Counselor Quick Reference
Key terms, DSM-5-TR criteria, and clinical checkpoints from MCPY 622 Module 6 — Depressive, Bipolar, and Anxiety Disorders (Dr. Lexi Wimmer, Summer 2026) — pulled from the full study guide for fast review before class or clinical work.
Depressive Disorders
Glossary
- Anhedonia
- Loss of interest or pleasure — one of the two gateway symptoms required for a Major Depressive Episode.
- Major Depressive Episode
- The core symptom cluster required for MDD, and relevant to Persistent Depressive Disorder and Bipolar diagnoses as well.
- Persistent Depressive Disorder (Dysthymia)
- Chronic, lower-grade depressive symptoms — ≥2 years in adults, ≥1 year in children/adolescents.
- Adjustment Disorder
- Distress tied to an identifiable psychosocial stressor, onset within 3 months, without needing the full MDD symptom count.
- Premenstrual Dysphoric Disorder
- A DSM-5-TR depressive disorder tied to the menstrual cycle.
- Disruptive Mood Dysregulation Disorder
- A DSM-5-TR depressive-disorders-category diagnosis distinct from MDD.
Major Depressive Episode — DSM-5-TR Criteria
Major Depressive Episode
Core building block for MDD, PDD, and Bipolar diagnoses
A. 5 or more symptoms present over ≥2 weeks, a change from baseline. At least one must be depressed mood or anhedonia (loss of interest/pleasure). Full 9-symptom list: depressed mood · anhedonia · significant weight/appetite change · insomnia or hypersomnia · psychomotor agitation or retardation (observable by others) · fatigue/loss of energy · worthlessness or excessive guilt · diminished concentration/indecisiveness · recurrent thoughts of death or suicidal ideation.
B. Causes clinically significant distress or impairment.
C. Not attributable to a substance or another medical condition; not better explained by a psychotic disorder; no history of a manic/hypomanic episode (→ would point to Bipolar instead).
(APA, 2022)
Depressive Look-Alikes — Quick Differential
- MDD — full 5+/9 symptom count, ≥2 weeks, not tied to a specific identifiable stressor
- Persistent Depressive Disorder — chronic, lower-grade symptoms, ≥2 years (adults) / ≥1 year (children/adolescents)
- Adjustment Disorder — onset within 3 months of an identifiable stressor; distress out of proportion to it
- Other Specified/Unspecified — catch-all once MDD, PDD, and Adjustment Disorder are ruled out
Clinical checkpoints
- Confirm 5+ of the full 9 Criterion A symptoms — not the 7 the M6 slide deck lists — before diagnosing MDD, and confirm the ≥2-week duration
- Rule out a manic/hypomanic history before finalizing an MDD diagnosis — that history redirects to a Bipolar diagnosis instead
- Distinguish Adjustment Disorder from MDD by timeline: onset within 3 months of an identifiable stressor, distress out of proportion to it
- Confirm Persistent Depressive Disorder's duration threshold: ≥2 years in adults, ≥1 year in children/adolescents
- Reserve Other Specified/Unspecified Depressive Disorder for cases where MDD, PDD, and Adjustment Disorder have all been ruled out
Bipolar and Related Disorders
Glossary
- Manic Episode
- Distinct period of abnormally elevated, expansive, or irritable mood plus increased energy, lasting ≥7 days or requiring hospitalization.
- Hypomanic Episode
- Same mood/energy disturbance as mania, lasting ≥4 days, but never severe enough to require hospitalization or involve psychosis.
- Cyclothymic Disorder
- ≥2 years (≥1 year in children and adolescents) of hypomanic- and depressive-level symptoms that never meet full episode criteria.
- IPSRT
- Interpersonal and Social Rhythm Therapy — built on the idea that disrupted daily rhythms and relationships knock mood off balance.
- MBCT
- Mindfulness-Based Cognitive Therapy — eases anxiety/depressive symptoms and may strengthen attention and emotion regulation (Lovas & Schuman-Olivier, 2018).
- Lithium
- First-line mood stabilizer with the best overall evidence for long-term bipolar treatment, typically paired with counseling as part of an interdisciplinary care team.
Manic & Hypomanic Episodes — DSM-5-TR Criteria
Manic Episode
A. Distinct period of abnormally elevated, expansive, or irritable mood + increased energy/activity, lasting ≥7 days or requiring hospitalization.
B. At least 3 symptoms (4 if mood is only irritable): inflated self-esteem/grandiosity · decreased need for sleep · more talkative than usual · racing thoughts/flight of ideas · distractibility · increased goal-directed activity or psychomotor agitation · excessive involvement in risky/impulsive activities.
C. Marked impairment, requires hospitalization, or includes psychotic features.
D. Not better explained by substance use or another medical condition.
(APA, 2022)
Hypomanic Episode
A. Same mood/energy disturbance, lasting ≥4 days.
B. Same symptom list and 3(4) threshold as mania.
C. An uncharacteristic change in functioning.
D. Mood disturbance and functional change are observable by others.
E. Does not cause severe impairment, does not require hospitalization, no psychosis.
F. Not better explained by substance use or another medical condition.
(APA, 2022)
Bipolar I vs. II vs. Cyclothymia
Bipolar I
- Must have had a manic episode
- Depressive episode common but optional
- Mania lasts ≥7 days or lands the person in the hospital
- Can escalate to severe, even psychotic
Bipolar II
- No manic episode — hypomania only
- Depressive episode mandatory, typically deeper than the hypomanic lows
- Hypomania ≥4 days; depression ≥2 weeks
- Impairing, but no psychotic features in the hypomania
Cyclothymia
- No full manic or depressive episode — sub-threshold only
- ≥2 years running (≥1 year for children and adolescents)
- Milder overall, yet still disrupts day-to-day life
Assessment & Treatment
Mood screeners
- MDQ (Hirschfeld et al., 2000) — validated across the bipolar spectrum; later comparisons find it more sensitive to Bipolar I than II
- HCL-32 (Angst et al., 2005) — sensitive screen for hypomanic symptoms (bipolar vs. unipolar depression); the lecture prefers it when Bipolar II is suspected
- Clinical interview covers mood-episode history, family psychiatric history, risk factors
Treatment
- First-line: psychotropic medication — lithium has the best overall evidence for long-term treatment, typically paired with counseling
- IPSRT: clients log a Social Rhythm Metric (SRM-II-5) chart comparing planned vs. actual timing of daily anchor points, plus mood/energy ratings (−5 to +5)
- MBCT: has not been shown to trigger mania; whether it prevents relapse is still an open question
Clinical checkpoints
- Screen with the MDQ (validated across the bipolar spectrum, most sensitive to Bipolar I); the lecture prefers the HCL-32 when Bipolar II is suspected
- Confirm hypomania never involves psychosis or hospitalization — either one reclassifies the episode as manic
- Bipolar II requires a confirmed history of at least one hypomanic + one major depressive episode, with zero history of mania
- Cyclothymia requires ≥2 years (≥1 year for children and adolescents) of sub-threshold symptoms, never meeting full episode criteria
- Pair medication (lithium, first-line) with counseling as part of an interdisciplinary care team rather than medication alone
Anxiety Disorders
Glossary
- Fear vs. Anxiety
- Fear responds to an identifiable, present threat. Anxiety is future-oriented, tied to something unknown and ongoing rather than acute.
- Generalized Anxiety Disorder
- Excessive, hard-to-control worry about a number of events/activities, present more days than not for ≥6 months.
- Panic Disorder
- Recurrent, unexpected panic attacks followed by ≥1 month of persistent worry about further attacks or maladaptive behavior change.
- Panic attack specifier
- A specifier attached to another disorder (e.g., GAD, PTSD, MDD) when panic attacks occur but don't meet Panic Disorder's own criteria.
- Separation Anxiety Disorder
- Developmentally inappropriate, excessive fear/anxiety about separation from attachment figures.
- PCIT
- Parent-Child Interaction Therapy — targets the parent-child relationship for young children with Separation Anxiety Disorder (Choate et al., 2005; PCIT itself is designed for ages 2–7).
GAD & Panic Disorder — DSM-5-TR Criteria
Generalized Anxiety Disorder
A. Excessive anxiety/worry, more days than not, for ≥6 months, about a number of events/activities.
B. Difficult to control the worry.
C. 3+ of 6 symptoms: restlessness/keyed up · easily fatigued · difficulty concentrating/mind blank · irritability · muscle tension · sleep disturbance.
D. Clinically significant distress or impairment.
E. Not attributable to a substance or medical condition (e.g., hyperthyroidism).
F. Not better explained by another disorder.
(APA, 2022)
Panic Disorder
A. Recurrent unexpected panic attacks — abrupt surge of intense fear/discomfort peaking within minutes (palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, chills/heat, numbness/tingling, derealization/depersonalization, fear of losing control, fear of dying).
B. Followed by ≥1 month of persistent worry about additional attacks/consequences and/or maladaptive behavior change (e.g., avoidance).
C. Not due to substances/medical condition; not better explained by another disorder.
(APA, 2022)
Separation Anxiety Disorder
A. 3+ symptoms: excessive distress anticipating/experiencing separation · persistent worry about losing an attachment figure · worry about events causing separation · reluctance/refusal to leave home/school/work · fear of being alone · refusal to sleep away from attachment figures · nightmares about separation · physical complaints around separation.
B. Duration: ≥4 weeks in children/adolescents; typically ≥6 months in adults.
C. Clinically significant distress/impairment; not better explained by another disorder.
(APA, 2022)
Specific Phobia
A. Marked fear/anxiety about a specific object or situation — almost always provokes fear on exposure.
B. Actively avoided or endured with intense distress; fear is out of proportion to actual danger; persistent, typically ≥6 months.
C. Clinically significant distress/impairment. Specifiers: animal · natural environment · blood-injection-injury · situational · other.
(APA, 2022)
Panic Disorder vs. Panic Attack Specifier
Panic Disorder
- Stand-alone diagnosis — the attacks are the disorder
- Recurrent, unexpected attacks
- Requires ≥1 month of persistent worry/behavior change
Panic Attack Specifier
- Rides along with another disorder — social anxiety, specific phobia, GAD, PTSD, OCD, MDD, and others
- Attacks may be expected or unexpected
- No ongoing-worry requirement
BAI severity bands
- 0–7 Minimal · 8–15 Mild
- 16–25 Moderate · 26–63 Severe
- Reliability α = .94 (Fydrich et al., 1992); convergent validity r = .54 with diary-tracked anxiety
Continuum of Approaching Diagnosis
Overlook (under-diagnosing)
Failing to catch distress or impairment that's clinically real.
Pathologize (over-diagnosing)
Treating an understandable reaction to circumstances — including reactions to oppression — as if it were pathology.
Clinical checkpoints
- Distinguish Panic Disorder (recurrent, unexpected attacks + ≥1 month worry/behavior change) from a panic-attack specifier riding on another disorder
- Rule out other disorders by worry content before finalizing GAD — panic attacks point to Panic Disorder, negative evaluation to Social Anxiety, contamination/obsessions to OCD, separation to Separation Anxiety, trauma reminders to PTSD
- Separation Anxiety Disorder's duration threshold differs by age: ≥4 weeks in children/adolescents vs. ≥6 months in adults
- Consider PCIT over standard CBT for Separation Anxiety Disorder in young children — it targets the parent-child relationship rather than the child alone
- At every diagnosis, check which failure mode you're closer to: overlooking real impairment, or pathologizing a normative or oppression-related response
- Screen with GAD-7, BAI, or SPIN as indicated, and score the BAI against its published severity bands rather than raw total alone