Differentiating Between Grief and Clinical Depression

There is ongoing controversy about the diagnosis of Complicated Grief, and the underlying reasons for this are good ones. It is vital that we recognize that there is no timetable for grief, and that each person’s mourning process will look different. Much care must be taken not to pathologize a person’s grieving process.

While most who grieve do not experience Complicated Grief, some will. The Center for Complicated Grief at Columbia University has done a wonderful job in identifying some of the criteria which might lead to a diagnosis of Complicated Grief, as well as creating some innovative treatment options.

Study is ongoing about this. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) has labeled Persistent Complex Bereavement Disorder as a diagnosis for individuals who experience an unusually disabling or prolonged response to bereavement, and they are recommending future study on this. To currently qualify for this diagnosis at least 6 months must have elapsed since the loss took place.

I recently came across this article which speaks to the complexity of recognizing “when mourning becomes mental illness.” It brings up the question of how soon after a loss a bereaved person should be able to be diagnosed with depression. On one hand, most bereaved people will present with depressive symptoms as a result of the loss, and we definitely do not want to pathologize their mourning process. On the other hand, a loss could trigger a full blown clinical depression for some, and we do not want to deny anyone needed treatment. The article points out that a clinical depression might be triggered by a loss, and that it would be cruel to deny a person treatment for 6 months.

The article concludes that careful clinical judgment will be needed. I think that this is the vital message. Each person will have their own trajectory in the grieving process, and might have unique needs. Clinicians must be adept in listening, supporting, and assessing. The research about Complicated Grief continues to grow, which means that resources are also expanding, both for the bereaved and for those who work with them.

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