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The bereavement exclusion and DSM-5.

Sidney Zisook1, Emmanuelle Corruble, Naihua Duan

  • 1Department of Psychiatry, University of California, San Diego, CA 92093, USA. szisook@ucsd.edu

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|April 13, 2012
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Summary

The bereavement exclusion (BE) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) should be removed. Research indicates that bereavement-related depression is similar to major depressive episodes (MDE) in other contexts and responds to treatment.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Mental Health Research

Background:

  • Historically, the Diagnostic and Statistical Manual of Mental Disorders (DSM) excluded major depressive episodes (MDE) if symptoms were attributable to bereavement.
  • This 'bereavement exclusion' (BE) was based on early studies suggesting transient depressive syndromes after loss.
  • The current diagnostic criteria, established in DSM-III (1980), maintain this exclusion unless symptoms are severe and highly impairing.

Purpose of the Study:

  • To evaluate current research on the bereavement exclusion (BE) for major depressive episodes (MDE).
  • To determine if the BE should be retained in the upcoming DSM-5.
  • To critically analyze arguments for and against the BE's continued use.

Main Methods:

  • A comprehensive literature review was conducted.
  • Studies published up to 2006 were considered in prior reviews.
  • The current review incorporates research published since 2006, critically examining evidence for and against the BE.

Main Results:

  • The majority of data indicate that bereavement-related depression is indistinguishable from MDE in other contexts.
  • Bereavement-related depression shares similar genetic influences, risk factors (personal/family history of MDE), personality traits, and comorbidity patterns.
  • It is equally likely to be chronic or recurrent and responds to antidepressant medications.

Conclusions:

  • The bereavement exclusion (BE) is not supported by current scientific evidence.
  • The BE should be removed from the DSM-5.
  • Bereavement-related depression should be diagnosed and treated similarly to major depressive episodes (MDE) regardless of context.