Wednesday, January 25, 2012

APA Responds to N.Y. Times Article on Proposed DSM Change

The “bereavement exclusion”—the criteria in DSM-IV that distinguish grief following a traumatic loss from depression—has been proposed for elimination in DSM-5 by the Work Group on Depressive Disorders. The Work Group says research has shown no difference in symptoms or in treatment response between grief-related depression and any other depression. Moreover, since virtually all depression arises in the context of adverse life events, it makes little sense to single out grief-related sadness for exclusion from diagnosis and treatment.

The proposed elimination of the bereavement exclusion—which like all proposals for DSM-5 is still being reviewed—is the subject of an article in the New York Times today citing researchers at Columbia who claim that removing the exclusion would medicalize normal grief.

But Jan Fawcett, M.D., chair of the work group, told Psychiatric News that people who develop the symptoms and the level of impairment associated with major depression should have access to treatment. And he wondered: Is there any difference between depression that occurs in response to grief and that which occurs in response to any other life stress? "Where do you draw the line?" he asked.

In a statement released last year and published on the DSM-5 Web site, former work group member Ken Kendler, M.D., who is now a member of the DSM-5 Scientific Review Committee, put forward a similar argument. "The DSM-IV position [on the grief exclusion] is not logically defensible," Kendler said. "Either the grief exclusion criterion needs to be eliminated, or [it should be] extended so that no depression that arises in the setting of adversity would be diagnosable. This latter approach would represent a major shift, unsupported by a range of scientific evidence, in the nature of our concept of depression, as epidemiologic studies show that the majority of individuals develop major depression in the setting of psychosocial adversity."

Psychiatric News coverage about the proposed exclusion is here.

(Image: Lane V. Erickson/


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