Bereavement is diagnosed when the focus of clinical attention is a reaction to the death or loss of a loved one. As part of their reaction to the loss, some grieving individuals present with symptoms characteristic of a Major Depressive Episode (e.g., feelings of sadness and associated symptoms such as insomnia, poor appetite, and weight loss).

The bereaved individual typically regards the depressed mood as “normal,” although the person may seek professional help for relief of associated symptoms such as insomnia or anorexia. The duration and expression of “normal” bereavement vary considerably among different cultural groups.

The diagnosis of Major Depressive Disorder is generally not given unless the symptoms are still present 2 months after the loss. However, the presence of certain symptoms that are not characteristic  of a “normal” grief reaction may be helpful in differentiating bereavement from a Major Depressive Episode. These include:

1. Guilt about things other than actions taken or not taken by the survivor at the time of the death;
2. Thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person;
3. Morbid preoccupation with worthlessness;
4. Significant psycho-motor retardation;
5. Prolonged and serious functional impairment; and
6. Hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.