Is Grieving a Disorder?

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.

Controversial Revisions

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.

Related Care2 Coverage

Will New Diagnostic Criteria End the “Autism Epidemic?”

Did the DSM Create an Epidemic of Asperger’s?

The DSM Gets an Upgrade

Photo by Joelk75

Disclaimer: The views expressed above are solely those of the author and may not reflect those of
Care2, Inc., its employees or advertisers.

Patricia S.

1:10PM PDT on May 10, 2012

They say Time heals all wounds. Now, grief may be natural and healthy when one goes through the stages in a reasonable amount of time -- but what does one do when it goes on and on and on and on for years? That feels neither healthy nor normal... I have been struggling with this for much too long, and I have yet to find a grief counselor in my area who has been helpful. If one more person says to me, "Just give it time," I will go right over the edge. As noted in a previous comment, for some people there is trauma attached; that is certainly true for me. I am nearly at my wit's end trying to deal with this. Any helpful suggestions? (Emphasis on "helpful," thanks.)

send a green star

Fiona D.

8:37AM PDT on May 10, 2012

Grief is normal. But in some circumstances, it goes beyond grief into trauma. After caring for a close relative at home for 2 years and watching him die of lung cancer, I truly felt like I was post-traumatic. I didn't seek help right away, but I'm glad I did when I realized after many months that I was definitely depressed and it wasn't going away all by itself. I am sure there are many people out there who go through traumatic bereavements, and I hope the DSM WILL include this as a consideration for diagnosis and recognition by health care providers.

Amber B.

8:13PM PST on Feb 25, 2012

grief is something you have to go through, it needs to be done by you on your own. why in the world would we need medication for it???? TIME is the only medication that can truly heal grief. and even then you never TRULY heal. but drugs are for sure not going to fix it. cause it's NOT A DISEASE. it's a normal human process, not just another reason for doctors to pump out the pills.

I Care F.

7:25PM PST on Feb 20, 2012

Health workers investigated over serious crimes
Julia Medew
February 17, 2012

Corporate video productions Kingsgrove (02) 8959 3024
Checks found nearly 3000 health professionals had some kind of criminal history.

Checks found nearly 3000 health professionals had some kind of criminal history. Photo: Glen Hunt

HUNDREDS of doctors, nurses and other health professionals were found to have worrying criminal histories that prompted investigations last year.

In its annual report for 2010-11, the Australian Health Practitioner Regulation Agency said criminal checks on 52,445 health professionals found nearly 3000 or 6 per cent had some kind of criminal history. Of those, 449 had committed offences serious enough to potentially affect their registration.

After national boards investigated these matters, the report said the registration of 40 health professionals was impacted by their offences, with one psychologist refused registration.

Read more: http://www.theage.com.au/national/health-workers-investigated-over-serious-crimes-20120216-1tbwy.html#ixzz1mz0OlDgr

Dena G.

7:26AM PST on Feb 20, 2012

reply to Sarah M........this is defiitely NOT stupid. many lives hang in the balance with reference to mental health issues. life is too beautiful to waste or be lived in sickness. body, mind, and spirit need to be healthy & in harmony in order to live life to it's fullest, as our Creator intended. some of us need help, some are more fortunate that don't and some are MOST UNfortunate who don't even realize they have a problem. peace.

7:16AM PST on Feb 20, 2012

i am a mental health patient diagnosed with bipolar disorder. i have had several diagnosiis starting in 1971, from severe depression, dual diagnosis, schizo-affective, anxiety disorder, to present. as you see...i have been a long-term patient now for over 40 years. within these years i too have suffered from various forms of grief. grief is a process. certain steps must be taken before grief is accepted. there are various forms of grief...loss of a loved one, loss of health, losss of a limb or eyesight, loss of mental health, loss of firm spiritual beliefs or just a strong belief which is uncovered as non-truth........etc. in the process of grief, certain steps are taken in an ideal order & processed one by one until total acceptance is achieved. these steps may not be taken in the same order by everyone & may be jumped back & forth & back & forth & even stuck in a particular step such as the victim for example. having said all this...arriving at pure acceptance is attained in different ways by different people. the length of grief varies. individuals process grief differently & should be allowed to feel their grief & work through it. this often required professional guidance if the grief is prolonged & threatens quallity of life. it is my opinion that grief is a process which is indeed mental, but not a lifetime disorder requiring long term medication, with reference especially to SSRI medications and/or long term benzodiazipin

Debbie C.

6:20AM PST on Feb 14, 2012

My Mom died almost 2 years ago and I am still grieving. My doctor put me on Effexor. I stopped taking it and when I think about my Mom, I start crying all over again. When I am on it, I don't cry. How long does grieving last?

Sarah M.

6:59PM PST on Feb 11, 2012

this is so stupid

naomi c.

8:26PM PST on Jan 30, 2012

there are numerous disorders that are labeled ' depression or bi-polar'. doctors are so willing to push medications on people, that they never have the chance to get through their condition on their own. grieving is not a disorder. it is imperative that one grieves over a person's death or a pet's demise.

Suzanne L.

12:24PM PST on Jan 30, 2012

I am horrified by the pathologizing of grief. It is a normal response to loss. If people are given medications, particularly SSRI type meds. that they have to take every day, they may not process their grief well. These drugs can dim down symptoms such as crying, but they may not allow for the bereaved to work through the loss. Bereavement counselling is a better alternative for those who are struggling with the loss and change that comes with the death of a loved one.