At some point in our grief experience we all have that moment where we wonder, “Is this normal?” Now the word “normal” is pretty much impossible to define in the context of grief, but professionals in bereavement education, coaching, and counseling have been trying for some time to establish if there is a diagnoseable psychological pathology associated with grief. That’s a very technical way of saying that they’re trying to figure out the difference between “normal” and “abnormal” grief.
Persistent Complex Bereavement Disorder (PCBD), formally referred to as complicated grief, has been labeled as a “condition for further study” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It’s like the bible psychiatric disorders. The DSM-5 is published by the American Psychiatric Association (APA) and “offers a common language and standard criteria for the classification of mental disorders.” So, the thing that no one is quite ready to commit to, is calling any form of bereavement a diagnosable mental disorder, but they will say it’s worth further study.
There are pros and cons to having a bereavement disorder officially included in the DSM. On one hand, if you can diagnose a disorder, mental health practitioners will have a diagnostic code with which to bill an insurance company for medical treatment, which would improve access and coverage for psychological care of that condition. On the other hand, once you are diagnosed you then have a recorded history of mental illness, the stigma of which could affect your career, custody of children, future medical coverage, etc. This is just one pro and con. Whether or not any type of bereavement can be labeled a mental disorder is a very complicated issue.
But what you’re probably wondering is, how do I know if I have something beyond “normal” grief? Since PCBD is not officially recognized, the closest diagnoseable condition is Major Depressive Disorder which is the diagnosis most commonly received in cases of persistent, complex bereavement. So how can you tell the difference between typical grief and a major depressive episode? The first and best way is to talk to a mental health professional. They can help you sort out exactly what it is that you’re going through.
If you want some general guidelines of the difference between typical grief and major depression therapychanges.com offers the following comparison:
Clinical Indications of Typical Grief
- May have tendency to isolate, but generally maintains emotional connection with others
- Hope and belief that the grief will end (or get better) someday
- Maintains overall feelings of self-worth
- Experiences positive feelings and memories along with painful ones
- Guilt, if present, is focused on “letting down” the deceased person in some way
- Loss of pleasure is related to longing for the deceased loved one
- Suicidal feelings are more related to longing for reunion with the deceased
- May be capable of being consoled by friends, family, music, literature, etc.
Clinical Indicators of Major Depression
- Extremely “self-focused”; feels like an outcast or alienated from friends and loved ones
- Sense of hopelessness, believes that the depression will never end
- Experiences low self-esteem and self-loathing
- Experiences few if any positive feelings or memories
- Guilt surrounds feelings of being worthless or useless to others (not related to the loss)
- Pervasive anhedonia [inability to feel pleasure]
- Chronic thoughts of not deserving, or not wanting to live [planning harmful action against yourself]
- Often inconsolable
If you find yourself identifying with some of the indicators for major depression please consider talking with a bereavement or mental health professional, or if you find that your symptoms fall more toward typical grief, then you may be getting sufficient support already. But please remember that, no matter if your grief is typical or complicated or a major depression, there is nothing–not one thing–wrong with asking for some help.
Thanks for visiting Grief Compass. We’re sorry you have to be here, but are glad we’ve found each other.