Bereavement (DSM-5): Grief And Major Depressive Disorder

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) generally categorizes different types of psychological and mental disorders. The DSM-5 is currently the newest version of the manual, and it can help those in the mental health community understand how to diagnose and treat different patients based on the symptoms they’re experiencing. Although experiencing bereavement once meant a person could not be diagnosed with major depressive disorder at that time, the DSM-5 removed this exclusion, essentially stating that it can be possible for a person to be living with both grief and major depressive disorder. If you’re having trouble with grief, symptoms of depression, or both, please don’t hesitate to reach out for help from a licensed therapist. A potential way to connect with a mental health professional, particularly for those facing grief or other related bereavement issues, can be through an online therapy platform.

Understanding bereavement according to the DSM-5

When you're going through grief and the loss of someone you care about, it can greatly affect you, your well-being, and your everyday life. Bereavement, or losing someone you love, can result in many different emotions, some of which may present as depression or other mental health disorders. An individual may also experience physical symptoms alongside mental ones, such as headaches, muscle tension, or gastrointestinal distress.

How grief and intense longings affects each person differently

Grief often affects people in different ways, and that can mean it's difficult to say what your experience may be like when you lose someone you care about. In the field of psychology, the process of diagnosing major depressive disorder used to be tied very closely to a recent death in the family.

The bereavement exclusion

Changes in the latest DSM

In the newest version of the DSM, the bereavement exclusion has been removed, which can give licensed mental health professionals the freedom to start treatment for patients who show symptoms of major depressive disorder without having to wait for symptoms of grief to pass.

Reasons behind the removal of the bereavement exclusion

Previously, the DSM-IV advised against diagnosing MDD within two months following a loved one's death (bereavement exclusion) to avoid mistaking normal grief for MDD. However, this exclusion has been removed in DSM-5. The update includes guidance for clinicians to distinguish between normal grief and MDD, noting that while grief and MDD have symptoms like sadness and withdrawal, they differ significantly; grief often includes waves of painful feelings with positive memories and preserved self-esteem, whereas MDD involves persistent negative mood and feelings of worthlessness.

Criteria for diagnosing major depressive disorder and grief

There are usually various aspects to be considered for the diagnosis of major depressive disorder, including the symptoms themselves, their severity, and their duration. These are generally required to form an official diagnosis, and it is usually up to the discretion of a psychologist or psychiatrist to determine whether those symptoms form a diagnosis for major depressive disorder or grief.

Evaluating depressive symptoms in bereavement (DSM 5)

The current timetable for diagnosing depression rather than grief is generally two weeks. However, this may be carefully considered by the professional that you interact with. In general, symptoms of a major depressive disorder that occur with a range of severity and exist for longer than two weeks can lead to a diagnosis, but this is not necessarily definitive.

When grief and bereavement are both at play, this can be even more important, and a mental health professional will normally have the final say as to how they want to diagnose and treat the patient.

Once the two-week period has expired and the patient is still experiencing symptoms, they may be diagnosed with major depressive disorder, but this may vary depending on the mental health professional you're working with. 

Variations in grief and the diagnosis of major depressive disorder

It can be helpful to remember that many factors can be involved, and a patient may experience grief in different ways than others. This can mean that one patient may be feeling better and starting to experience fewer symptoms within the two weeks following a loss, while another patient may take much longer. That does not necessarily mean that either patient has a major depressive disorder. Still, it can mean that they cope with grief on different timelines, which can be completely normal and acceptable.

Prolonged grief disorder

Prolonged grief disorder is recognized by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is a mental illness characterized by intense emotional pain, significant distress, and disabling grief that persists beyond the normal course of bereavement. 

What is prolonged grief disorder?

Symptoms of prolonged grief include profound sadness, intense loneliness, and emotional numbness, which can disrupt daily functioning and lead to complications. This condition, often investigated in bereavement research, differs from normal grief in its severity and persistence, often requiring specialized mental health treatment to support bereaved patients. 

Causes and treatment of prolonged grief disorder

Developing prolonged grief disorder, also known as persistent complex bereavement disorder, traumatic grief, and complicated grief, is often linked to personal vulnerabilities and the nature of the loss experienced. The diagnostic criteria set by the DSM-5 help distinguish between normal processes of grief and the more severe, persistent form that could turn into prolonged grief disorder. 

To support those living with prolonged grief disorder, mental health professionals might use various strategies, including therapy and medication. The goal is to alleviate the intense emotional pain associated with this condition and assist patients in working through their grief more effectively. 

When to seek help for intense longings and bereavement

If you've experienced a loss, you may want to seek professional help to guide you through it in a more positive way. This does not necessarily mean that you have a depressive disorder, but it can mean that you may need assistance in feeling like yourself again. You might keep in mind that experiencing grief and its symptoms can be perfectly normal, and it often takes time to work through your loss and get back to your everyday life.

A mental health professional can also help determine whether you might have a risk of developing prolonged grief disorder. They may also be able to distinguish between prolonged grief disorder and other types of mental illness that may have similar symptoms, including post-traumatic stress disorder (PTSD) and major depression. 

The important thing can be that you notice a gradual improvement in the way you feel over time, even if you don't feel fully yourself again. If you don't feel like you're getting better after weeks or months have passed, that may be a sign to seek out the professional help you deserve. 

Finding support online for bereavement

When you’re experiencing grief, it can be quite a challenge just to get ready and leave the house. If you believe you’d benefit from working with a licensed therapist but don’t feel that traditional face-to-face therapy is the right choice for you at this time, then you might consider online therapy instead. 

Effectiveness of online therapy for bereavement (DSM 5)

With online therapy, you can receive professional guidance from the comfort of your home.

One analysis that included various randomized clinical trials looked at the efficacy of online therapy to see how it compares to traditional face-to-face therapy. It found that, in general, both modes of therapy were equally effective.