Diagnosis and Measurement of Subjective Incompetence: The Clinical Hallmark of Demoralization

Cockram, Cheryl A.; Doros, Gheorghe; Figueiredo, John M. de

doi:10.1159/000235737

Cited by 66 publications

(66 citation statements)

References 24 publications

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“…8,[14][15][16][17] . Recently a scale to measure subjective incompetence was used in a study of outpatients with cancer 18,19 . With these methods in place, a number of studies conducted in the United States, Canada, Europe, Israel, Australia and New Zealand have documented demoralization in both clinic populations and community samples.…”

Section: Understanding Demoralizationmentioning

confidence: 99%

“…Like inflammation, the distress component of demoralization can be non-specific, may or may not resolve itself if the stressor is removed, and may start as a non-pathological reaction of an individual to the stressor, but become a pathological process or state and require intervention under certain conditions. Recently a scale to measure subjective incompetence was used in a study of outpatients with cancer 18,19 . With these methods in place, a number of studies conducted in the United States, Canada, Europe, Israel, Australia and New Zealand have documented demoralization in both clinic populations and community samples.…”

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Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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-Background 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.Methods: A MEDLINE search using the keywords distress, subjective incompetence, depression, demoralization, helplessness, hopelessness and psychopathology was conducted. This was supplemented by a manual search of the literature.Results: Demoralization can be distinguished from passing or transient distress, nonspecific distress, sub-threshold depression or anxiety, and certain mental disorders. 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. The domains of distress and demoralization are described and research diagnostic criteria for demoralization are presented.Conclusions: 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. The role of demoralization as a risk factor for mental disorders is just beginning to be understood. The domains and the diagnostic criteria for demoralization presented in this article need to be confirmed by epidemiological and empirical studies. 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. ObjectivesThis 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. Understanding demoralizationAs 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. He proposed that this state of mind occurs in many persons who seek psychotherapy, whatever their diagnostic label 1,2 . Demoralization always takes place within the context of a past, present, anticipated or imagined stressful situation. 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 . S...

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Section: Understanding Demoralizationmentioning

confidence: 99%

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confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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“…At variance with DSM-III-R [3], in DSM-IV there is no attempt to rate the severity of stressors. Further, there is no reference to the modulating effects of individual variables, such as coping and adaptation [4,5]. Not surprisingly, the fourth axis of DSM-IV has not achieved wide currency in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Clinical Assessment of Allostatic Load and Clinimetric Criteria

Fava

Guidi²,

Semprini³

et al. 2010

Psychother Psychosom

112

102

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The concept of allostasis emphasizes that healthy functioning requires continual adjustments to the internal physiological milieu. Allostatic load reflects the cumulative effects of stressful experiences in daily life. When the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine responses exceeds the coping resources of an individual, allostatic overload ensues. So far these issues have been addressed only on pathophysiological terms that do not find application in clinical settings. However, several features that have been described in psychosomatic research may allow the assessment of allostatic load on clinical grounds. Clinimetric criteria for the determination of allostatic overload are suggested. They are based on: (a) the presence of a stressor exceeding individual coping skills, and (b) clinical manifestations of distress. They may provide specification to the fourth axis of DSM, may supplement the Diagnostic Criteria for Psychosomatic Research, and may help discriminate neuroendocrine patterns with important clinical and research implications. A state of allostatic overload is frequently associated with alterations in biological markers and calls for a close medical evaluation of the patient’s condition. The ultimate goal is to be able to prevent or decrease the negative impact of excessive stress on health.

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“…Major depression according to DSM-IV criteria is heterogeneous and associated with other psychological constructs, such as hostility and demoralization [47,48] . Subtypes of depression are proposed to exist that differ in etiology, manifestation and are responsive to different kinds of antidepressant treatment [49] .…”

Section: Discussionmentioning

confidence: 99%

Onset and Recurrence of Depression as Predictors of Cardiovascular Prognosis in Depressed Acute Coronary Syndrome Patients: A Systematic Review

Zuidersma

Thombs

Jonge

2011

Psychother Psychosom

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Background: Depression after acute coronary syndrome (ACS) is associated with worse cardiac outcomes. This systematic review evaluated whether depressed ACS patients are at differential risk depending on the recurrence and timing of onset of depressive episodes. Methods: MEDLINE, EMBASE and PsycINFO were searched from inception to 11 April 2009. Additionally, reference lists and recent tables of contents of 34 selected journals were manually searched. Eligible studies evaluated cardiovascular outcomes for subgroups of ACS patients with depression or depressive symptoms according to recurrence or onset. Results: Six studies were included that reported outcomes for subgroups of ACS patients with first-ever versus recurrent depression. Four of these reported also outcomes for post-ACS onset versus pre-ACS onset depression, and incident versus nonincident depression. Worse outcomes (odds ratio >1.4) were reported for ACS patients with first-ever depression in 3 of 6 studies (1 study p < 0.05), for patients with post-ACS onset depression in 3 of 4 studies (1 study p < 0.05, but better outcomes in one study) and for patients with incident depression in 2 of 4 studies (no studies p < 0.05). Conclusions: Although it is still suggested that ACS patients with first and new-onset depression are at particularly increased risk of worse prognosis, the inconsistent results from the studies included in this systematic review show that there is no consistent evidence to support such statements.

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Diagnosis and Measurement of Subjective Incompetence: The Clinical Hallmark of Demoralization

Cited by 66 publications

References 24 publications

Distress, demoralization and psychopathology: Diagnostic boundaries

Distress, demoralization and psychopathology: Diagnostic boundaries

Clinical Assessment of Allostatic Load and Clinimetric Criteria

Onset and Recurrence of Depression as Predictors of Cardiovascular Prognosis in Depressed Acute Coronary Syndrome Patients: A Systematic Review

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