Unlike previous editions of The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the fifth edition (DSM-5) fails to underline the need to consider, and generally exclude, bereavement prior to diagnosis of a major depressive disorder, according to an editorial in this week’s Lancet.
The report states:
“In the draft version of DSM-5, however, there is no such exclusion for bereavement, which means that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction.
Medicalizing grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed. The evidence base for treating recently bereaved people with standard antidepressant regimens is absent.”
The World Health Organization’s Classification of Disease, which is currently under revision as ICD-11, is also underlined in the report. The WHO revision team is currently debating whether or not to include a category on “prolonged grief disorder.”
According to the report:
“Bereavement is associated with adverse health outcomes, both physical and mental, but interventions are best targeted at those at highest risk of developing a disorder or those who develop complicated grief or depression, rather than for all.”
The editorial concludes:
“Grief is not an illness; it is more usefully thought of as part of being human and a normal response to death of a loved one. Putting a timeframe on grief is inappropriate – DSM-5 and ICD-11 please take note. Occasionally, prolonged grief disorder or depression develops, which may need treatment, but most people who experience the death of someone they love do not need treatment by a psychiatrist or indeed by any doctor. For those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy, than pills.”
Written by Grace Rattue