Jen is a 31-year-old female who presents for care complaining of depressed mood. During the interview it becomes apparent that she has a long history of depressive symptoms, as well as a long history of being socially isolated and feeling generally inadequate. When considering a diagnosis of persistent depressive disorder, the PMHNP considers that the core concept of persistent depressive disorder refers to subaffective or subclinical depressive disorder with all of the following except:

A. Low-grade chronicity for at least 2 years  
B. Insidious onset, usually in childhood or adolescence
C. Strong family history of depression and bipolar disorder 
D. Long asymptomatic periods between episodes  

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