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DSM-5: When Grief And Depression Mingle

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By: Wynne Parry, LiveScience Contributor
Published: 05/22/2013 07:37 AM EDT on LiveScience

Editor's Note: With the release of the latest edition of the mental health manual, the Diagnostic and Statistical Manual of Mental Disorders (the DSM), LiveScience takes a close look at some of the disorders it defines. This series asks the fundamental question: What is normal, and what is not?

The profound sadness that stems from grief can look a lot like the sadness depression brings. The similarity can create a dilemma for mental health professionals: When should someone experiencing the loss of a loved one be diagnosed as depressed?

In its criteria for depression, the previous version of the mental health manual, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), gave many people who are grieving a two-month pass on being diagnosed with depression. (This exemption did not apply to people experiencing extreme symptoms, such as psychosis.)

The architects of the new DSM-5, which will be released tomorrow (May 22), found this two-month cutoff arbitrary and unnecessary and so have removed it, making it much easier to diagnose a grieving person with depression. [The 10 Most Controversial Psychiatric Disorders]

Bereavement doesn't necessarily last two months, and someone could grieve and suffer from major depression at the same time, argue the leaders of the DSM-5 task force in a summary published online in February in the Journal of the American Medical Association.

In both forms of sadness, someone can experience a loss of interest or pleasure in activities they normally enjoy, as well as changes in sleeping patterns, difficulty concentrating, fatigue and other symptoms. However, there are distinctions. Someone who is grieving typically focuses his or her thoughts on the person who has passed away and experiences waves of pain rather than the constant pain typical of depression. Research also indicates that in most cases the depression-mimicking symptoms associated with grief tend to lessen over time with the help of family and friends.

"When there wasn't effective medication available for depression, I think people had a higher tolerance for grief," said Robin Rosenberg, a clinical psychologist and co-author of "Abnormal Psychology" (Worth Publishers, 2009). "But because there is medication available, some people feel that because we can do something that potentially alleviates the suffering associated with grief, we should."

Those in favor of removing the two-month "pass," known as the bereavement exclusion, argue that allowing the diagnosis of depression among those in mourning could prevent or reduce suffering. Those on the other side worry about an over-diagnosis of depression and unnecessary prescriptions, as well as a reduced tolerance for grief as a natural process, Rosenberg said.

Being diagnosed with major depressive disorder has many repercussions and can affect how those diagnosed view themselves and their risk of subsequent depressive episodes, she added.

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