Distinguishing Grief, Complicated Grief, and Depression

Ronald W. Pies, MD; M. Katherine Shear, MD; Sidney Zisook, MD


December 26, 2014

In This Article

More on Parsing Complicated Grief and MDD

Dr Pies: That's extremely helpful, Sid, and you remind us once again that grief and major depression are not mutually exclusive—that one can be grieving a death and also be experiencing an MDE.

Kathy, how about your take on what differentiates complicated grief from major depression?

Dr Shear: Complicated grief is at the high end of the grief spectrum in both intensity and duration. People with complicated grief are often caught up in ruminations, avoidance, or maladaptive proximity-seeking. Complicated grief ruminations are usually focused on counterfactual accounts of the death—for example, "If only I had made him go to the doctor sooner" or "If only I had not left the room right before she died."

Depressive rumination is different. Depressed people get caught up in thoughts about being worthless or being a bad person or thoughts that nothing good ever happens in the world, etc. With depression, people may become withdrawn and not want to go out or socialize.

With complicated grief, avoidance is more specific, focused on not wanting to confront reminders of the person who died. People with complicated grief are desperate to feel close to their deceased loved one and may spend hours looking at photos, touching or smelling their clothes, or daydreaming about times they were together. These times are usually pleasurable until the person "wakes up" and remembers that the person is gone.

Dr Pies: I want to thank my colleagues, Dr Zisook and Dr Shear, for helping us understand this complex and difficult area of diagnosis.


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