One month after her mother’s death from hea failure; a 25-year-old woman with no prior psychiatric history is still very sad and tearful. She has difficulty concentrating and failing asleep at night and has lost three pounds. The most likely diagnosis is
**Core Concept**
The patient's symptoms of persistent sadness, tearfulness, difficulty concentrating, insomnia, and weight loss in the context of a recent loss, suggest a diagnosis of a mood disorder, specifically a type of depression known as bereavement-related depression or major depressive disorder with a clear precipitant.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with a diagnosis of major depressive disorder (MDD), as defined by the DSM-5. The presence of at least five symptoms, including depressed mood, loss of interest in activities, changes in appetite or weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of death, meets the diagnostic criteria for MDD. In this case, the recent loss of her mother serves as a clear precipitant for her depressive symptoms.
**Why Each Wrong Option is Incorrect**
**Option A:**
This option is incorrect because it is a type of anxiety disorder that typically presents with excessive worry, fear, or anxiety, which is not the primary symptomatology in this case.
**Option B:**
This option is incorrect because it is a type of personality disorder characterized by a pervasive pattern of detachment, lack of emotional expression, and difficulty forming close relationships, which is not consistent with the patient's symptoms of sadness and tearfulness.
**Option C:**
This option is incorrect because it is a type of dissociative disorder that involves a detachment from reality, which is not evident in this patient's presentation.
**Clinical Pearl / High-Yield Fact**
It's essential to note that bereavement-related depression can be a normal response to a significant loss, and a diagnosis of MDD should be made with caution. The DSM-5 suggests that a diagnosis of MDD should not be made if the symptoms are better explained by the bereavement, and the symptoms do not cause clinically significant distress or impairment.
**Correct Answer:** D. Major depressive disorder.