Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms?

Major depressive disorder (MDD) is a highly heterogeneous diagnosis wherein the nine MDD criterion signs and symptoms reflect 256 unique symptom combinations. Accordingly, MDD comprises a broad set of phenotypes observed across clinical practice, including primary care. With intensifying global efforts to prevent male suicide, attention has rapidly focused on better understanding men’s experiences of MDD. Pertinent to these efforts is the operationalization of MDD, which is characterized by the two cardinal symptoms of depressed mood and anhedonia (the loss of interest or pleasure in all, or nearly all, activities for most of the day nearly every day). However, debate remains regarding the adequacy of this conceptualization of depression as applied to men socialized within dominant discourses of masculinity that prohibit men acknowledging or seeking help for depression.