The DSM-5: Over-Diagnosis of Depression Could Ensue from Removal of “Bereavement Exclusion”

The revised DSM-5, due to be released in May, has generated an unusual amount of heat. The removal of the “bereavement exclusion” has raised the concern that depression, once under-diagnosed in seniors, may become over-diagnosed.

Traditionally, depression has been under-diagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? But critics of the DSM-5 now argue that depression may become over-diagnosed with the elimination of the “bereavement exclusion.” This is because in the DSM-5, anyone experiencing normal symptoms of grief two weeks after the loss of a loved one can be diagnosed with and treated for depression.

The “bereavement exclusion” was a paragraph in the DSM-4 that cautioned against diagnosing depression in someone for at least two months after the loss of a loved one, unless that patient had severe symptoms such as suicidal thoughts. The DSM-4 recognizes that symptoms that look like depression are a normal part of human emotion following the death of a loved one.

The debate surrounding revisions to the DSM-5 from the American Psychiatric Association (APA) questions whether this grief is a normal human process or a mental disorder that requires diagnosis and treatment.

Even though everyone experiences grief differently, grief is a necessary response to the loss of a loved one and part of the human experience. Regardless of the revised DSM-5 criteria, clinicians should take caution to avoid under- and over-diagnosing depression in bereaved individuals and include compassion and empathy as a key part of effective therapy.

Are you suffering from  the loss of a loved one? Do you have a family member who suffers from special needs, clinical depression, or any of the disorders outlined in the DSM? At the Fairfax Elder Law Firm of Evan H. Farr, P.C., our team provides life-long guidance, management, and oversight on vital issues such as medical and nursing care, housing options, financial management, estate planning, asset protection, Medicaid eligibility, and more for our clients and their families.  Call 703-691-1888 to make an appointment for a no-cost consultation.

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