Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Differentiating Depressed Moods

Among the mental disorders listed in the DSM are mood disorders, and for today, the one that interests us is major depressive disorder.

Major depressive disorder may arise from a number of critical life events, and, in some cases, it emerges without an event triggering it.

Bereavement (loss resulting in a grief reaction) is the only life event that is singled out in the DSM-IV as *not* major depressive disorder. Thus, you do not diagnose a patient who is grieving the loss of loved one with major depressive disorder. Instead, you diagnose them with uncomplicated bereavement, and their response is considered “normal”; not a disorder.

However, recently, a dispute has arisen as to whether such a distinction (bereavement vs. major depressive disorder) is fair and accurate. The symptoms arising from bereavement are the same as those brought on by other stressful life events that we accept as causes of major depressive disorder (such as job loss, financial setbacks, spousal infidelity, illness in a child, etc. etc). Thus, depression occurring in the context of loss of a loved one, is identical to depression that occurs from any other negative life event.

If we single out those going through bereavement and do not diagnose them with major depressive disorder, we are potentially depriving them of care that they would receive if diagnosed with major depressive disorder. Using the bereavement exclusion rule basically says that they do not need treatment since what they are experiencing is “normal grief.”

So, you bring up an important question: Is depression from chronic injury pain a disorder, but depression arising from the death of a parent simply normal grief?

Many are beginning to accept that both give rise to major depression.

The counter argument is that if we increasingly label all human experiences as pathological, we reduce human experiences to little more than a series of disorders.

For your particular case, be aware that treating the patient for depression related to pain should also ease the depression encountered from the death of family members, but the focus under workers’ compensation should be pain management rather than resolution of family loss.”

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