Psychotherapy For The Gifted
Jerald Grobman M.D.
Madelon Sann L.C.S.W.

All sessions are on Zoom, join easily from any location.

Existential Depression: Explained

Step 1. What are the Symptoms of an Existential Depression

An Existential Depression begins when some of the symptoms of an Existential Crisis combine with some of the symptoms of a Major Depressive Disorder or a Persistent Depressive Disorder;

The symptoms of Existential Distress or Crisis are alienation, detachment, isolation disillusionment, dissociation, and feelings of meaninglessness.

Combine with

The symptoms of Major Depressive Disorder are intense sadness most of the time, little pleasure in most things, decreased appetite, weight changes, sleep disturbances, agitation, fatigue, inappropriate guilt, decreased ability to concentrate, indecisiveness, and suicidal thoughts.

To cause

Serious impairment in daily cognitive, emotional behavioral functioning.

Step 2. Avoiding Misdiagnosis: Secondary Symptoms Often Associated with Existential Depression:

Existential Depressions often have other symptoms associated with them:

  • Symptoms that may be caused by coexisting conditions.
  • Symptoms that are secondary reactions to Existential Depression.

Understanding these distinctions helps avoid misdiagnosis.

Common symptoms that can occur with symptoms of Existential Depression

  • Anxiety and episodes of panic – misdiagnosed as a type of anxiety disorder
  • Mood swings – misdiagnosed as a type of Bipolar disorder
  • Obsessive fixations and rituals – misdiagnosed as an Obsessive-Compulsive disorder
  • Physical complaints with no clear medical causes- misdiagnosed as somatic disorders or hypochondriasis – (a false belief in a serious illness when none exists)
  • Memory and processing disorders – misdiagnosed as a type of learning disorder
  • Distractibility and decreased ability to stay focused and concentrate-inattentiveness – especially during periods of intense creativity – misdiagnosed as attention deficit disorder

Step 3. Making the Diagnosis: Factors in the Assessment 

  • What are the Existential Symptoms?
  • What are the Depressive Symptoms?
  • A recent history of the Symptoms of Existential Depression.
  • When did the symptoms of Existential Depression first appear?
  • Are the symptoms an intensification of a long-standing pattern of existential symptoms?
  • Was there a precipitating event or circumstance that preceded the symptoms of Existential Depression?
    • An event related to Giftedness: Spectacular success or spectacular failure
    • Rejections
    • Preoccupations with big existential questions: The Nature of life and its meaning
    • Preoccupations with personal existential questions: The how and why of my own  
    • Giftedness and my discomfort with it.
  • Non-gifted related issues: loss or death of important people, pets, financial reversals, medical illnesses, trauma, accidents, natural disasters. 
  • What makes the symptoms of Existential Depression better or worse?
  • Developmental History: When did the elements of Giftedness emerge?
  •  Advanced physical abilities.
  • When did h/s teach themselves to read, acquire advanced vocabulary, and start talking in full sentences?
  • Intense curiosity: What are the specific areas of interest? Are these pursued with passion and ambition? Is the child a polymath?
  • Special Sensitivities: Sounds (is there a perfect pitch?), fabric, food, temperature, light.
  • Special intensities and passions

 Reactions to the Giftedness:

  • The child’s reactions to h/h advanced abilities.
  • The parent´s reaction to their child’s giftedness: confusion, excitement, support, and encouragement, or ambivalence and neutrality.
  • School’s response to giftedness: Was giftedness recognized and supported by teachers or restricted and discouraged? Were there any skipped grades?
  • Academic performance: specific areas of advanced performance or underachievement.
  • Spectacular Successes followed by dramatic unexplained failures.
  • Extracurricular activities to help develop giftedness.

Giftedness in Relationships:

  • With Parents: early signs of independence – refusal to accept certain kinds of parenting or dependence
  • With Peers: initiating peer relationships or passively accepting them or ignoring them – Are there soul mates and an appropriate peer group?
  • Family History: Parent´s experience with their own giftedness; marital history; the current state of the marriage.
  • Sibling Issues: Rivalry & Guilt.
  • Adolescence: Gender issues

Step 4. Pulling It All Together: Establishing the Cause of an Existential Depression 

  • What are the primary causes and secondary contributing factors of Existential Depression?
  • Is the depression primarily about Existential Issues surrounding Giftedness?
  • Is the Existential Depression primarily about non-gifted issues?
  • Where do the other symptoms: anxiety, mood swings, and obsessive thinking fit into the diagnostic picture?

A  brief narrative – the formulation -describes how all factors – primary and secondary – combine to cause a particular Existential Depression

No narrative statement of the causes of a Gifted Individual’s existential or other type of depression can be complete without describing the Gifted Individual’s emotional response to h/h Giftedness and how h/s has chosen to use or not use the elements of Giftedness :

Has this gifted person embraced and accepted this part of their personality or neglected, disavowed, denied, or rejected it?

This more, than any other factor, is often the key to an in-depth psychological understanding of any depression – existential or other types of depression- in Gifted Individuals.

This narrative statement of the cause of an Existential Depression provides a focus on where and how the treatment should begin

Treating Existential Depression

Step 1: Evaluating the Severity of the Symptoms

  • If the symptoms seriously compromise aspects of daily function, frequent and intensive talk sessions may be indicated.
  • Proper selection and use of medication can provide the quickest symptom relief so that a daily health activities routine can be restored.

Step 2: Focus on the Central Problem

  • Is it a practical problem? Do the current circumstances, or relationships need to be changed?
  • Is the central problem primarily a depressive one?
    • Unresolved grief from the loss of an important person or job that is separate from issues of giftedness?

Step 3: Focus on Issues About Giftedness Itself

  • Is the problem one of accepting Giftedness and/or a problem developing and using giftedness?

Step 4: Barriers to the Successful Treatment of Existential Depression in Gifted Individuals

  • Once symptoms have improved, Gifted Individuals often are reluctant to dig deeper into the issues about giftedness and are reluctant to continue with the temporary reliance on another person – even one with obvious expertise.

Contact Us

7pm - 9pm EST

Jerald Grobman M.D.

Madelon Sann L.C.S.W.​

We offer our sessions through Zoom’s virtual platform, providing flexibility to participate from any location.