Grief VS Major Depressive Episode

The update of the DSM in 2013 from 4 to 5 involved many changes throughout, one of the most controversial and talked about changes was on that altered the criteria fro Major Depressive Episode. In the DSM 4 there was a bereavement exclusion criteria for Major Depressive Episode (MDE), that stated that someone going through the loss of someone and suffering from grief did not suffer from MDD as well, unless specific criteria were met. This exclusion criteria was eliminated in the newly revised DSM 5, and provides some guidance to distinguish grief from MDE. The fact that someone is grieving a loss does not make them immune to MDE (Pies, 2014). 

The DSM 5 includes a footnote to help distinguish between grief and MDE to be able to accurately diagnose MDE in everyone, even if they have recently lost someone. This states that “in grief the predominant affect is feelings of emptiness and loss, while MDE, it is persistent depressed mood and the inability to anticipate happiness or pleasure” (American Psychiatric Association, 2013). More differences are also talked about, such as when someone grieving talks about dying it is usually about reuniting with the recently deceased person, while MDE thoughts on suicide revolved around feeling worthless, and more (American Psychiatric Association, 2013). One of the reasons why this change was made was due to the high suicide rates of MDE, as well as the under-diagnosis of this. 

This situation of trying to differentiate between these two concepts where symptoms are very similar and even overlap, is common aspect of psychology. When does the normal become pathological, does one thing exclude another or can they occur at the same time. Psychology is as much an art as it is a science. 

References: 

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. https://doi.org/10.1176/appi.books.9780890425596

Pies, R. W. (2014). The Bereavement Exclusion and DSM-5: An Update and Commentary. Innovations in Clinical Neuroscience, 11(7-8), 19–22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204469/