Is it Grief or Depression?
The loss of a close and loved person through death is regarded as one of life’s most stressful events. Grief is a natural response to the loss of a loved one and can include a range of emotional, cognitive, behavioral and somatic reactions. Prolonged grief disorder also known as complicated grief is a form of grief where the immediate grief reactions persist over time and cause a considerable loss of everyday functioning, characterized by intense longing for the deceased person and difficulty accepting the death. Depression is a mental disorder characterized by low mood, lack of interest in activities, fatigue, poor self-esteem, hopelessness, sleep disturbances and loss of appetite. Loss of a loved one can increase the risk of developing depression. To distinguish between grief or prolonged grief and depression, it is important to consider whether the thoughts and emotions continue to revolve around the deceased (prolonged grief) or are globally negative (depression) .
What is Normal Grief?
Grief is a complex and multi-faceted experience that affects people differently following the loss of a loved one. Factors such as the relationship with the deceased, the circumstances of the death, and the support available can all play a role in how individuals experience grief. It is common for grief to come in waves, with intense reactions that can be triggered by internal or external reminders. Early on in the grieving process, it is not unusual to experience both positive and negative emotions, but over time, the intensity of grief reactions may lessen, although some losses may result in a more prolonged or different grieving process. Holidays and anniversaries can often bring about an intensification of grief reactions. Understanding the unique nature of grief and the individual differences in how people experience it can be helpful in providing support and promoting healing.
What is Abnormal Grief?
Prolonged grief disorder (also known as complicated grief) is a condition characterized by intense longing for or persistent preoccupation with the deceased person, difficulties in accepting the death, feeling of having lost a part of oneself, difficulties in continuing with life, emotional numbness, and avoidance of reminders of the deceased. It may also involve rumination, blaming of others and self-blame. According to the ICD-11, prolonged grief can be diagnosed six months after the bereavement if the intensity and duration of grief reactions go beyond what is expected in light of cultural and religious norms. Approximately 7% of people who lose a loved one may be affected by prolonged grief, with higher rates among parents who have lost a child and those who have experienced sudden, violent deaths. However, it’s important to note that intense and prolonged grief lasting more than six months doesn’t necessarily mean it’s abnormal. The defining feature of prolonged grief is its significant impact on daily functioning.
What is Depression?
Depression is a common mental illness characterized by low mood, lack of interest in activities, fatigue, difficulty concentrating, poor self-esteem, hopelessness, suicidal thoughts, sleep disturbances, loss of appetite, and/or psychomotor agitation or retardation. Depressions are frequently graded into mild, moderate and severe forms, and the symptoms must have persisted for more than two weeks before a diagnosis can be made. Loss of a loved one through death is a risk factor for depression, with studies showing that 15% of widows/widowers suffer from depression one year after the loss, and up to 70% of those who endure prolonged grief also suffer from depression. Prior history of depression increases the risk of developing depression and prolonged grief after the loss of a loved one.
What are some core differences between prolonged grief disorder and depression?
The distinction between prolonged grief and depression involves determining whether the symptoms revolve around the loss of the loved one (prolonged grief) or if they are more generalized and not tied to the loss (depression). Low mood in prolonged grief is linked to the separation from the deceased, while depression involves a persistent and pervasive low mood often accompanied by pessimistic thoughts and feelings of hopelessness.
In prolonged grief, the core symptom is intense and persistent longing for the deceased, which is not seen in depression. The bereaved may seek experiences that bring them closer to the deceased and may have feelings of guilt for things related to the deceased. In depression, the patient may experience a lowered interest in or ability to enjoy activities and express feelings of global guilt, worthlessness, and self-contempt. These feelings are not seen in prolonged grief.
Depression and prolonged grief also differ in terms of avoidance behavior. Those with prolonged grief tend to avoid specific reminders of the loss, while those with depression engage in more general avoidance and social withdrawal. Suicidal thoughts occur in both conditions but are associated with different motivations. In prolonged grief, they may be associated with a desire to be reunited with the deceased, while in depression, they may stem from a belief that one does not deserve to live or the idea that others would be better off without them.