The Bereavement Exclusion Debate in the DSM-5: A History

Abstract

Beginning with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III), depressive episodes following the loss of a loved one were considered to represent normal grief if they did not include certain severe symptoms or if they lasted less than 2 months. This was called the bereavement exclusion rule. A debate about whether to eliminate the bereavement exclusion became a hotly contested issue during the DSM-5 revision process. The debate involved disagreements about which research studies were most relevant to assessing the validity of the bereavement exclusion rule, different value commitments regarding the distinction between normal and abnormal, and contrasting philosophical assumptions about the nature of psychiatric disorder. Based on a review of the arguments offered in academic journals, the blogosphere, and in the mass media, and on interviews with active participants in the debate, this article narrates a consensus history that reflects the diversity of viewpoints promoted during the debate and the diversity of views on the outcome.