DSM-5 Controversy

Dear Share Friends, 

You may have seen and heard discussion around the topic of grief and bereavement and how medical professionals may categorize and treat it in the future. The issues involved in the creation or refinement of a diagnosis, the specific criteria used to define a diagnosis, and the related benefits and risks are complex and deserve further study.

Share understands that the grief borne by bereaved families transcends categorization. Our primary purpose has been, and continues to be, to provide support toward a positive resolution of grief experienced at the time of, or following the death of a baby. This support encompasses emotional, physical, spiritual, and social healing, as well as sustaining the family unit.

We asked C. Alec Pollard, Ph.D., a bereaved dad and past president of Share's board of directors and current member of our advisory committee, to comment on this important issue:

Proposed Changes to Psychiatric Diagnostic Manual Could Have Implications for Bereaved Parents


The DSM is the manual used in the United States to define and categorize mental illness. The fifth edition of the manual (DSM-5) is in development and will eventually replace the current manual (DSM-IV). Two of the proposed changes currently under consideration have drawn considerable attention within the field of bereavement. Some individuals and organizations have expressed strong opposition to changes they believe could negatively impact individuals experiencing grief.

Issues involved in the creation or refinement of a diagnosis, the specific criteria used to define a diagnosis, and the related benefits and risks are complex and deserve further study. While Share is concerned about any medical diagnosis, procedure, or policy that could potentially harm bereaved parents, our organization is equally committed to a fair evaluation of potential benefit. It is the position of Share that assuming an unequivocal stance on these issues is premature and could impair access to specialized care for some individuals with particularly problematic grief. The Share Board of Directors will continue to monitor future developments related to this issue, including scientific research, and welcomes input from all members of the bereavement community. It is also the position of our organization that the people we serve have access to all of the information necessary to make an informed decision about these issues. A brief review of the 2 relevant proposals for DSM-5 with links to additional information are provided below:

1) Addition of a New Diagnosis called Prolonged (Complicated) Grief Disorder

The proposed diagnosis would create a new category of mental illness that involves grief reactions and complications that exceed the experience of normal bereavement. Complicated Grief Disorder, also known as Prolonged Grief Disorder, involves significant impairment and distress related to the loss of a loved one that persists over an extended period of time. (e.g., 6 months or longer). Proponents suggest the addition of this diagnosis will enable clinicians to help those with problematic bereavement more effectively and point to related advancements in treatment that specifically address issues relevant to problematic grief. Critics have expressed concern about potential misdiagnosis and that clinicians might be more likely to treat normal grief as if it was a mental disorder. If you would like more information on the status of this diagnosis, please consider the following links:

http://focus.psychiatryonline.org/article.aspx?articleid=49444
http://www.csub.edu/~rhewett/english99/Craig.pdf


2) Elimination of the “Bereavement Exclusion” from Major Depression

In the current manual, a diagnosis of Major Depression cannot be assigned to an individual if the person has recently experienced the loss of a significant person in his or her life. This exclusion was intended to prevent the experience of grief from being misdiagnosed as depression. A proposal is currently being considered for DSM-5 that would remove the “bereavement exclusion” so that someone in the early stages of bereavement could be given a diagnosis of Major Depression. One argument against the change is that it will lead clinicians to inappropriately treat normal grief as if it was clinical depression. Defenders of the change suggest people who are grieving can also have Major Depression and deserve to have their condition diagnosed and treated. There are additional arguments on either side. The issue also rests on exactly how the criterion is finally worded, not simply whether the exclusion remains or is removed. If you would like to read more about this issue, you may find the following links helpful:

http://www.psychiatrictimes.com/dsm-5/content/article/10168/1568760
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922362/
http://www.medscape.com/viewarticle/740333_6
http://www.medscape.com/viewarticle/758097
http://www.nyu.edu/socialwork/pdf/wakefield.pdf
http://www.ncbi.nlm.nih.gov/pubmed/17404120
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219913/

C. Alec Pollard, Ph.D.
Director, Anxiety Disorders Center
Saint Louis Behavioral Medicine Institute
Professor of Community and Family Medicine
Saint Louis University

Please contact us if you have further questions about National Share's position or this issue in general.  

With Hope,
The National Share Office