Case Study
Patient Demographic: Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam
Presenting Problem: You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.
Other Contexts:    ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years

Question: Which is true of the American Psychological Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) inclusion criteria for persistent depressive disorder (PDD) and major depressive disorder (MDD)?
(A): PDD includes possible experiences of anhedonia; MDD does not.
(B): PDD symptoms must persist for more days than not for at least 1 year; MDD symptoms must persist every day for at least 2 weeks.
(C): PDD includes recurrent suicidality without a plan; MDD includes suicidality with a plan.
(D): PDD includes feelings of hopelessness; MDD includes feelings of worthlessness or inappropriate guilt.

Correct Answer: PDD includes feelings of hopelessness; MDD includes feelings of worthlessness or inappropriate guilt.
Explanation: The criteria for PDD criteria include feelings of hopelessness, and the criteria for MDD include feelings of worthlessness or inappropriate guilt. The DSM-5-TR criteria for PDD includes (in part): “The presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness” (APA, 2022). The MDD criteria for adults require at least five of nine qualifying criteria to be present over the course of a two-week period and represent a change in the individual’s behavior or functioning from baseline. These include “depressive symptoms, loss of interest/pleasure (one of these first two being required), in addition to weight loss/weight gain (not associated with diet) or a decrease in appetite, insomnia or hypersomnia, psychomotor excitement or delay, constant fatigue, excessive sense of guilt/worthlessness, inability to concentrate, and suicidal ideation/obsession/attempt” (APA, 2022). Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis