Demoralization

Demoralization, as described by Jerome Frank, is experienced as a persistent inability to cope, together with associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem. Demoralization was defined according to diagnostic criteria encompassing unpleasant, distressing feelings of personal failure and inadequacies, with a loss of continuity in the sense of sequence between past and future. Even though there was a considerable overlap between the two diagnoses, 59 (43.7%) patients with major depression were not classified as demoralized, and 169 (69%) patients with demoralization did not satisfy the criteria for major depression. This may lead to significant systematic differences in the outcome of the control group, obscuring the results of the study and threatening their validity. The findings suggest a high prevalence of demoralization in the medically ill and the feasibility of a differentiation between demoralization and depression. Further research may determine whether demoralization, alone or in association with major depression, entails prognostic and clinical implications.