Criteria for Diagnosing Major Depression Disorder

The life transition of death and dying is inevitably one with which we will all be faced; we will all experience the death of people we hold close throughout our lifetime. This paper will explore the different processes of grief including the bereavement, mourning, and sorrow individuals go through after losing someone to death. Bereavement is a period of adaptation following a life changing loss. This period encompasses mourning, which includes behaviors and rituals following a death, and the wide range of emotions that go with it. Sorrow is the state of ongoing sadness not overcome in the grieving process; though not pathological, persistent

Loss is a phenomenon that is experienced by all. Death is experienced by family members as a unique and elevated form of loss which is modulated by potent stages of grief. Inevitably, everyone will lose someone with whom they had a personal relationship and emotional connection and thus experience an aftermath that can generally be described as grief. Although bereavement, which is defined as a state of sorrow over the death or departure of a loved one, is a universal experience it varies widely across gender, age, and circumstance (definitions.net, 2015). Indeed the formalities and phases associated with bereavement have been recounted and theorized in literature for years. These philosophies are quite diverse but

Sigmund Freud was an influential psychoanalyst in the late 18th century to the early 19th century. He made many advances in the field of psychology which have impacted other academic areas such as sociology and social work. In his 1915 paper “Mourning and Melancholia” he connected the normal realm with the pathological. In which he “compared mourning – a normal if painful event from which hardly anyone is spared – with a pathological although very common one: melancholia” (Fiorini et al. 2007). The natural human process is to mourn the loved subject or object when it is lost. Freud explains that grief is the feeling of losing love and once it is fully lost desolation and fear takes its place

296.32 (F33.1) Major Depressive Disorder, recurrent episode, moderate severity, with anxious distress. Ms. Client meets eight of the nine diagnostic criteria for Major Depressive Disorder (MDD). Specifically, during several periods of time she experienced depressed mood, diminished interest in things she enjoyed to do, hypersomnia, psychomotor agitation, fatigue, feelings of worthlessness, decreased concentration, and suicidal thoughts without intent. Additionally, as Ms. Client expressed, these symptoms are source of continuing distress and interfere with her academics and social functioning. Also, her symptoms started four years prior to the psychological assessment and persisted intermittently since then, lasting for several weeks to several months, with the most recent period of extended length (enduring two weeks) approximately one year ago. Since the last episode she has experienced these symptoms for two to three days at a time. Although the last episode that met the criterion of two weeks duration occurred approximately a year ago, the symptoms have not disappeared, but they occur periodically since then and when they do, they cause considerable distress and impairment in functioning. Thus, the disorder cannot be coded as ‘in partial or full remission’. The specifier ‘with anxious distress’ was given, because Ms. Client reports feelings of difficulty in concentration because of worry and restlessness.

Grief is the act following the loss of a loved one. While grief and bereavement are normal occurrences, the grief process is a social construct of how someone should behave. The acceptable ways that people grieve change because of this construct. For a time it was not acceptable to grieve; today, however, it is seen as a necessary way to move on from death (Scheid, 2011).The grief process has been described as a multistage event, with each stage lasting for a suggested amount of time to be considered “normal” and reach resolution. The beginning stage of grief is the immediate shock, disbelief, and denial lasting from hours to weeks (Wambach, 1985). The middle stage is the acute mourning phase that can include somatic and emotional turmoil. This stage includes acknowledging the event and processing it on various levels, both mentally and physically. The final stage is a period of

The article “DSM-5: An Overview of Changes and Controversies” by Wakefield (2013), discusses the positives changes of diagnosis with individuals dealing with Major Depressive Disorder. In order to create a more specific diagnosis, the DSM 5 now excludes bereavement as a criteria. According to the DSM-IV, Major Depressive Disorder is diagnosed when a client displays five of the nine lasting symptoms for two or more weeks. An individual can qualify for Major Depressive disorder if they have five of the general distress symptoms which someone dealing with grief can experience easily. Considering this, the DSM 5 excludes this requirement in order to distinguish between depressive disorders and normal grief symptoms. Now, the DSM states that if

A major depressive episode is described as having a depressed mood or loss of interest or pleasure along with five (or more) of the following symptoms: (a) significant weight loss, (b) insomnia or hypersomnia, (c) psychomotor agitation or retardation, (d) fatigue or loss of energy, (e) feelings of worthlessness or excessive or inappropriate guilt, (f) diminished ability to think or concentrate, or indecisiveness, and (g) recurrent

The loss of a loved one is a very crucial time where an individual can experience depression, somatic symptoms, grief, and sadness. What will be discussed throughout this paper is what the bereavement role is and its duration, as well as the definition of disenfranchised grief and who experiences this type of grief. I will also touch upon the four tasks of mourning and how each bereaved individual must accomplish all four tasks before mourning can be finalized. Lastly, with each of these topics, nursing implications will be outlined on how to care for bereaved individuals and their families.

The stages of grief have been a topic of debate in grief counseling since their introduction in 1969 by Elisabeth Kubler-Ross, in her book “On Death and Dying”. These stages of grief can be loosely described as a cycle of emotions that humans can expect to feel, resulting from some type of unexpected loss. Grief and loss is very normal process, and something most people will be forced to cope with at some point in their lives. However, to categorize each person’s feelings into an arbitrary set of stages would not be realistic.

The loss of a loved one is a painful experience followed by a period of grief and mourning. Bereavement is an experience most individuals will endure at least once in their lives. For most people symptoms such as persistent yearning for the deceased, intense emotional pain, preoccupation with the deceased, and overwhelming sense of sadness only last for a period of 12 months or less before the symptoms begin to subside. For approximately 2.4%-4.8% of the population grief symptoms persist for more than 12 months. These symptoms begin to impair their social and/or occupation functioning (American Psychiatric Association, 2013). This is a condition known as complicated grief (CG), also referred to as prolonged grief, or persistent complex bereavement disorder (Bryant, 2014). The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), includes CG in the Appendix entitled ‘conditions for further study’. CG was proposed as an adjustment disorder when the DSM-5 was being written. A multitude of research had been completed to prove this was a maladaptive response to a significant stressor in an individual’s life (Bryant, 2014). Unfortunately, the American Psychiatric Association did not believe there was a sufficient amount of evidence to prove this constituted a formal diagnosis (Bryant, 2014). Nevertheless, this topic remains a prevalent concern in our society. Researchers have started to identify certain risk factors as well as mechanisms that cause CG

Sadness and great happiness are part of everyday life. Sadness is a comprehensive response to defeat, disappointment, and other upsetting circumstances. Happiness on the other hand is a worldwide response to success, achievement, and other promising situations. Grief, a form of sadness, is a deliberate normal emotional response to a loss. Bereavement applies specifically to the emotional response to the loss of a loved one. Mood disorders are emotional disturbances consisting of prolonged periods of sadness, happiness, or both. Mood disorders are categorized into two groups; depressive or bipolar. Normality is a difficult thing to define, but most would agree on: the efficient perception of reality, self-knowledge and voluntary control of behavior, having high self-esteem & acceptance, ability to form intimate relationships, and productivity of a person whether as a worker or a student. Something abnormal in a person would be regarded as a change from statistical norms as well as social norms, and maladaptive behavior. However, social norms differ from society to society & can change over time. Considering the difficulty in distinguishing normal from abnormal, categorizing & diagnosing the different types of abnormalities can be difficult to determine a person with a sickness of the mind. In the case of Tamara, a 37 year old woman, we will examine her using the DSM diagnose her with major depression,....(week 8)…., and finally by using psychodynamic therapy and the use of

The results showed depressive symptoms did not differ between the non-complicated bereavement group and the unbereaved control group, both groups displayed little to no depressive symptoms. Although the CG showed slightly higher ratings of depressive symptoms, the results showed only mild to moderate depressive symptoms were present on average in the CG group (O’Connor & Arizmendi, 2014). These results demonstrate the participants who were suffering from CG were not suffering from MDD.

DSM-5 criteria defines major depressive disorder would be qualified for a diagnosis if it demonstrate five or more of the following symptoms during the same 2-week period and represent a change from previous functioning: depressed mood, marked diminished interests or pleasure in activities, significant changes in weight or appetite, insomnia/hypersomnia, psychomotor agitation, fatigue, hopeless and worthless feelings, diminished concentration, and suicide thoughts or intentions (Kosslyn, Rosenberg, & Lambert, 2012). Previous literatures have identified a number of possible causes that may lead to depression, such as genetics, brain differences, social factors like poverty, ethnicity, and childhood experience (Read, J. & Sanders, P., 2010). There are different schools that use different theories as the basis to analyse how psychological problems and symptoms start and develop into life-affecting depression and distress.

Freud (1957) was initially attributed with the term grief work which traditionally stated that individuals who were experiencing bereavement must experience some form of grief work in order to progress through the motions of loss, in more recent times research has suggested that while it may provide benefits for some individuals, others may appear to benefit more through methods of distractions or through the suppression of emotions related to grief (Bonanno 1995). Doughty et al (2001) employs this argument by criticizing the five stage model for its method of universality that perhaps ignores the individuality of the human experience and how it manifests in the grieving process, while some may go through the five stages in a linear process, others may not experience most of the phases in the model. This is an important factor to note for care practitioners as it is critical to be aware when working with diverse clients of their unique experiences, in order to provide practises that tailor to the needs of the client (Goldsworthy

Bereavement is defined as the state or the fact of being bereaved or deprived of someone or something. During the bereavement process people may experience a period of intense grief, which can negatively impact their physical and psychosocial wellbeing (Waller et al., 2016). This may be known as complicated grief and be accompanied by symptoms of loneliness, isolation, suicidal thoughts, and an obsession with the deceased person that they are mourning over. Sufferers also tend to show no or limited interest in ongoing life. Factors that