Part 3: Changes in the DSM-5 Will Affect Those Who Deal with the Loss of a Loved One

In December 2012, we covered changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that will affect parents of children with special needs and LGBT adults.  This article will discuss the elimination of the “bereavement exclusion” in the DSM-5 (which is due to come out in May 2013) and how this change affects the diagnosis of depression.

Nearly every person has suffered the loss a loved one. And, in most cases, the people left behind feel intense sadness, feelings of grief, loss, an inability to concentrate, crying, and sleeplessness. The debate surrounding revisions to the DSM-5 from the American Psychiatric Association (APA) questions whether this grief is a normal human process or a mental disorder that requires diagnosis and treatment.

The “bereavement exclusion” was a paragraph in the DSM-4 that cautioned against diagnosing depression in someone for at least two months after the loss of a loved one, unless that patient had severe symptoms like suicidal thoughts. The DSM-4 recognizes that symptoms that look like depression are a normal part of human emotion following the death of a loved one.

The revised DSM-5 will eliminate the “bereavement exclusion.” Without the exception, anyone experiencing normal symptoms of grief two weeks after the loss of a loved one can be diagnosed with and treated for depression. 

According to Dr. David Kupfer of The University of Pittsburgh, “with the “bereavement exclusion,” depression was often underdiagnosed in older adults. When people’s health suffered and they lost friends and loved ones, the sentiment was, “why wouldn’t they be depressed?” A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” 

Even though everyone experiences grief differently, grief is a necessary response to the loss of a loved one and part of the human experience. Regardless of the revised DSM-5 criteria, clinicians should take caution to avoid under- and over-diagnosing depression in bereaved individuals and include compassion and empathy as a key part of effective therapy.