest generalized slowing of body movements, thinking, or speech
|
| Fatigue or loss of energy | Nearly every day | - Feel tired, exhausted, listless
- Feel the need to rest during the day
- Experience limb heaviness
- Feel that initiating or completing activities is difficult
|
| Feelings of worthlessness or excessive/inappropriate guilt | Nearly every day | - Feel inadequate, inferior, worthless, like a failure
- Misinterpret neutral events or minor setbacks as personal failures
- Self-reproach or guilt about being sick does not meet criteria on their own
|
| Decreased ability to think or concentrate, or indecisiveness | Nearly every day | - Can be indicated by subjective self-report or third-party observations
- Be more easily distracted than previously
- Have memory problems
- Subjective complaints often exceed objective findings
|
| Suicidal ideation and behavior | | - Experience recurrent thoughts of death (not just fear of dying)
- Think that life is not worth living
- Think others would be better off without them
- Want to die or commit suicide with or without a plan
- Have attempted suicide
- May engage in acts of nonsuicidal self-injury
|
