Grief could be classified as a psychiatric disorder under the proposed revisions to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), due out in May of 2013. The American Psychiatric Association is currently reviewing the criteria for depression and seeking to expand these to include bereavement, the grieving most of us experience at the loss of someone close to us. But a new report by psychiatric researchers from Columbia and New York Universities contends that this expansion of what constitutes depression could create the “potential for considerable false-positive diagnosis and unnecessary treatment of grief-stricken persons,” including treating many more people with psychiatric medications which can have a range of side effects.
The revisions planned for DSM-V also include different criteria for other conditions. The criteria for autism are being changed such that, as a recent study shows, many now diagnosed with Asperger’s Syndrome and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) may well no longer qualify for a diagnosis of autism. In fact, PDD-NOS is being eliminated as a diagnosis altogether, along with “eating-disorder-not otherwise specified.”A number of new disorders are being introduced including “binge eating,” “premenstrual dysphoric disorder” and “attenuated psychosis syndrome.”
Researchers’ arguments for the changes are that — in the case of expanding the criteria for depression to include grief — many people are unduly suffering now who could benefit from a diagnosis and treatment. The inclusion of “attenuated psychosis syndrome” — given to those exhibiting delusional thinking and hallucinations and, sometimes, saying nonsensical things — in the DSM-V is an attempt to detect someone who is at risk for schizophrenia. However, as the New York Times points out, such symptoms are actually “poor predictors” of schizophrenia; researchers wish to note them due to wanting to detect schizophrenia, a life-long disorder, early on.
The Medicalization of Grief?
Some psychiatrists contend that medicalizing grief will lead to too many people being given psychiatric diagnoses excessively and to normal behavior being termed pathological. Dr. Allen Frances, an emeritus professor at Duke University and the chairman of the task force that revised the previous DSM edition, has been particularly critical of the revisions and has singled out how the DSM-IV’s expanded criteria for autism have led to so many being diagnosed that (in his own words) autism has become “fashionable.”
On the other hand, it is also widely acknowledged that depression is underdiagnosed and therefore untreated. If more people are given a diagnosis and are able to get help — and, perhaps even to speak about their struggles with depression and grieving — the stigma that is too often attached to psychiatric diagnoses may be lessened. Certainly when my son was diagnosed with autism in 1999, there was much less understanding about this neurodevelopmental disability; families with an autistic child felt much more of a sense of shame and found themselvves very much alone. Knowing that there are more autistic children and adults out there — right in my neighborhood, indeed — has made a huge difference.
The DSM is authoritative in the sense that its criteria can determine what treatments insurance companies can provide. But we need to remember that its criteria are not set in stone; that, in future years, the APA will be revising the criteria again.
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