Maya, a 20-year-old second-year student, comes to the campus counseling center describing the past six weeks as "a fog." She used to enjoy her weekly pottery class but hasn't gone in over a month, saying she "just can't feel excited about anything anymore." She reports sleeping ten to twelve hours a night yet still feeling exhausted, has withdrawn from her usual friend group, and describes difficulty concentrating on readings she used to finish easily. Maya says this started gradually after a disappointing exam grade in week three of the semester but has not improved even though the semester has otherwise gone reasonably well since. She denies ever having had a period of unusually high energy, decreased need for sleep, or impulsive spending. She mentions feeling "like a burden" to her friends and worries she is "just lazy," though she used to be highly organized and engaged. Her roommate has noticed she seems "flat" most of the time now, not just sad. She also mentions, almost in passing, that she has been thinking about applying to a study-abroad program next fall.
Step 1
Read Presenting Info
Read the presenting information above carefully, then continue when ready.
Step 2
Identify Salient Features
Select the features from this vignette that are most diagnostically salient.
Step 3
Identify Possible Families
Which disorder families should be considered as possible explanations for this presentation?
Step 4
Select Relevant Evidence
Select the pieces of evidence that most directly support the leading formulation.
Step 5
Consider Competing Explanations
Select the explanations that are legitimate competing possibilities worth weighing, even if ultimately less supported.
Step 6
Choose Best Formulation
Which formulation is best supported by the full pattern of evidence?
Step 7
Explain Reasoning
In 2-4 sentences, explain which evidence most strongly supports your formulation and why you ruled out the alternatives. Use hedged, professional language.
Step 8
Review Expert Explanation
Compare your reasoning to the expert explanation below.
Expert reasoning
This vignette is most consistent with a major depressive episode: Maya shows anhedonia and hypersomnia present nearly every day for more than a month, a clear change from her prior baseline, with associated concentration difficulty and feelings of being a burden. The gradual onset following a disappointing grade does not, by itself, rule out MDD -- an educational case would weigh whether the reaction is proportionate and self-limiting (favoring normal adjustment) against its persistence, pervasiveness, and functional impact (favoring MDD); here the month-plus persistence without improvement despite an otherwise reasonable semester favors MDD. Her explicit denial of any lifetime manic/hypomanic history is the key piece of evidence that keeps this formulation within the depressive disorders rather than redirecting toward a bipolar-spectrum diagnosis. A real clinician would still gather further history and would frame any conclusion as a hypothesis requiring fuller assessment, not a definitive diagnosis from a brief vignette.