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Grief vs. Depression
Some rights reserved by SpitefullyWe’ve all experiences losses of different types in life. Death, divorce, job loss and so on can all lead to a process of grieving, or bereavement. And during periods of grief people, quite naturally, feel very sad and this sadness can manifest like depression. So how is one to know if what they are feeling is grief or depression?
The Diagnostic and Statistical Manual of Mental Disorders and Bereavement
Currently in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the diagnosis of major depression contains an exclusion for bereavement. Specifically, if the depressive symptoms are due to the loss of a loved one, this is not to be diagnosed as major depressive disorder.
However, it’s acknowledged that a person could be experiencing a disorder after the loss of a loved one, so the bereavement responses may be classified as major depressive episodes if, for example: [i]
“. . . the symptoms last more than 2 months or if there is marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.”
The New Diagnostic and Statistical Manual of Mental Disorders and Bereavement
However, in the version of the DSM in the works, the DSM-V, there is a move to remove the bereavement exclusion for the diagnosis of major depressive disorder. It’s still recognized that grief can be a normal, human process, but diagnostically, it is argued, it does not vary from major depressive disorder.
For example, it was expected that cognitive impairment be less in those experiencing bereavement compared to those in a major depression, however, as it turns out, the cognitive impairment is actually the same. Many doctors feel, when looking at the symptoms, there is no good way to separate bereavement from major depressive disorder.
Is it Grief or Depression?
These are points for diagnosticians and scientists to work out and there are certainly proponents both of removing the bereavement exception and keeping the bereavement exception. Until then, though, there are a series of questions that have been designed to separate the two phenomena. These questions are known as the Post-Bereavement Phenomenology Inventory (PBPI) and were created by Dr. Ronald W. Pies.
(It’s important to note that these questions are not scientifically validated. These questions are more to be used as an indicator of what the patient is experiencing.)
Out of each pair, which describes better how you have been feeling over the last one-two months, one or two?
- I am filled with despair nearly all the time, and I almost always feel hopeless about the future.
- I feel sadness a lot of the time, but I believe that eventually, things will get better.
- My sadness or depressed mood is nearly constant, and it isn’t improved by any positive events, activities, or people.
- My sadness or depressed mood usually comes in “waves” or “pangs,” and there are events, activities, or people who help me feel better.
- When friends or family call or visit and try to cheer me up, I don’t feel anything or I may feel even worse.
- When friends or family call or visit and try to cheer me up, I usually “perk up” for a while and enjoy the social contact.
- I feel “slowed down” inside, like my body and mind are stuck or frozen, and like time itself is standing still.
- My concentration isn’t as good as usual, but my body and mind aren’t slowed down, and time passes in the usual way.
(Find all questions on the Post-Bereavement Phenomenology Inventory here.)
Not surprisingly, identifying with the number one statements is more indicative of major depression while identifying with number two statements is more indicative of bereavement.
Treating Grief and Depression
Grief is a natural part of the human spectrum of emotion and thus requires no “treatment” per se (which is not to suggest that things like counselling can’t help with the process). However, bereavement and other types of grief can occur alongside a major depressive disorder and that is when treatment may be indicated.
Keep in mind though, only a qualified professional can make this determination so always talk to a doctor and don’t self-diagnose.
[i] Extending the Bereavement Exclusion for Major Depression to Other Losses - Evidence From the National Comorbidity Survey by Jerome C. Wakefield, PhD, DSW; Mark F. Schmitz, PhD; Michael B. First, MD; Allan V. Horwitz, PhD