Uncomplicated depression as normal sadness: Rethinking the boundary between normal and disordered depression

About half of all individuals meet the criteria for DSM-defined major depressive disorder (MDD) by the age of 30. These and other considerations suggest that MDD criteria are too inclusive and apply to individuals who are not ill but are experiencing normal sadness. This chapter reviews a research program that attempts to address this issue by examining “uncomplicated depression, " a subcategory of MDD that is hypothesized to consist of false positive diagnoses in which normal sadness is misdiagnosed as MDD. Data on uncomplicated depression suggest that many individuals who currently meet the DSM criteria for MDD are at no greater risk for subsequent depressive episodes, attempting suicide, or development of generalized anxiety disorder than members of the general population. These data suggest that uncomplicated depression is normal sadness, not major depression, and should not be diagnosed as disordered. They thus indicate that current DSM criteria for MDD are overly inclusive.