Prolonged Grief

Where to After Diagnostic and Statistical Manual of Mental Disorders, 5th Edition?

Richard A. Bryant

Disclosures

Curr Opin Psychiatry. 2014;27(1):21-26. 

In This Article

Bereavement and Depression in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition

It is worthwhile considering the role of grief in DSM-5 in relation to how it is understood in the context of depression. Prior to DSM-5, a bereavement exclusion existed such that clinicians were cautioned against diagnosing a major depressive episode within 2 months of bereavement. DSM-5 has omitted this clause, partly because of the lack of evidence bereavement-related depression is distinct from depression secondary to other life stressors[28] and that it may limit genuinely depressed people from receiving appropriate and timely treatment.[41] The DSM-5 has attempted to placate opponents to this change, who have argued that it will potentially lead to overprescription of antidepressant medication in people suffering transient responses to their loss,[42] by noting in the text that clinicians should take care in distinguishing between normal grief and major depression. Of course, this step relies on clinicians being led by details provided in the text of DSM-5 rather than being primarily influenced by the specific criteria. In fact, the DSM-IV did not actually preclude the diagnosis of major depression in recently bereaved people – it simply encouraged caution because of the potential confusion between depression and acute sadness following bereavement.[43] In this context, it may have been safer to retain this cautionary note to discourage inappropriate diagnoses.

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