The new (2013) Diagnostic And Statistical Manual 5 (DSM) changed some categories of depression. It replaces the older category of dysthymia, or long-term depression from childhood, with persistent depressive disorder. For lack of scientific basis to differentiate dysthymia from chronic major depressive disorder, this new category includes both.
Disruptive mood dysregulation disorder now includes what was before called childhood bipolar disorder and can be diagnosed up to 18 years. Major depressive disorder can now include at least three manic symptoms insufficient to qualify for a manic episode reported as “with mixed features.”
DSM5 also removed the bereavement exclusion for four reasons:
1. To remove the implication that bereavement typically lasts only 2 months when both physicians and grief counselors recognize the duration as more commonly 1–2 years.
2. DSM5 recognizes bereavement as a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable person, generally beginning soon after the loss. When major depressive disorder occurs in the context of bereavement, it adds an additional risk for suffering, feelings of worthlessness, suicidal thoughts, poorer physical health, worse relational and work functioning, and an increased risk for persistent complex bereavement disorder (described in Conditions for Further Study in DSM-5 Section III).
3. Bereavement-related major depression most likely occurs in individuals with past personal and family histories of major depressive episodes. Genetic influences affect it, as do similar personality characteristics, patterns of comorbidity (other illnesses at the same time), and risks of chronicity and/or recurrence as non–bereavement-related major depressive episodes.
4. The depressive symptoms associated with bereavement-related depression respond to the same psychosocial and medication treatments as non-bereavement-related depression. In the criteria for major depressive disorder, a detailed footnote replaces the more simplified DSM-IV exclusion to aid in making the critical distinction between the symptoms characteristic of bereavement and those of a major depressive episode. Thus, although most people who experience the loss of a loved one experience bereavement without developing a major depressive episode, evidence does not support the separation between loss of a loved one from other stressors, in terms of the likelihood of bereavement precipitating a major depressive episode or the possibility that the symptoms will abate spontaneously.
Sorting out normal grieving from major depression can present difficulties. If you or a friend or loved one has had a significant loss, and the depression fails to lift or to begin lifting, it’s time to check in with your primary care provider, counselor, or pastor.
[Source: DSM-5 Changes: Depression and Depressive Disorders. http://pro.psychcentral.com/dsm-5-changes-depression-depressive-disorders/004259.html Image: pixaby.com]