By generalizing and modifying slightly a definition proposed for cancer patients, distress may be defined as follows: "An unpleasant emotional experience of a psychological, social, and/or spiritual nature that may interfere with the ability to cope effectively with a stressful situation. Having lost the cognitive map, a person with SI has no guide, chart or hint to get out of the predicament. Individuals with SI are puzzled, indecisive, uncertain, facing a dilemma, unclear as to ways out of the situation, placed in a deadlock, impasse, quandary, or plight. The stressful situation disconfirms assumptions about self and others and about the continuity of the past and present with the future. SI is a self-perceived incapacity to perform tasks and express feelings deemed appropriate in a stressful situation, resulting in pervasive uncertainty and doubts about the future. To further characterize the concept of demoralization, it has been proposed that the clinical hallmark of demoralization is "subjective incompetence" (SI) and that demoralization involves both SI and symptoms of distress, such as depression, anxiety, resentment, anger, or combinations thereof 3,4. Demoralization always takes place within the context of a past, present, anticipated or imagined stressful situation. He proposed that this state of mind occurs in many persons who seek psychotherapy, whatever their diagnostic label 1,2. This article has the following objectives: (a) to review the evolving understanding of demoralization and the methods proposed for its assessment (b) to describe the clinical progression of demoralization (c) to explain the differences between demoralization and passing or transient distress, non-specific distress and sub-threshold depression or anxiety, as well as the differences between demoralization and mental disorders such as major depressive disorder, dysthymic disorder, acute stress disorder, posttraumatic stress disorder, and adjustment disorder and (d) to propose a set of criteria that may be considered for future research on demoralization.Īs defined by Frank, demoralization is the state of mind of a person deprived of spirit or courage, disheartened, bewildered, and thrown into disorder or confusion. Key words: Demoralization Distress Psychopathology Depression. Future research should continue to clarify its role in the pathogenesis of both mental disorders and physical illnesses and identify appropriate interventions for its arrest or prevention. The domains and the diagnostic criteria for demoralization presented in this article need to be confirmed by epidemiological and empirical studies. The role of demoralization as a risk factor for mental disorders is just beginning to be understood. The domains of distress and demoralization are described and research diagnostic criteria for demoralization are presented.Ĭonclusions: The scales discussed in this article differ in their time frames and have not yet been applied to the same population at the same time. Demoralization can be a risk factor for the manifestation of psychopathology, the prodromal phase of a mental disorder, or a trigger for exacerbation or recurrence of psychiatric distress symptoms. Results: Demoralization can be distinguished from passing or transient distress, non-specific distress, sub-threshold depression or anxiety, and certain mental disorders. This was supplemented by a manual search of the literature. Methods: A MEDLINE search using the keywords distress, subjective incompetence, depression, demoralization, helplessness, hopelessness and psychopathology was conducted. Distress, demoralization and psychopathology: Diagnostic boundariesīackground and Objectives: The objectives of the manuscript are: (a) to review the understanding of demoralization and its assessment (b) to describe its clinical progression (c) to explain the differences between demoralization and other form of psychological distress (d) to propose a set of criteria for future research on demoralization.
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