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Friday, February 1, 2013

Bereavement or Depression--The Great Debate Continues

Lately the mainstream media has picked up on the discussion that has been raised regarding the changes in how depression and bereavement are going to be designated in the revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  This manual and its revisions, have been published since 1994 by the American Psychiatric Association and is used by all mental health professional in the United States to categorize and diagnose mental health disorders in adults and children.

What has caught the attention of professionals and lay-people alike is the changes that are being made in the categorization of depression.  In the current edition of the DSM, bereavement has been carved out as a separate category from a Major Depressive Episode. The guideline states that diagnosis of Major depressive Disorder would not be given until the symptoms had been experienced for at least 2 months after the loss.  Symptoms include: feelings of sadness, insomnia, poor appetite, and weight loss. The DSM differentiates between normal grief and a Major Depressive Episode by advising the professional to look for subtle differences in symptom presentation.

The removal of the bereavement category was explained by the American Psychiatric Association in a news release of 12/1/12 that stated:

Removal of bereavement exclusion: the exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one. 

"Grief is an equal opportunity human reaction; grief affects everyone." explained J. Shep Jeffreys in his book   "Helping Grieving People: When Tears Are Not Enough."  This is an accurate statement.  Everyone will eventually experience bereavement if they live long enough.  However each person reacts differently to the stressors of grief and just as with physical illness some people will be resilient and able to bounce back while others may have a more difficult time and may need support and treatment.  The thing is to not spend so much time debating whether this change is "pathologizing" grief but to spend the time helping those who need it. 

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