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THE BEREAVEMENT EXCLUSION AND DSM-5

Authors

  • Sidney Zisook M.D.,

    Corresponding author
    1. Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, California
    • Department of Psychiatry, University of California, San Diego, California
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  • Emmanuelle Corruble M.D., Ph.D.,

    1. INSERM U669, Department of Psychiatry, Bicêtre University Hospital, Assistance Publique–Hôpitaux de Paris,, France
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  • Naihua Duan Ph.D.,

    1. Departments of Biostatistics and Psychiatry, Columbia University, New York, New York
    2. Division of Biostatistics and Data Coordination at New York State Psychiatric Institute, New York, New York
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  • Alana Iglewicz M.D.,

    1. Department of Psychiatry, University of California, San Diego, California
    2. Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, California
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  • Elie G Karam M.D.,

    1. Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Balamand University, Beirut, Lebanon
    2. Faculty of Medicine, Medical Institute for Neuropsychological Disorders (MIND) and Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
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  • Nicole Lanuoette M.D.,

    1. Department of Psychiatry, University of California, San Diego, California
    2. Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, California
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  • Barry Lebowitz Ph.D.,

    1. Department of Psychiatry, University of California, San Diego, California
    2. Departments of Biostatistics and Psychiatry, Columbia University, New York, New York
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  • Ronald Pies M.D.,

    1. Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York
    2. Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts
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  • Charles Reynolds M.D.,

    1. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    2. Department of Community and Behavioral Health Science, University of Pittsburgh Graduate School of Public Health, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
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  • Kathryn Seay B.S.,

    1. University of California and San Diego State Joint Doctoral Program in Clinical Psychology and Veterans Medical, Education and Research Foundation, La Jolla, California
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  • M. Katherine Shear M.D.,

    1. Complicated Grief Treatment Research Program, Columbia University School of Social Work and Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
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  • Naomi Simon M.D.,

    1. Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Massachusetts General Hospital, Boston, Massachusetts
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  • Ilanit Tal Young M.D.

    1. Department of Psychiatry, University of California, San Diego, California
    2. Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, California
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Errata

This article is corrected by:

  1. Errata: THE BEREAVEMENT EXCLUSION AND DSM-5 Volume 29, Issue 7, 665, Article first published online: 2 July 2012

Correspondence to: Sidney Zisook, Department of Psychiatry, University of California, 9500 Gilman Dr. #9116A, La Jolla, San Diego, CA 92093. E-mail: szisook@ucsd.edu

Abstract

Background

Pre-DSM-III (where DSM is Diagnostic and Statistical Manual), a series of studies demonstrated that major depressive syndromes were common after bereavement and that these syndromes often were transient, not requiring treatment. Largely on the basis of these studies, a decision was made to exclude the diagnosis of a major depressive episode (MDE) if symptoms could be “better accounted for by bereavement than by MDE” unless symptoms were severe and very impairing. Thus, since the publication of DSM-III in 1980, the official position of American Psychiatry has been that recent bereavement may be an exclusion criterion for the diagnosis of an MDE. This review article attempts to answer the question, “Does the best available research favor continuing the ‘bereavement exclusion’ (BE) in DSM-5?” We have previously discussed the proposal by the DSM-5 Mood Disorders Work Group to remove the BE from DSM-5.

Methods

Prior reviews have evaluated the validity of the BE based on studies published through 2006. The current review adds research studies published since 2006 and critically examines arguments for and against retaining the BE in DSM-5.

Results

The preponderance of data suggests that bereavement-related depression is not different from MDE that presents in any other context; it is equally genetically influenced, most likely to occur in individuals with past personal and family histories of MDE, has similar personality characteristics and patterns of comorbidity, is as likely to be chronic and/or recurrent, and responds to antidepressant medications.

Conclusions

We conclude that the BE should not be retained in DSM-5.

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