Atypical depression: a reappraisal.
OBJECTIVE
The study evaluated the DSM-IV definition of the atypical features specifier for a major depressive episode in major depressive disorder.


METHODS
Nonpsychotic patients with major depressive disorder were assessed to determine if the DSM-IV model and decision rules for the atypical features specifier for a major depressive episode could be supported.


RESULTS
The five clinical features of the DSM-IV atypical features specifier for a major depressive episode showed weak internal consistency, and the mandatory criterion A feature of mood reactivity did not show specificity in relation to any of the four criterion B accessory symptoms. The more severe the depression, the less likely the patient was to report criterion A and hence to meet criteria for the atypical features specifier. Remodeling the five features favored the personality style descriptor of interpersonal rejection sensitivity as an alternate primary feature. A reformulated model also suggested lifetime panic disorder and social phobia as higher-order determinants of atypical features in major depressive disorder. Additional analyses of criteria suggested that interpersonal rejection sensitivity and leaden paralysis had a phenomenological base in anxiety, that mood reactivity was linked with irritability, and that neither weight gain nor hypersomnia were clearly aligned with anxiety or depression, raising questions about their status as symptoms.


CONCLUSIONS
The current definition and modeling of the DSM-IV atypical features specifier for a major depressive episode in major depressive disorder appears problematic. As suggested by earlier descriptions of atypical depression, certain expressions of anxiety may have primacy, and some clinical features associated with the DSM-IV model may be adaptive homeostatic responses rather than pathological symptoms.
School of Psychiatry, University of New South Wales, Australia. g.parker@unsw.edu.au
Gordon
G
Parker
Kay
K
Roy
Philip
P
Mitchell
Kay
K
Wilhelm
Gin
G
Malhi
Dusan
D
Hadzi-Pavlovic
D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D006963:Hyperphagia / Q000175:diagnosis / Q000523:psychology; D007398:Interpersonal Relations; D008297:Male; D008960:Models, Psychological; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D012044:Regression Analysis; D012059:Rejection, Psychology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D009626:Terminology as Topic; D016896:Treatment Outcome; D015430:Weight Gain
D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors