FINAL PUBLIC COMMENT INVITED ON DSM CHANGES FOR BEREAVEMENT

The American Psychiatric Association has opened a final period of public comment on the draft criteria for the new version of the Diagnostic and Statistical Manual (DSM-5). The DSM -- the catalog of mental illnesses in the United States -- serves as the ultimate authority regarding which constellations of symptoms are designated as bona fide illnesses and, therefore, are proper objects of professional treatment. Public comment can be submitted through June 15 on the DSM-5 Development website.

I recommend an article in MedPage Today, "DSM-5: What's In, What's Out" as an excellent summary of all the criteria still subject to further comment and revision before the new manual is released in May 2013.

Several of the proposed revisions are of special interest to grief support practitioners:

In the case of eliminating the bereavement exclusion for diagnosing a Major Depressive Episode, which MedPage Today notes has been "one of the most controversial proposals in DSM-5,"* the APA workgroup is now proposing that the exclusion be retained but that a prominent notice be added to the diagnostic criteria, differentiating symptoms of normal grief from those that might need clinical intervention:

Note: The normal and expected response to an event involving significant loss (e.g, bereavement, financial ruin, natural disaster), including feelings of intense sadness, rumination about the loss, insomnia, poor appetite and weight loss, may resemble a depressive episode. The presence of symptoms such as feelings of worthlessness, suicidal ideas (as distinct from wanting to join a deceased loved one), psychomotor retardation, and severe impairment of overall function suggest the presence of a Major Depressive Episode in addition to the normal response to a significant loss.

In addition, it is proposed that Persistent Complex Bereavement-Related Disorder -- which refers to an experience of grief that is prolonged or severe but cannot be diagnosed as including a Major Depressive Episode -- be placed in Section III of the DSM-5, which highlights conditions that merit further research before being included as diagnosable mental illnesses.

* Two previous Unified Community Solutions blog posts have covered the bereavement exclusion:

• Feb. 16, 2012: "Bereavement Exclusion Debate Intensifies as DSM-V Nears Completion"
  
• Feb. 21, 2012: "Free Scientific Report, Webinar Available on DSM Bereavement Exclusion"