The severity issue deserves further consideration. It is elevated to an important consideration in ICD-10. As an episode qualifier it is useful, since severity does carry implications for treatment, and severe depressions also tend to have worse outcome than do mild. It is not well recognized that, in practice, ICD-10 mild depressive episode is by no means minor, at least in the Research Criteria. The definitions for individual symptoms and the absence of some symptoms from the list means that subjects who fit these criteria usually have sufficient depression also to qualify as DSM-IV major depressives.
DSM-IV Codes are the classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders. The DSM-IV codes are thus used by mental health professionals to describe the features of a given mental disorder and indicate how the disorder can be distinguished from other, similar problems.
This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia)
Axis II: Developmental Disorders and Personality Disorders
Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood
Personality disorders are clinical syndromes which have a more long lasting symptoms and encompass the individual's way of interacting with the world. They include Paranoid, Antisocial, and Borderline Personality Disorders.
Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders
Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness are included here.
Axis IV: Severity of Psychosocial Stressors
Events in a persons life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II. These events are both listed and rated for this axis.
Axis V: Highest Level of Functioning
293.83 Mood Disorder Due to...[Indicate the General Medical Condition]
96.90 Mood Disorder NOS
300.4 Dysthymic disorder
Major depressive disorder
300.23 Social phobia
300.3 Obsessive-compulsive disorder
309.81 Posttraumatic stress disorder
308.3 Acute stress disorder
293.84 Anxiety disorder due to a general medical condition
293.89 Anxiety disorder due to... [indicate the general medical condition]
300.00 Anxiety disorder NOS
Sexual and gender identity disorders
Gender identity disorders
307.1 Anorexia nervosa
307.51 Bulimia nervosa
Impulse-Control Disorders Not Elsewhere Classified
309.24 With anxiety
309.0 With depressed mood
309.3 With disturbance of conduct
309.28 With mixed anxiety and depressed mood
309.4 With mixed disturbance of emotions and conduct
Cluster A (odd or eccentric)
301.0 Paranoid personality disorder
301.20 Schizoid personality disorder
301.22 Schizotypal personality disorder
Cluster B (dramatic, emotional, or erratic)
301.7 Antisocial personality disorder
301.83 Borderline personality disorder
301.50 Histrionic personality disorder
301.81 Narcissistic personality disorder
Cluster C (anxious or fearful)
301.82 Avoidant personality disorder
301.6 Dependent personality disorder
301.4 Obsessive-compulsive personality disorder
301.9 Personality disorder
This raises another issue, the lower boundary to distinguish pathological depression from normal mood change. Although defined by the number of symptoms present, it is not in fact well-defined, since the thresholds for individual symptoms are not clear or easy to be sure about: when does lowering of mood, even if present every day, cross the threshold in severity to count as being present? The issue is not crucial in the clinic, but it has become important as psychiatric research has extended to the community, and to community epidemiology. Comparatively high rates of depression arc found in community prevalence studies.33 It is not clear whether all these depressions share fully the qualities of depression presenting for medical or psychiatric treatment. Similar issues arise in the use of “symptomatic volunteers” for research.