Demoralization in patients with medical illness.

Demoralization is a dysphoric state encountered in both psychiatric and medical populations, and is characterized by the individual's sense of disempowerment and futility. While depression may coexist with demoralization, they appear to be distinct clinical entities, with the former being characterized by anhedonia and the latter being characterized by helplessness. Assessment measures for demoralization are available, such as the Diagnostic Criteria for Psychosomatic Research and the Demoralization Scale of the Minnesota Multiphasic Personality Inventory version 2 restructured clinical scales. However, the administration requirements of these measures tend to limit them to research environments. As for prevalence, demoralization is commonplace in medical populations, perhaps even normative. However, up to one-third of physically ill patients experience clinically meaningful demoralization. Identification by the clinician is important as there are several proposed interventions that may be helpful in alleviating demoralization in medically compromised patients.