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The Removal of the Bereavement Exclusion in the DSM-5: Exploring the Evidence

  • Mood Disorders (SM Strakowski, Section Editor)
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Abstract

Since 1980, the DSM-III and its various iterations through the DSM-IV-TR have systematically excluded individuals from the diagnosis of major depressive disorder if symptoms began within months after the death of a loved one (2 months in DSM-IV), unless the depressive syndrome was ‘severely’ impairing and/or accompanied by specific features. This criterion became known as the ‘bereavement exclusion’. No other adverse life events were noted to negate the diagnosis of major depressive disorder if all other symptomatic, duration, severity and distress/impairment criteria were met. However, studies since the inception of the bereavement exclusion have shown that depressive syndromes occurring after bereavement share many of the same features as other, non-bereavement related depressions, tend to be chronic and/or recurrent if left untreated, interfere with the resolution of grief, and respond to treatment. Furthermore, the bereavement exclusion has had the unintended consequence of suggesting that grief should end in only 2 months, or that grief and major depressive disorder cannot co-occur. To prevent the denial of diagnosis and the consideration of sometimes much needed care, even after bereavement or other significant losses, the DSM-5 no longer contains the bereavement exclusion. Instead, the DSM-5 now permits the diagnosis of major depressive disorder after and during bereavement and includes a note and a comprehensive footnote in the major depressive episode criteria set to guide clinicians in making the diagnosis in this context. The decision to make this change was widely and publically debated and remains controversial. This article reports on the rationale for this decision and the way the DSM-5 now addresses the challenges of diagnosing major depressive disorder in the context of someone grieving the loss of a loved one.

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Acknowledgments

This paper was supported by grants from the American Foundation for Suicide Prevention, John Majda Foundation, and National Institutes of Health.

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Conflict of Interest

Alana Iglewicz, Kathryn Seay, Samuel David Zetumer, and Sidney Zisook declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr. #9116A, La Jolla, CA, 92093, USA

    Alana Iglewicz, Samuel David Zetumer & Sidney Zisook

  2. Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA

    Alana Iglewicz, Samuel David Zetumer & Sidney Zisook

  3. University of California and San Diego State Joint Doctoral Program in Clinical Psychology and Veterans Medical, Education and Research Foundation, La Jolla, CA, USA

    Kathryn Seay

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  1. Alana Iglewicz
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  2. Kathryn Seay
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  4. Sidney Zisook
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Correspondence to Alana Iglewicz.

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This article is part of the Topical Collection on Mood Disorders

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Iglewicz, A., Seay, K., Zetumer, S.D. et al. The Removal of the Bereavement Exclusion in the DSM-5: Exploring the Evidence. Curr Psychiatry Rep 15, 413 (2013). https://doi.org/10.1007/s11920-013-0413-0

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