In Major Depressive Disorder, what must a person avoid having?

In Major Depressive Disorder, it is essential for a person to avoid having a history of mania or hypomania in order to meet the diagnostic criteria outlined in the DSM-5. The rationale behind this requirement is rooted in the distinction between Major Depressive Disorder and Bipolar Disorder. If an individual has a history of manic or hypomanic episodes, the diagnosis would shift to a bipolar spectrum disorder rather than a unipolar depressive disorder. Consequently, the presence of a manic or hypomanic history is a crucial factor in accurately diagnosing and understanding the individual’s mental health condition, ensuring appropriate treatment and management.

Other options, while they may contribute to the individual's overall mental health experience, do not serve as exclusion criteria for Major Depressive Disorder. Symptoms of anxiety, existential thoughts, and spiritual concerns can co-occur with depression but do not preclude the diagnosis of Major Depressive Disorder, making them less relevant in this context. Therefore, avoiding a history of mania or hypomania is the key criterion for maintaining the classification of Major Depressive Disorder.