Agent harnesses truncate file reads around ~60k characters, so the largest dsm5 reference files (up to 132k chars) were being cut off mid-file (reported: "The neurodevelopmental file was truncated"). - Split 15 reference files over 50k chars into a small index (original filename preserved, so all existing links keep resolving) plus part files of <= ~40k chars each, organized by disorder group - Updated SKILL.md routing rows to point at indexes and read the part for the condition; added large-file handling guidance - Updated dsm5/README.md What You Get table; documented the size convention in 00-overview-and-method.md (Maintaining this library) - Verified: no reference file exceeds 50k chars (66 files), all 466 relative links resolve, validators pass, lookup.py lists all parts Co-authored-by: factory-droid[bot] <138933559+factory-droid[bot]@users.noreply.github.com>
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Depressive Disorders — DSM-5-TR Companion Reference
Summarized and paraphrased from DSM-5-TR (American Psychiatric Association, 2022). This file is for orientation and education; verify exact criteria wording, codes, and recording procedures against the official DSM-5-TR before any formal clinical, legal, insurance, or research use.
Chapter Overview
The depressive disorders share the presence of sad, empty, or irritable mood accompanied by changes that significantly affect the capacity to function; what differs among them is duration, timing, or presumed etiology. The chapter covers disruptive mood dysregulation disorder (DMDD), major depressive disorder (MDD, including the major depressive episode), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication- induced depressive disorder, depressive disorder due to another medical condition, and other specified/unspecified depressive disorder. A key task is distinguishing normal sadness and grief from a major depressive episode: bereavement may cause great suffering but does not typically produce an episode of MDD, though the two can coexist.
Disorders in this chapter
| Disorder | ICD-10-CM code(s) | One-line "what it is" |
|---|---|---|
| Disruptive Mood Dysregulation Disorder | F34.81 | Chronic severe irritability with frequent, developmentally inappropriate temper outbursts in children |
| Major Depressive Disorder | F32.x (single) / F33.x (recurrent) | One or more major depressive episodes with no history of mania/hypomania |
| Persistent Depressive Disorder (Dysthymia) | F34.1 | Depressed mood most days for ≥2 years (≥1 year in youth) |
| Premenstrual Dysphoric Disorder | F32.81 | Mood and physical symptoms in the week before menses, remitting after menses |
| Substance/Medication-Induced Depressive Disorder | F10.14–F19.94 (class-dependent) | Depression caused by substance intoxication/withdrawal or medication |
| Depressive Disorder Due to Another Medical Condition | F06.31, F06.32, F06.34 | Depression caused by the physiological effects of a medical condition |
| Other Specified Depressive Disorder | F32.89 | Depressive symptoms with a specified reason for not meeting full criteria |
| Unspecified Depressive Disorder | F32.A | Depressive symptoms; reason criteria are unmet not specified |
| Unspecified Mood Disorder (cross-listed) | F39 | Mood symptoms not clearly fitting bipolar or depressive classes |
Parts of this chapter reference
This chapter reference is split into parts (each ≤ 40,000 characters) so it loads without truncation. The chapter overview, disorder index table, and cross-cutting notes remain here; the specific disorders are in the parts below.
| Part | Covers |
|---|---|
| DMDD and major depressive disorder | Disruptive mood dysregulation disorder; major depressive disorder (including the major depressive episode) |
| Persistent, premenstrual, and etiological disorders | Persistent depressive disorder (dysthymia); premenstrual dysphoric disorder; substance/medication-induced depressive disorder; depressive disorder due to another medical condition |
| Other depressive disorders and shared specifiers | Other specified and unspecified depressive disorder; unspecified mood disorder (cross-listed); shared specifiers for depressive disorders |
Cross-cutting notes
- Suicide risk: Depressive illness carries a 17-fold increased risk for suicide relative to the age- and sex-adjusted general population rate; the most consistent predictor is a past history of suicide attempts or threats, and anhedonia is particularly associated with suicidal ideation. Screen directly whenever depressive symptoms are present.
- Bipolar conversion: A substantial minority of people with MDD later prove to have bipolar disorder — more likely with adolescent onset, psychotic features, mixed features, or family history of bipolar illness. Screen every depressive presentation for a past manic or hypomanic episode (see 12-bipolar-and-related-disorders.md).
- Grief vs. major depressive episode: Bereavement and other significant losses can resemble an MDE but typically feature emptiness and waves of dysphoria rather than persistent depressed mood and anhedonia; clinical judgment, history, and cultural norms for expressing distress distinguish them.
- Differentials that cut across chapters: substance/medication-induced depression (see 25-substance-related-and-addictive-disorders.md), depression due to a medical condition, and depressive symptoms within psychotic (11-schizophrenia-spectrum-and-other-psychotic.md), anxiety (14-anxiety-disorders.md), trauma (16-trauma-and-stressor-related-disorders.md), OCD-related (15-obsessive-compulsive-and-related-disorders.md), and personality (27-personality-disorders.md) presentations.