Grief is a painful but normal part of the human condition — we all, at one point or another, lose someone or something important. Besides grieving the death of a loved-one, maybe a spouse, a parent, or a child, people also grieve as they process things like infertility, divorce, job loss, and many other things.
Grief: A complicated beast
You may have heard of the "five stages of grief", or the Kübler-Ross model, which holds that grief progresses in five neat stages. First, you're supposed to be in denial — numb, perhaps, not fully realizing your loved-one is truly gone, or your life really has changed permanently. Anger follows, it's said, and then comes bargaining, in which you level with God, the universe, or whatever, to prevent a bad outcome or to reverse it. The fourth stage involves feelings of depression, after which you come to acceptance, and begin to find ways to be in the world without the person or thing you lost.
What separates normal grief from depression? That's a question even many mental health professionals, research shows, struggle to answer. Like depressed people, grieving people may feel down, low, guilty, worthless, lonely, depressed, sad, anxious, unhappy, dissociated, angry, and numb.
In grieving people, this process changes over time and:
- Is most intense right after a loss, and gradually transforms itself into a new way of being — you may never "get over" the loss of a loved-one, but you will find a way to continue, to give your life meaning again and even to be happy.
- Looks a lot like depression at the beginning, but with an identifiable cause that others recognize as being normal in the context of the situation.
- Often means finding comfort in connecting with other people, especially in relation to the loss, while depressed people lose interest in social interactions.
- Feelings of grief can subside, only to come to the forefront again around anniversaries connected with the loss — holidays, birthdays, the anniversary of a loved one's passing.
What is adjustment disorder?
Some currently grieving people may be diagnosed with "adjustment disorder with depressed mood". This is a diagnosis found in the current version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, that laypeople would refer to as "situational depression". That is, adjustment disorder with depressed mood means you meet some, but not all, of the criteria for major depressive disorder and there is an identifiable trigger for your symptoms — something exactly like the loss of a loved-one, being laid off, or going through a divorce.
You may be diagnosed with adjustment disorder with depressed mood if:
- The symptoms hit within three months of an identifiable stressor and end within six months after the the stressor or its consequences come to a halt. (That itself makes it hard to identify — while you may easily get over a job loss after finding new employment, the same isn't true for the loss of a relative or close friend.)
- You have some of the symptoms of clinical depression — being depressed, feeling low, guilt, and worthlessness, but also appetite and weight changes, trouble sleeping, a loss of interest in previously meaningful activities, and even thoughts about death or suicide. You do not, however, meet the full diagnostic criteria for depression.
- Some of these symptoms are perfectly normal in grieving people, and that is where the subjective part of this diagnosis comes in — your healthcare provider must deem the symptoms to be disproporionate to "the severity or intensity of the stressor", another mental disorder shouldn't be able to explain them, and your symptoms have to impact your daily functioning signficicantly. Your diagnosing healthcare provider has to determine that you are going through something beyond normal bereavemeny. This will depend on your personality, culture, and the nature of your loss.
Major depressive disorder: Symptoms
You may meet the diagnostic criteria for major depressive disorder after a loss as well — in this case, it is, once again up to your doctor or other diagnosing professional to determine whether your symptoms are solely caused by grief or you are clinically depressed.
The hallmarks of depression are:
- A depressed mood on most days or for most of the day — this can manifest as feeling sad, tearful, hopeless, empty, and even irritable.
- A loss of interest in everyday activities.
- Weight loss or weight gain, resulting from corresponding appetite changes.
- A physical slowing down or speeding up.
- Fatigue or low energy on most days and for most of the day.
- Experiencing worthlessness or guilt.
- Being indecisive and unable to concentrate.
- Thoughts about death or suicide.
To be diagnosed with depression, these symptoms have to represent a significant change in your daily functioning — and if there is another logical explanation for the full extent of the symptoms, such as a recent loss, that also rules this diagnosis out. The symptoms have to last at least two weeks, and you have to meet five of the criteria. It is up to your healthcare provider to determine whether you meet the diagnostic criteria for major depressive disorder — which would lead to a corresponding suggestion of treatment with antidepressants, talk therapy, or noth — or you are just grieving. They'll get a clearer picture by discussing this with you in detail.
If you have recently experienced a loss and are struggling, chances are that you will benefit from therapy whether or not you meet the diagnostic criteria for either adjustment disorder or depression. Everyone grieves in their own way, but a therapist can help you go through the process in a way that helps you look to the future.