A 58-year-old man lost his wife 3 months ago. He feels sad in waves, especially when reminded of her, can still enjoy visits from grandchildren, maintains self-respect, and occasionally wishes he could join her but has no intent or plan. His brother had similar grief after losing his spouse. Which feature, if present, would most strongly indicate major depression rather than normal grief?
- A Persistent pervasive low mood with feelings of worthlessness and self-loathing ✓
- B Sadness occurring in waves triggered by specific reminders
- C Transient wish to have died alongside the deceased
- D Preserved capacity to experience positive emotion during certain moments
Correct answer: A. Persistent pervasive low mood with feelings of worthlessness and self-loathing
Explanation
DSM-5 distinguishes grief from major depression by pattern and content: grief comes in waves triggered by reminders with preserved self-esteem and capacity for pleasure, whereas depression is pervasive, sustained, and accompanied by worthlessness, self-critical rumination, and persistent anhedonia. Passive thoughts of joining the deceased are common in uncomplicated grief and are not sufficient. Waves of sadness and preserved positive emotions actually favour normal grieving.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.