Is there a relationship between depression
and crying? A review
Vingerhoets AJJM, Rottenberg J, Cevaal A, Nelson JK. Is there a
relationship between depression and crying? A review.
Objective: To conduct a systematic examination of the relationship
between depression and crying by reviewing all relevant theory and
empirical data including the performance of crying items in measures
Method: Review of the extant literature on depression and crying
using PubMed, PsychInfo and Google Scholar databases.
Results: Scores on crying items of depression inventories correlate
moderately with overall depression severity. Otherwise, there is
surprisingly little evidence for the widespread claim that depression
leads to more frequent and/or easier crying. There is also little
empirical support for the competing claim that severely depressed
individuals lose their capacity to cry.
Conclusion: Current claims about the relationship between depression
and crying lack a robust empirical foundation. Assessment instruments
and diagnostic systems for mood disorders are inconsistent in how they
handle crying as a symptom. Further work to investigate the causes
and the context of crying in depressed patients is needed.
A. J. J. M. Vingerhoets1,
J. Rottenberg2, A. Cevaal1,
J. K. Nelson3
1Department of Psychology and Health, Tilburg
University, Tilburg, The Netherlands2Mood and Emotion
Laboratory, Department of Psychology, University of
South Florida, Tampa, FL, USA and3The Sanville
Institute, Berkely, CA, USA
Key words: crying; depression/diagnosis; humans;
Ad Vingerhoets PhD, Department of Psychology and
Health, Tilburg University, PO Box 90.153, 5000 LE Til-
burg, The Netherlands.
Accepted for publication November 2, 2006
• Crying is generally considered a feature of depression, although occasionally the loss of the ability to
cry in severely depressed patients is emphasized.
• Assessment instruments and diagnostic systems for mood disorders are inconsistent in how they
handle crying as a symptom.
• Most, but not all, depression measures contain an item on crying or tearfulness. Most measures view
increased crying as an indicator of depression.
• Future work needs to clarify the precise nature of the relationship between depression and crying and
the role of possible moderators, such as gender and premorbid characteristics.
• The inclusion of crying as a diagnostic sign of depression and the scoring of crying items as
indicators of depression requires further evaluation.
• Research on crying is critical for expanding our knowledge concerning emotional experience and
emotional expression in depression.
Major depressive disorder (MDD) is characterized
by persistent sad mood and a loss of interest or
pleasure in daily activities and by a number of
associated symptoms (1). Because sad mood is
among the most frequently occurring states that
precede crying (2, 3), it is often presumed that
Acta Psychiatr Scand 2007: 115: 340–351
All rights reserved
Copyright ? 2006 The Authors
Journal Compilation ? 2006 Blackwell Munksgaard
depressed people cry more often than healthy non-
depressed persons do. Only rarely, however, have
empirical data been marshaled to test this idea.
This article is thus intended to address a number of
critical theoretical and empirical questions con-
cerning crying and depression. The major ques-
tions addressed in this review are: how does
depression influence crying? Are gender differences
in crying maintained during depression? Finally,
what is the role of crying behavior in the diagnosis
Definition, neurobiology, and functions of normal adult crying
Crying, the excretion of tears in response to
emotional stimuli, is typically accompanied by
alterations in facial expression, vocalization, and
respiration, including, in some cases, sobbing,
which is the convulsive inhaling and exhaling of
air with spasms of the respiratory and truncal
muscle group (4). Crying occurs in various emo-
tionally charged settings, often with negatively
evaluated situations related to separation and loss,
but also with positive events, such as reunions,
weddings, or winning a sports game (3, 5–7). To
provide some context for understanding how
crying might be altered by a pathological mood
state, such as clinical depression, it is helpful to
discuss the background and functions of ordinary,
non-pathological adult crying.
Shedding emotional tears is regarded as a
typically and probably even uniquely human emo-
tional expression. It has been suggested that it
originates from the audiovisual communication
designed to maintain maternal–offspring contact,
which can be observed in mammals. The so-called
separation cry is thus considered the earliest and
most basic mammalian vocalization, serving to
promote and maintain contact between mother
and child as well as between members of an
affiliated group. Separation cries (also referred to
as isolation or distress cries) are produced by all
mammals, sometimes in the ultrasonic domain (e.g.
in the case of small rodents), probably as a
protection against predators.
Human and non-human animal research has
increasingly elucidated several neurobiological sub-
strates for crying. According to MacLean (8),
based mainly on his research with squirrel mon-
keys, it is in particular the thalamocingulate
division of the limbic system that has become
increasingly important for both crying and laugh-
ter. Additional evidence from patients suffering
from uncontrolled laughter and/or crying suggests
also a role for the amygdala. More recently,
evidence has been presented indicating a major
role of the cerebellum in crying and laughing (9).
This structure may determine if the appropriate
emotional behavior will indeed be expressed.
MacLean further points to observations suggesting
a role for opioids in crying behavior, as there is a
high concentration of opiate receptors in the
primate cingulated cortex. Consistent with this
position, it has been shown that small doses of
morphine sulphate suppress the separation cry in
squirrel monkeys, whereas naloxone, an opiate
antagonist, restores it. Panksepp (10) reports
additional similar findings, suggesting a link
between opiate addiction and feelings of isolation
and alienation. These ideas are, among others,
based on animal research examining the effects of
drugs on separation-induced distress vocalizations
(11). Finally, in work that indicates that central
serotinergic activity may be related to the disinhi-
bition of the crying response, Murai et al. (12) has
shown that serotonin transporter-binding ratios in
the midbrain were significantly lower in stroke
patients suffering from pathological crying com-
pared with matched stroke patients who did not
have these uncontrolled emotional outbursts.
Several functions for human crying have been
claimed. Following much of the literature on
emotion expression, theorists have distinguished
between inter- and intrapersonal functions of
crying (cf. 2, 13).
The interpersonal view of crying emphasizes in
particular communicating the need for care and
evoking care from others. Darwin (14) took this
view, considering crying as a universal response for
the communication of distress. Kottler (15) also
postulates that crying is a non-verbal language that
functions when words fail or are inadequate.
Others emphasize the importance that crying has
in motivating others to engage in prosocial behav-
iors (16). Bowlby (17) likewise considered child
crying as attachment behavior, securing the prox-
imity of the caregiver, and Nelson (6) expanded on
this view of crying, stressing that crying is an
attachment behavior throughout life, which con-
tinues to elicit caregiving from others or from
internalized objects. The interpersonal effects of
crying have also been seen in terms of catharsis
(18–20). According to this view, the cathartic effect
of crying – positive affect change and tension
reduction – depends on the social context of one’s
crying and the feedback of the social environment
one receives. That is, crying typically elicits cathar-
tic interpersonal effects (comfort and sympathy)
but catharsis will not occur if crying elicits disre-
gard or disapproval by others.
A second, not mutually exclusive, view of crying
focuses on intra-individual aspects of this behavior.
Relationship between depression and crying
This view has been elaborated in a number of
different ways. For example, many theorists have
of this behavior. Breuer and Freud (21) regarded
weeping as a means to discharge negative effect and
to reduce internal tension. According to these
authors, tears flow when distress exceeds a certain
quantitative level thus avoiding an excessive build
up of emotions which may lead to symptom forma-
tion. Crile (22) similarly postulated that crying
results from the build up of tension, in preparation
for action that subsequently is not performed.
Shedding tears then helps to discharge the idle
neural energy and to facilitate physiological recov-
ery. In a very similar vein, according to Bindra (23),
tears may help to discharge tension in situations in
which an individual is unable to cope effectively. He
intense mood after the episode, implying a mood-
relieving role for crying behavior. Tompkins (24)
suggested that crying further functions as a form of
motivating oneself to action, and in this way it
contains aspects of both the inter- and the intra-
the cathartic function of crying to be the result of a
biochemical process. These authors hypothesized
that emotional tearing may serve to remove waste
products or toxic substances from the body that
build up during emotional stress. Similarly, recent
the activity of the parasympathetic nervous system,
which has been hypothesized to neutralize sympa-
thetic arousal and promote physiological home-
ostasis (13, 26).
Crying in depression: theoretical perspectives
Associations between crying and depression have
long been pointed out. Darwin (14), for example,
considered crying as a sign of depressed mood: ?The
insane notoriously give way to all their emotions
with little or no restraint; and I am informed by Dr.
J. Crichton Browne, that nothing is more charac-
teristic of simple melancholia, even in the male sex,
than a tendency to weep on the slightest occasions,
on the occurrence of any real cause of grief. The
length of time during which some patients weep is
astonishing, as well as the amount of tears they
shed.? (14). Theorists have thus commonly observed
that depression alters crying, but have disagreed
over how. Three differing theoretical views of the
depression–crying relationship can be extracted
from the clinical literature.
First, following Darwin (14), is the view that
there is a simple linear relationship between the
severity of depressive symptoms and crying fre-
quency. Most depression questionnaires assume a
linear relationship between crying and depression
severity (see below). A number of other consider-
ations underlie the logic of linearity. First, there is
no disagreement that low mood, often described as
sadness, is among the key symptoms of depression.
A closer look at both phenomena reveals that they
share some important characteristics. At the neu-
robiological level, there is evidence that common
limbic, paralimbic, and cortical brain structures are
activated both in ordinary sadness and in clinical
depression, more precisely, the subgenual cingulat-
ed, anterior insula and the right dorsolateral
prefrontal, inferior parietal areas (27). Interest-
ingly, these investigators explicitly emphasized that
similar patterns of limbic activation and cortical
deactivation were found in participants who did
and who did not become tearful. However, it must
be emphasized that this comparison had inad-
equate power, implying that until now this issue
has not definitely been settled.
Moreover, at the level of the functions of
depression and sadness or grief there are also
some remarkable hypothesized correspondences.
For both phenomena, it has been suggested that
they communicate an extorting need for help and
that they may signal yielding in conflicts (see 28,
29). Then there is the idea that depression and
sadness or physical and emotional pain both draw
attention to problems, that, if not fixed adequately,
may have detrimental fitness consequences and
therefore motivate actions aimed to remedy the
problem (30). A final similarity in function might
be what Frijda (31) describes as the white flag,
indicating surrender, function of crying and what
Price (32, see also 28), in case of depression, refers
to as signaling yielding in a hierarchy conflict.
A final observation that suggests a generally
linear relation between depression, sadness, and
crying is the remarkable correspondence in the
age–gender distribution of crying and depression.
Not only are both phenomena observed more often
in females than in males, there is evidence that both
the gender difference in crying and in depression
incidence emerges in adolescence (see 33, 34).
The second major view of crying and depression
hypothesizes that the relationship between these
phenomena is nonlinear. That is, some authors
suggest that although increased crying may accom-
pany milder formsof
depressed patients often experience an inability to
cry (4–6, 35, 36). For instance Hamilton (37), in
giving guidelines for scoring his depression scale,
Vingerhoets et al.
stated that it should be taken into account that
severely depressed patients may ?go beyond weep-
ing? into a non-crying state. Both Davis et al. (38)
and Beck (35, 36) agree that increased periods of
crying are a common symptom in depression, but
they stress that more severely depressed patients
lose their ability to cry. Patel (4, 39) also states that
crying occurs more frequently in dysthymic states
and mild depressions, but that severe depressions
are associated with a reduction of crying behavior.
Interestingly, theorists have postulated that
severe sadness, like severe depression, might inter-
fere with emotion expression. Parallel to clinicians?
views that deep depression blocks rather than
facilitates the ability to cry, Frijda (31) offers
discussion of instances where sadness was too
intense for expression. This concerned Herodotus’
account of the anecdote of the Egyptian king
Psammenitus, who was defeated by the Persian
king Cambyses and was forced to watch the
captives parading by. Among them were his
daughter dressed in slave’s attire and his son on
his way to execution. Psammenitus looked at this
scene without batting an eyelid. However, when a
little later, an old drinking friend turned beggar
passed by, he burst into tears. When Cambyses
asked for an explanation of this paradox, Psam-
menitus answered that some grief simply is too
fierce for tears.
Finally, a third view of the relationship between
depression and crying is that premorbid character-
istics, such as attachment style, moderate the
relationship. According to Nelson (5, 6), adult
attachment styles influence the frequency and
duration of crying patterns generally and may
therefore also influence the amount of crying in
depressed individuals. Adults who fit the ?preoccu-
pied? style of attachment typically hyperactivate
their attachment behaviors (crying) leading to
more frequent and more prolonged crying epi-
sodes, even when they are not clinically depressed
or experiencing a significant loss. Individuals with
?dismissing? attachment styles tend to deactivate
attachment behaviors, such as crying, meaning that
they are at greater risk of tearless detached
depression. The crying patterns of non-depressed
securely attached adults range from those who
never cry to those who cry frequently. Their crying
frequency during depression would be expected to
reflect their crying tendencies when not depressed.
Aims of the study
The aims of this review are: i) to describe how
crying has been viewed as a diagnostic criterion for
depressive disorders and how it has been dealt with
in depression inventories; ii) to summarize the
available empirical evidence concerning crying in
association with depression; and, finally, iii) to
review the issue of gender in relation to crying and
Material and methods
To collect published material relevant to this
review, we scrutinized the literature in the follow-
ing databases: PubMed, PsychInfo and Google
Scholar, with depression and crying, weeping or
tearfulness as search terms. In addition, we combed
the references of the identified articles for addi-
tional sources. To select instruments that are
frequently applied to measure depression, we
inspected the same databases with the search
terms review, depression and measurement or
assessment. For completeness, we also referred to
major chapters on the assessment of mood disor-
ders (e.g. 40, 41).
In addition to considering the small body of
studies that make detailed measurements of crying
in depressed patients, we also examined whether
single items measuring crying on depression inven-
tories evidence a relationship with overall depres-
sion severity. To enable this analysis, we focused
on the Beck Depression Inventory (BDI, 36)
because it contains a crying item and because an
initial search indicated that it was the only depres-
sion scale with a body of reported psychometric
data assessing the relationship between crying and
depression. To collect studies that contained the
relevant item–total correlations, two research
assistants performed a series of paired keyword
searches. In these searches, the keywords ?item–
total correlation,? (both singular and plural, with
and without hypen), ?item correlation,? and ?psy-
chometrics? were paired with a second relevant
keyword, ?depression?, ?Beck Depression Inven-
tory?, ?BDI?, ?BDI-II?, and ?crying?. The same
databases as mentioned above were used in these
Crying and the diagnosis of depression
Despite theoretical disagreement about the role
that crying behavior plays in depression, most
depression inventories nevertheless include an item
on crying or tearfulness. We summarize how crying
is handled in nine commonly used instruments in
As is apparent from Table 1, with only one
exception (i.e. BDI-II), all inventories assume a
Relationship between depression and crying
Table 1. Overview of crying items in depression inventories
Item on crying (yes/no)
Response possibilities and their weight/scores
Is more/easier crying an indication for depression?
Center for Epidemiologic studies-Depression (CES-D) (83)
During the last week
I had crying spells
Rarely or none of the time (less than 1 day)
Some or a little of the time (1–2 days)
Occasionally or a moderate amount of the time (3–4 days) 2
Most or all of the time (5–7 days)
Minnesota Multiphasic Peronality Inventory-2 (MMPI-2) (84)
I cry easily
Do not agree
Beck Depression Inventory-II (BDI-II) (85)
I don't cry any more than I used to
Yes, but the inability to cry
obtains the highest score
I cry more than I used to
I cry over every little thing
I feel like crying but I can't
Symptom Check List-90 (SCL-90) (68)
How much were you distressed
or bothered by crying easily?
Not at all
A little bit
Quite a bit
Zung Self-rating Depression Scale (SDS) (52)
I have crying spells or feel like it A little of the time
Some of the time
Good part of the time
Most of the time
Edinburgh Postnatal Depression Scale (EPDS) (86)
I have been so unhappy
that I have been crying
Yes, most of the time
Yes, quite often
Hamilton Rating Scale for Depression (HAM-D or HDRS) (37)
Depressed mood, hopeless,
helpless and worthless
These feeling states only indicating on questioning
These feeling states spontaneously reported verbally
Communicates feeling states non-verbally, i.e. through
facial expression, posture, voice, and tendency to weep
Patient reports virtually only these feeling states in his
spontaneous verbal and non-verbal communication
Geriatric Depression Scale (87, 88)
Original 30-item version:yes Do you frequently
feel like crying?
Short 15-item version: no
Hospital anxiety and depression scale (HADS) (89)
Montgomery-?sberg Depression Rating Scale (MADRS) (90)
Vingerhoets et al.
linear relationship between crying and depression,
with more frequent and easier crying scored as
indicating a more severe level of depression. To a
certain extent this also holds for the BDI-II, but in
this questionnaire, a reported inability to cry
obtains the highest score and is considered to be
a sign of severe depression. Inventories also differ
in what is counted as increased crying. Some scales,
such as the BDI-II and CES-D are more focused
on reports of overt crying behavior (e.g. BDI-II, I
do not cry any more than I used to, I cry more than
I used to, I used to be able to cry, but now I cannot
cry even though I want to), whereas other scales,
such as the Zung Self-rating depression scale, also
include impulses to cry or ?feeling like crying? as a
sign of increased crying.
A review of the different editions of the
Diagnostic and Statistical Manual of Mental
Disorders (DSM, American Psychiatric Associ-
ation) (see also 39) reveals that crying or tearful-
ness has not been handled consistently as a
diagnostic criterion for various mood disorders
depressed mood and MDD). In DSM-III (42),
crying proneness and fits of crying are listed
among 13 symptoms, of which three must be met
for the diagnosis of dysthymia. Remarkably, in all
later editions of the DSM (1,43,44), crying is no
longer mentioned as a symptom of dysthymia.
Nor is crying required in the diagnosis of adjust-
ment disorder. Adjustment disorder may obtain
the qualifier ?with depressed mood in the last four
editions of DSM by virtue of increased tearful-
ness, or by other manifestations of depressed
mood, such as reports of depressed mood or
feelings of hopelessness. Finally, neither DSM-III
nor DSM-III-R (43) mention crying or tearfulness
as a symptom of MDD. Subsequently, in DSM-
IV (44) and DSM-IV-TR (1) one of the two
symptoms at least one of which should be met for
a diagnosis MDD, is depressed mood, a psycho-
logical state that can be derived from a list of
symptoms that includes feeling or appearing
?tearful? based on subjective reports or observa-
tions made by others. In sum, while crying has
often been mentioned as a sign of mood disorders,
the evaluation of crying as relevant for depression
by DSM has been inconsistent, and this symptom
is neither a necessary nor a sufficient criterion to
diagnose any of the mood disorders. This uncer-
tain posture towards crying is not unique to the
DSM. Crying is not also a necessary or sufficient
criterion for diagnosis of any of the mood
disorders in ICD-10 (45). Crying is not included
in the Major Depression module in the Composite
International Diagnostic Interview (46), only the
Dysthymia module has an item ?During a two
year period of being depressed, were you often in
tears? (No ¼ 1, Yes ¼ 5).?
Are crying items on depression inventories related to overall
A review of the performance of the BDI crying
item as a depression indicator across a number of
studies reveals a moderate positive relationship
between the BDI crying item score and overall
depression severity (i.e. BDI total score). As
displayed in Table 2, the range of item–total
correlations is 0.27–0.61, and the overall mean is
0.40. The item–total correlation for the crying item
is representative of how other items on the BDI
perform, and there is no obvious difference in the
magnitude of this relationship between affectively
disordered and non-disordered samples. While
these data are consistent with the clinical reports
that suggest a positive relationship between depres-
sion and crying, these data should not be regarded
as strong evidence because: i) the use of a single-
item measure of crying does not provide an
optimal estimate of this behavior; ii) shared meas-
urement of crying and depression by self-report
may inflate this correlation because depression
introduces a negative response bias on all self-
report measures; iii) the retrospective nature of the
data (i.e. depressive memory biases may inflate
reports of crying). And finally, iv) interpretation of
these correlations is clouded by the fact that the
BDI crying item is actually scored in a curvilinear
fashion, in which the most severe response on the
crying item is to indicate that the person is no
longer able to cry. Importantly, none of the studies
in Table 2 formally assessed whether there was a
nonlinear relationship between the crying item and
BDI total scale score. Given the limitations inher-
Table 2. Item–total correlations between the crying item and overall depression
severity scores on the Beck Depression Inventory in clinical and non-clinical
Gorenstein et al. (91)No
Whisman, 2000 (92)
Olsoon and von Knorring (94)
Steer et al. (95) Yes
Kajima et al. (96)
Relationship between depression and crying
ent in this approach, we now review the small body
of work containing other estimates of crying in
non-clinical samples and in clinical samples of
individuals suffering from case-level depression.
The relationship between depression and crying in non-clinical
and clinical studies
Despite the strong theoretical assumptions of a
systematic relationship between crying and depres-
sion that are reflected in depression inventories,
empirical research on the association between
crying and depression has been surprisingly lim-
ited, and largely confined to non-clinical samples.
Moreover, as our findings demonstrate, strong
relationships between depression and crying have
rarely been documented, either in non-clinical or in
Non-clinical studies A number of studies have
examined the relationship between crying and
depression in non-clinical samples. Kraemer and
Hastrup (47) found no relationship between
general depression levels, measured by the Mul-
tiple Affect Adjective Checklist (48) and estimated
yearly crying frequencies in a non-clinical sample.
measured crying frequency. In contrast, Hastrup
et al. (50) demonstrated a significant correlation
between the frequency of feeling like crying and
the BDI score, in a non-clinical sample of
volunteers 65 years and older. No association
was found between the yearly crying frequency
and the BDI score, but when the sample was
divided into a mildly depressed (BDI > 4) and a
non-depressed group (BDI < 4) there was a small
but statistically significant difference in yearly
crying frequency, with greater crying frequency
found in the mildly depressed than in the non-
depressed group. Frey et al. (51) reported a
significant difference in crying, indicating a greater
monthly crying frequency, in a depressive group
(defined on the basis of Zung Depression Scale
scores (52), compared with healthy controls.
These investigators noted, however, that the
ranges of the crying frequencies of both groups
were quite similar, and that this overlap limits the
usefulness of crying as a diagnostic criterion for
depression. In a non-clinical sample of 82 men
and 118 women with a BDI score of 15 and
higher, 43% of the depressed men reportedly were
unable to cry, even if they wished to, compared
with 14% of the depressed women (53). This
finding suggests that the gender differences in
crying frequency (possibly related to premorbid
emotional expressivity) may moderate the associ-
ation between crying frequency and depression as
well. However, it would be necessary to know
whether the depressed men and women cry at all
when they are not suffering from depression to
accurately interpret this finding. As will be seen
later on, some researchers in particular point to
the role of sex role socialization rather than
specifically biological sex (cf. 54).
Recently, Gran (55) conducted a population-
based study among Norwegian women on depres-
sion with special attention for the postpartum
period. She concluded that crying did not reflect
the prevalence of other depression symptoms and
therefore could not be considered an expression of
depression. A remarkable finding was that post-
partum women reported easily crying more often
than non-postpartum women.
Clinical studies It is possible that a more robust
association between depression and crying would
be found if clinically depressed individuals were
studied or if behavioral measures of crying were
used. Unfortunately, prior studies of crying in
clinically depressed samples have largely been
limited to describing demographic and clinical
features associated with this behavior. For exam-
ple, on the basis of ward observations, Davis et al.
(38) concluded that crying was more common
among neurotic than among psychotic depressives.
In a rare experimental study, Rottenberg et al.
(56) examined crying behavior in a clinically
depressed sample. Their study revealed that there
was no significant difference in the likelihood of
crying in response to a sad film between the
depressed and the non-depressed group. These
results again fail to support the idea that a lower
crying threshold characterizes depression.
We are unaware of studies that have explicitly
focused on the effects of anti-depressive medication
on crying in depressed patients. Research on
patients with neurological disorders also suffering
from pathological crying or emotional incontin-
ence suggests dramatic decreases in crying even
after rather low doses of different medication
including tricyclic antidepressants, but in partic-
ular SSRIs (57).
Gender, depression, and crying
Both depression and crying are more prevalent
among women. Especially during their reproduc-
tive years, women are more at risk of developing
depression (33), the average female-to-male ratio in
different populations being approximately 2:1 (58–
60). Crying also occurs more frequently in women,
Vingerhoets et al.
perhaps in particular in association with reproduc-
tive events including menstruation, pregnancy and
lactation (61). Vingerhoets and Scheirs (34) iden-
tified 14 studies, many with different research
approaches and methodologies, that all confirmed
the view that women cry more frequently and more
intensely than men.
What happens to this gender difference in
crying when people are depressed? Do depressed
women also cry more often than depressed men?
depressed males to report increased crying (e.g.
58, 60, 62–64), there is also older evidence to
suggest that this gender difference may be less
reliable in depressed samples than it is among
non-depressed controls (e.g. 38, 48, 65, 66).
Hamilton (37) disputes that depressed women
weep more readily than depressed men. Contrary
to this idea that the gender difference in crying
disappears during depression, most research find-
ings suggest that this gender difference continued
to exist. Okada (67) found during a 10-year period
of observing crying in depressed individuals that
57.7% of women easily shed tears during the
course of their visit to the clinic compared with
only 4.9% of men. Hammen and Padesky (53)
found that 43% of dysphoric men compared with
14% of dyphoric women indicated that they could
not cry even if they wished to do so (BDI item
10). This suggests that depressed men experience
an inability to cry more often than depressed
women. Carter et al. (62) also reported a signifi-
cant gender difference in a depressed group, in the
mean score on the item about crying of the
Symptom Check List-90 (SCL-90, 68). Women
scored significantly higher on this item than
men. Oliver and Toner (54) demonstrated that
depressed women differ from depressed men by
their emotive symptoms including sense of failure,
sadness, and crying. These investigators further
demonstrated that not only gender, but also sex-
role typing was a very important determinant for
how depression was expressed. Vredenburg et al.
(63) demonstrated that depressed men were more
likely to report traditional sex-role appropriate
symptoms, because they have learned through
social rejection that it is inappropriate for them to
openly express depressive feeling. Similar findings
were reported by Padesky and Hammen (69),
Keinke et al. (70), and Dempsey (71). Baron and
Joly (72), in contrast, failed to replicate these
findings. In the only experimental study of this
question, Rottenberg et al. (56) found robust
gender differences in depressed persons? propen-
sity to cry in response to a sad film.
The aim of the present review was to obtain more
insight into the relationship between depression
and crying. To this end, we scrutinized diagnostic
instruments and summarized relevant findings.
This approach made clear that many sources,
including DSM-IV and most depression invento-
ries, consider increased crying to be an indicator of
addressing the relationship between depression
and crying do not yield strong evidence for this
claim. Moreover, the idea that severe depression
involves a loss of the capacity to cry has rarely
been tested and thus needs special attention. Our
review of extant findings further suggests that,
although there are some remarkable exceptions,
the preponderance of evidence favors the idea that
gender differences in crying are maintained in
depression. Depressed women seem to cry more
often than depressed men, whereas depressed more
likely seem to suffer from the inability to shed
tears. Finally, little is known about the possible
role of premorbid person characteristics, as well as
the possible moderating effects of medication in
altering crying behavior. Future research should
therefore address the possible role of potential
moderators, in particular premorbid features, such
as gender and attachment style.
To guide future work on crying in psychopa-
thology, we recommend that research uses frame-
works drawn from basic research on adult crying
behavior. Although a large number of factors
undoubtedly influence crying, Bekker and Vinge-
rhoets (73) have identified four main factors that
may be especially critical for influencing crying in
adulthood. These factors include: (i) the baseline
threshold for shedding tears; (ii) the amount of
exposure to cry-eliciting stimulation; (iii) appraisal
processes and capacity to regulate emotional
impulses; and (iv) social factors that may encour-
age or inhibit crying.
Within this four-factor framework, the first
question for future research is whether depressed
and non-depressed individuals differ in their base-
line threshold for shedding tears. Naturalistic
studies suggest that the individual’s crying thresh-
old can be reduced by changes in physical state,
such as tiredness, sleeplessness, menstrual cycle
changes, and fluctuation in serotonin levels, as well
as changes in psychological state, such as low
mood (2). Depression involves several of these
symptoms, presumably reducing the threshold for
crying. Careful measurement of these symptoms, as
well as experimental studies that present well-
controlled cry-eliciting stimuli – ideally using
Relationship between depression and crying
stimuli that vary in intensity – are needed to clarify
how depression alters the threshold for crying.
Brain imaging studies will also be important for
elucidating the neuroanatomical bases for altered
crying threshold in depression.
The second question within this framework is to
specify how depression influences exposure to
negative and positive cry-eliciting events. Existing
research suggests that there is a strong correlation
between depression and exposure to stressors, in
particular loss and exit events (74) that are
ostensibly capable of eliciting crying. Second, it is
well known that depression is associated with
reduced exposure to positive, rewarding events.
Presumably, reduced exposure to positive life
events in depression, in turn, reduces exposure to
the positive stimuli that are typically associated
with crying (e.g. winning an award). Detailed
ambulatory studies are needed to clarify the
contingency between exposure to positive and
negative events to depressed crying episodes. We
believe that appropriate attention to event valence
(positive vs. negative crying antecedents) may yield
important information: in a current investigation
of event valence and crying during depressive
episodes, we hypothesize that patients with mood
pathology will report increased crying proneness to
negative events but not to positive events. Data
such as these will be critical for demonstrating how
mood disorders may selectively alter different
aspects of crying.
The third question within this research frame-
work is the role of self-regulatory processes and
appraisal in depressed persons? crying. Abundant
research has already demonstrated that depressed
persons generally have more negative information
processing, e.g. negative biases in attention and
memory (cf. 75). This could lead to increased
crying via increased attention to sad material when
reading newspapers, watching the TV news, or
when attending to ones own thoughts. This would
also be reflected in a bias to recall more frequent
memories of loss and failure (76), themes that are
associated with crying. Depressed patients (similar
to anxiety patients) may also be biased to appraise
neutral stimuli as negative, in this way increasing
the likelihood of a low mood, even with relatively
little environmental input (but see also Ref. 77).
At the same time, and possibly countervailing
the influence of appraisal processes, depression in
some contexts is associated with a generalized
blunting of affective responding, as indicated by
emotional indifference, reduced emotional reactiv-
ity, and reduced pain perception (78, 79). Finally,
in spite of the lack of relevant data, it has been
argued that depression involves a reduced capacity
to regulate emotional impulses, an incapacity that
may lead to more frequent and intense crying.
However, related work suggests that depressed
persons engage in affect management strategies,
such as rumination (80), that may prolong the
effects of negative cry-eliciting stimuli. Depressed
individuals may also engage in mood-congruent
mood management strategies that lead to a more
frequent sampling of cry-eliciting stimuli (reading
sad stories and poems, watching sad movies). In
sum, processes involving appraisal and the regula-
tion of affect would appear to have contradictory
effects upon crying in depression. To sort out these
between appraisal and self-regulatory processes
to crying episodes in depression are badly needed.
The fourth and final area for future study
concerns crying behavior as a socially sensitive
phenomenon that is powerfully influenced by the
presence of sympathetic others. Depression is well
known to have profound effects upon the social
field. For example, depressed individuals are prone
to excessive self-disclosure and may search for the
company of other vulnerable persons (e.g. 81, 82),
effects that, presumably, would be associated with
increased crying. Possibly countervailing this,
however, depression is associated with smaller
social networks, reduced social contacts, and
reduced social support. Better measurement of
social contextual factors is needed to test these
ideas about crying in depression, including the
hypothesis that having few shoulders to cry upon
will lead a depressed person to actually reduce his/
In closing, we believe this review suggests that
the relationship between crying and depression is
more complicated than meets the eye. Our sugges-
tions are designed to allow researchers collect more
precise information about the nature of cry-elicit-
ing stimuli and the context of crying in depression.
Ultimately, we hope that this contribution will lead
not only to a more differentiated picture of how
depression influences crying but also that it will
shed light on the possible larger clinical significance
of this mysterious human behavior.
We thank Vanessa Wolvin and Sarah Bolden for assistance
with library research.
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Res in Psychiatry
Relationship between depression and crying