The Bereavement Exclusion and DSM-5

Abstract

We conclude that the BE should not be retained in DSM-5.

Perspective: psychiatric diagnosis is too important for its own good

“…Striving to do too much, it has introduced new disorders (Batstra and Thoutenhoofd, 2012) and reduced criteria for existing ones (Zisook et al 2012) in a way that will further complicate psychiatric diagnosis and reduce its credibility (Dayle Jones, 2012). The best approach for Irish psychiatry is to ignore simply DSM-V.…”

Distinguishing Grief From Depression During Acute Recovery From Spinal Cord Injury

“…There is no longer a bereavement exclusion for diagnosing and treating MDD, 19 primarily because antidepressants have been found to be as effective for treating MDD that occurs in the context of bereavement as they are for treating MDD that occurs in other situations. 35 Psychotherapeutic options for treating depression after SCI are promising. 36,37 In addition, recent research demonstrates that venlafaxine XR is an effective treatment of core symptoms of depression, specifically in people with SCI.…”

Culture and Context in Mental Health Diagnosing: Scrutinizing the DSM-5 Revision

“…During the review process, critics questioned both the short span that the bereavement exclusion allowed for grief and the narrow understanding of loss that it contained and argued in favour of paying much more attention to context in order not to pathologize normal sadness (Wakefield 2013). The DSM-5 Task Force, however, took another turn and instead eliminated the exclusion all together (Zisook et al 2012;Regier et al 2013). To be fair, the Task Force agreed that it was too limited and that other circumstances than grief could cause similar reactions.…”

“…Their main argument, however, was not that there was too little context but rather the opposite -that context was not relevant for the diagnosis as such (Barnhill 2014). To the contrary, the Task Force and DSM-5 Mood Disorders Work Group argued that the bereavement exclusion could hinder people who develop major depression while grieving from receiving appropriate care (Zisook et al 2012). Nevertheless, DSM-5 do still comment upon affective differences between grief and major depression and encourages clinicians to pay attention to experiences of loss when judging the symptoms of the patient.…”

“…Among the major issues at stake was what impact current developments in neurobiology would have on the structure and content of the manual. Another issue that hit the news was how DSM-5 got rid of the so called Bbereavement exclusion^that existed in DSM-IV and that prevented people in grief after the loss of someone close from being diagnosed with Major Depression Disorder (Zisook et al 2012). This led critics to raise their voice against what they saw as a decontextualisation of mental distress and an expanding medicalization of normal sadness (Cosgrove and Wheeler 2013;Frances 2013;Wakefield 2013;Whooley 2014).…”