depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is
likely to decrease in intensity over days to weeks and occurs in waves, the so-called pangs of
grief. These waves tend to be associated with  thoughts or reminder s of the deceased. The
depressed mood of a MDE is more persistent and not tied to specific thoughts or preoccupations.
The pain of grief may be accompanied by positi ve emotions and humor th at are uncharacteristic
of the pervasive unhappiness and misery charac teristic of a major depressive episode. The
thought content associated with grief generally  features a preoccupation with thoughts and
memories of the deceased, rather than the self-c ritical or pessimistic ruminations seen in a MDE.
In grief, self-esteem is generally preserved, whereas in a MDE, feelings of worthlessness and self-
loathing are common. If self-derog atory ideation is present in grief, it typically involves per-
ceived failings vis-à-vis the deceased (e.g., no t visiting frequently enough, not telling the
deceased how much he or she was loved). If a be reaved individual thinks  about death and dying,
such thoughts are generally focu sed on the deceased and possibl y about “joining” the deceased,
whereas in a major depressive episode such th oughts are focused on ending one’s own life
because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.Bipolar I disorderCurrent or 
most recent 
episode 
manicCurrent or 
most recent 
episode 
hypomanic* Current or 
most recent 
episode 
depressedCurrent or 
most recent 
episode 
unspecified**
Mild (p. 154) 296.41