Table 3.
Proposed criteria for demoralization in the medically ill, including cancer patients
| Demoralization/subjective incompetence (De Figueiredo) [34] |
| A combination of distress (anxiety, sadness, discouragement, and resentment) and subjective incompetence (a feeling of being trapped or blocked because of a sense of inability to plan and initiate concerted action toward one or more goals) |
| Persistent failure of coping with internally or externally induced stress |
| Feelings of impotence, isolation, and despair |
| Individual’s self-esteem damaged |
| Feelings of rejection by others because of his or her failure to meet their expectations |
| Diagnostic Criteria for Psychosomatic Research (DCPR Criteria)—demoralization module (Fava et al.) [35] |
| A. A feeling state characterized by the patient’s consciousness of having failed to meet his or her own expectations (or those of others) or being unable to cope with some pressing problems; the patient experiences feelings of helplessness, or hopelessness, or giving up |
| B. The feeling state should be prolonged and generalized (at least 1 month duration) C. The feeling closely antedated the manifestations of a medical disorder or exacerbated its symptoms |
| DCPR Criteria - demoralization module -Revised (Fava et al.) [38••] |
| A. A feeling state characterized by the perception of being unable to cope with some pressing problems and/or of lack of adequate support from others (helplessness); the individual maintains the capacity to react |
| B. The feeling state is prolonged and generalized (duration of at least 1 month) C. A feeling state characterized by the consciousness of having failed to meet expectations associated with the conviction that there are no solutions for current problems and difficulties (hopelessness) |
| [criteria A and B are required; criterion C is a specifier for the presence of hopelessness] |
| Demoralization syndrome (Kissane et al.) [36, 37] |
| Encompassing hopelessness or loss of meaning and purpose in life |
| Cognitive attitudes of pessimism, helplessness, sense of being trapped, personal failure |
| Absence of drive or motivation to cope differently |
| Associated features of social alienation or isolation and lack of support |
| Fluctuation in emotional intensity |
| Persistence of above-mentioned phenomena across two or more weeks (and a major depressive or other psychiatric episode should not be present as the primary condition) |