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

Existential depression is the most common problem of gifted individuals

Avoiding Misdiagnosis

Understanding the general symptom profile of elements of Existential Depressions

An Existential Depression begins when some of the symptoms of and 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:

Alienation, detachment, isolation disillusionment , dissociation and feelings of meaninglessness.

Combine with 

The symptoms of Major depressive disorder:

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. 

Identifying other symptoms often associated with existential Depression : Avoiding the common problem of Misdiagnosis

Existential Depressions often have a series of other symptoms associated with them that may be caused by  coexisting conditions or may simply be symptomatic secondary reactions to the existential depression

Understanding  the nature of how these symptoms appear and function in any particular person existential depression allows the clinician to distinguish between secondary reactions to  the depression or  part of the symptom profile of a co-existing condition. This distinction is what helps avoid misdiagnosis 

common symptoms that can occur alongside 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 a 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 

Making the diagnosis

Describing the specific symptom profile of the gifted person’s unique form of existential depression

An experienced practitioner who understands the context within which an individual’s unique form of giftedness exists and how and why it did or didn’t develop can determine whether the symptoms represent a diagnosis of an existential crisis/existential depression with issues of giftedness at its core; whether the symptoms represent a diagnosis of a major depressive disorder caused by life events/circumstances other than giftedness but with secondary existential features , which symptoms are reactions to these and/or whether a co-existing condition is present.

A comprehensive assessment identifies the primary and secondary causes of the existential depression and provides a guide for specific interventions

A recent history of the symptoms of existential depression 
  • When did the symptoms of existential depression first appear? 

  • Are the symptoms an intensification of 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 makethe symptoms of existential depression better or worse? 
Early history 

Birth circumstances : Medical ,genetic , congenital or traumatic issues at birth 

  • Was this child planned? 
  • Was the gifted child Adopted? 
Developmental history 

Early signs of giftedness/precocity  

  • Early developmental milestones 
  •  Advanced physical abilities 
  •  When did h/s teach themselves to read, acquire advanced vocabulary,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 perfect pitch) Fabric, food, temperature, light 

Reactions to the giftedness:

the child’s excitement or withdrawal: 

  •  the parents’ 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 

Relation ships:

  • 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 : parents experience with their own giftedness; marital history; current state of the marriage
  • Sibling issues :rivalry, guilt

Establishing a cause of the Existential depression

Now the the primary cause and secondary contributing factors  of the existential depression can be described . 

In addition the clinician is also able to distinguish an existential depression in a gifted individual that is primarily about h/h giftedness from a Major Depressive Disorder in a gifted individual that is primarily caused by non- gifted issues and has only secondary existential issues. 

A concise narrative shows how all the  conscious and unconscious factors have worked together  to cause the existential depression  

No narrative statement of the causes of  an 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 ? 

In gifted individuals, this more ,than any other factor, is often the key to an in-depth psychological understanding  any depression -existential or other type of depression- in gifted individuals. 

This narrative statement of cause for the existential depression provides a focused framework for where and how the treatment should begin 

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Jerald Grobman M.D.

Madelon Sann L.C.S.W.​