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Cited by 89Grief, Bereavement, and Mental HealthTreatment of Major DepressionMental Health and Psychiatry

THE BEREAVEMENT EXCLUSION AND DSM-5

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Zisook, Sidney, Corruble, Emmanuelle, Duan, Naihua, Iglewicz, Alana, Karam, Elie G, Lanuoette, Nicole, Lebowitz, Barry, Pies, Ronald +5 more·2012·Depression and Anxiety
DOI 10.1002/da.21927
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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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  • The bereavement exclusion was lifted and replaced with much more descriptive guidance on the distinction between symptoms characteristic of normal grief and those that are indicative of a clinical disorder.

    “As a result, the bereavement exclusion was lifted and replaced with much more descriptive guidance on the distinction between symptoms characteristic of normal grief and those that are indicative of a clinical disorder (46).”

    From The DSM-5: Classification and criteria changes (2013) · cites this paper as [46]

    The Discussion distinguishes ordinary grief from major depressive episodes, and the Summary and Conclusion recommends that the bereavement exclusion not be carried over to DSM-5. But the Discussion describes its elimination as a proposal, not an action already taken, and our copy does not say it was replaced with more descriptive diagnostic guidance. (LLM, conf=0.88)

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Research works printed but not linked: 7

  1. [6]6. Bornstein P, Clayton PJ, Halikas JA, et al. Depression of widow- hood after 13 months. Br J Psychiatry 1973; 122(570):561-566.
  2. [7]7. Clayton PJ, Maurice WL, Halikas JA. Depression of widowhood. Br J Psychiatry 1972; 120(554):71-77.
  3. [8]8. Clayton PJ, Maurice WL, Halikas JA. The depression of widow- hood. Dis Nerv Syst 1971; 32:597-604.
  4. [14]14. Depression and Anxiety 15206394, 2012, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/da.21927 by Mount Vernon Nazarene University, Wiley Online Library on [28/08/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
  5. [15]15. APA. Diagnostic and statistical manual of mental disorders (DSM-III). Washington, DC: American Psychiatric Associa- tion;1980:333.
  6. [30]30. Kendler KS, Zisook S. The importance of the main effect even within an interaction model: elimination vs. expansion of the be- reavement exclusion in the diagnostic criteria for depression reply. Am J Psychiatry 2009; 166(4):492-493.
  7. [51]51. Zisook S, Simon NM, Reynolds CF, III, et al. Bereavement, com- plicated grief, and DSM, part 2: complicated grief. J Clin Psychi- atry 2010; 71(8):1097-1098.

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Authors
Zisook, S., Corruble, E., Duan, N., Iglewicz, A., Karam, E. G., Lanuoette, N., Lebowitz, B., Pies, R., Reynolds, C., Seay, K., Katherine Shear, M., Simon, N., & Young, I. T.
Affiliations
  • University of California San Diego (US)
  • Inserm (FR)
  • New York State Psychiatric Institute (US)
  • University of Balamand (LB)
  • Tufts University (US)
  • University of Pittsburgh (US)
  • 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
  • Massachusetts General Hospital (US)
Corresponding author
Zisook, Sidney
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2012-04-11
Volume
29
Issue
5
Pages
425-443
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.21927
OpenAlex
W2039405381
Semantic Scholar
55003d66dbdb0c56594426515737f0cc3afad439
Cited by
89
References
47
Citations by year
2026: 3 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 7 · 2019: 10 · 2018: 5 · 2017: 7 · 2016: 5 · 2015: 8 · 2014: 9 · 2013: 21 · 2012: 4
FWCI
1.94
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1238 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01MH085297)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
bereavement exclusion, major depressive episode, DSM-5, diagnostic criteria, mood disorders, comorbidities, antidepressant response, personality traits
MeSH terms
Bereavement, Depressive Disorder, Major, Major Depressive Disorder, Humans, Diagnostic and Statistical Manual of Mental Disorders

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