title: The bereavement exclusion and DSM-5.
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.
authors.affiliation: Department of Psychiatry, University of California, San Diego, CA 92093, USA. szisook@ucsd.edu
authors.forename: Sidney
authors.initials: S
authors.lastname: Zisook
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Corruble
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.forename: Alana
authors.initials: A
authors.lastname: Iglewicz
authors.forename: Elie G
authors.initials: EG
authors.lastname: Karam
authors.forename: Nicole
authors.initials: N
authors.lastname: Lanouette
authors.forename: Nicole
authors.initials: N
authors.lastname: Lanuoette
authors.forename: Barry
authors.initials: B
authors.lastname: Lebowitz
authors.forename: Ronald
authors.initials: R
authors.lastname: Pies
authors.forename: Charles
authors.initials: C
authors.lastname: Reynolds
authors.forename: Kathryn
authors.initials: K
authors.lastname: Seay
authors.forename: M
authors.initials: M
authors.lastname: Katherine Shear
authors.forename: Naomi
authors.initials: N
authors.lastname: Simon
authors.forename: Ilanit Tal
authors.initials: IT
authors.lastname: Young
mesh_terms: D001601:Bereavement; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans