By David Joel Miller.
Do you have Reactive Depression?
Reactive depression is one of those terms, like Manic-Depressive Disorder, that still gets used even though we have come up with new, presumably more precise names. The underlying assumption, which is often hiding here, is that if we could find ways to categorize the various mental, emotional and behavioral problems, we should be able to find precise treatments, medication or therapy for your specific ailment. If only it was that simple.
The Reactive Depression terms meaning has changed over time. Most recently it was in use to describe times when a person became depressed as a result of a specific stressor. Say you lose your job, that loss might make you sad. A small amount of sadness for a while is normal. Staying a lot sad for a long time is excessive and so you are sort of depressed. In this view reactive depression is depression caused by your specific reaction to an identifiable event. That event might be a one-time thing or it might be repeated exposure to the same sorts of events. Some people have called this Situational Depression.
This is not the same thing as Posttraumatic Stress Disorder (PTSD.) A person with PTSD may or may not have depression but Depression is not part of the definition of PTSD. People with PTSD can’t get the thoughts of the event out of their head. It is as if they are continually re-experiencing the trauma. Anything that reminds them of the trauma is upsetting and they will try to avoid things that trigger those reminders. PTSD usually disturbs sleep. Other symptoms include disturbing dreams, nightmares, trouble falling asleep and more trouble staying asleep. PTSD is an ANXIETY disorder as opposed to an Anxiety disorder. It also includes a lot of stress and trauma-related features.
There is another idea, similar to reactive depression, currently called Minor Depressive Disorder which is currently listed as a disorder listed for further study. While Reactive Depression is in response to something that happened to you, Minor Depressive Disorder is a sad or depressed period with some symptoms but it is just not as deep or severe a depression as a Major Depressive Disorder. So far neither of these ideas are accepted diagnosis under the current text, the DSM-4-TR. Some of these ideas will change when the DSM-5 comes out but that is very controversial at this time.
There is another name and criteria set that we are currently using to cover both of these issues. We call this disorder or group of six disorders – Adjustment Disorders. There are good reasons why people might suffer from adjustment disorders and need treatment but still not have all the symptoms of Major Depressive Disorder or Bipolar Disorder.
In my experience, Adjustment Disorders result in more people in crisis than most of the other disorders. By definition, Adjustment Disorders should be time limited. If it goes on too long after the event or if the symptoms continue to be severe or worsen, then the diagnosis will get increased to Major Depressive Disorder.
That does not mean that a Reactive Depression or Adjustment Disorder is not dangerous. People, who find out their partner is leaving them or has cheated or those who lose a job or house they love, can and sometimes do get violent towards themselves and others.
So let’s return to the person who just lost their job, or spouse or has a sick family member. Might that make them sad? Might they be scared and anxious? Hey, what if they got both depressed and anxious?
This is why we have diagnoses of Adjustment Disorder with Depressed Mood, with Anxiety, and with Anxiety and Depressed Mood. What else might happen?
Could a person who lost their spouse start drinking and get arrested? Maybe a teen that fails a class or gets in trouble might run away from home or get mad and break windows? So one reaction to a problem, one adjustment difficulty, could be to behave in ways that makes society disapprove of you. We would call that Adjustment Disorder with Disturbance of Conduct.
Think about this for a moment. That teen, might he be depressed, anxious and act badly? What about his unemployed father who gets scared he won’t find another job, starts drinking and gets in a fight. We call these sets of behavior Adjustment Disorder with Disturbance of Emotions and Conduct. Lots of names for the ways in which adjusting to a problem could affect someone.
If you have been counting that is only five diagnoses and I promised you six.
We always need a loophole. We call that Adjustment Disorder Unspecified when we can’t figure out which other one it is.
Regardless of the name the preferred treatment for these issues is counseling. Cognitive Behavioral Therapy or solution focused counseling is recommended. The main direction of this kind of therapy is on problem-solving and changing the ways in which you think about your problems.
So whether you call it Reactive Depression, Minor Depression or an Adjustment Disorder, the way we react to life’s stresses can result in crises that require and often bring people to counseling.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books