Grief in the DSM-5: Agenda (09:22)

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Dr. Christina Zampitella discusses "housekeeping" aspects of the webinar. She provides personal background information and outlines the agenda on grief and the DSMs.

Diagnostic and Statistical Manual of Mental Disorders and Grief (09:00)

Changes in the conceptualization of mental health since the first DSM include: mentioning neurotic, reactive, and bereavement depression; the five-access system; changes to the bereavement exclusion; adding bereavement exclusion to adjustment disorder; wording changes; removal of bereavement exclusion from Major Depressive Disorder, and a PCBD name change.

DSM-III, DSM-III-R, and Grief (09:55)

Zampitella considers clinical differentiation and discusses Uncomplicated Grief; COVID has created more problems. Topics include grief reactions, separation distress, bonds with the deceased, if/only thoughts, and reconstruction of post-traumatic growth.

When Grief Goes Awry (06:57)

Zampitella discusses aspects of Complicated Grief. Topics include Acute Grief, Integrated Grief, adaptation, relationship reconfiguration, redefinition of life goals, and excessive avoidance of loss reminders.

DSM-III and Bereavement (12:09)

The publication adds Uncomplicated Grief as a V-Code and the Bereavement Exclusion to Major Depressive Disorder. The exclusion results in increased research and controversy. Zampitella explains the bereavement disclaimer, diagnostic criteria, V-Code language, and problems with the DSM-III.

DSM-III-R and the Bereavement Exclusion (07:48)

Patients must meet five criterion to be diagnosed with a Depressive Disorder. Zampitella cites definition changes within criteria; the V-Code does not change. Anticipatory Grief is grief experienced as one knowingly approaches a loss.

DSM-IV, DSM-IV-TR, and Grief (14:42)

In the DSM-IV, the bereavement disclaimer includes the addition of a two-month time period. Zampitella cites Bereavement Exclusion criterion and V-Code wording changes. One cannot make an Adjustment Disorder diagnosis for uncomplicated bereavement.

Bereavement Exclusion Conflict (10:04)

The Bereavement Exclusion incites controversy—should it be removed from the DSM? Zampitella discusses research findings. BRMD and NBRMD have similar clinical characteristics. She pauses for questions and a break.

Bereavement Exclusion: Questions (04:40)

Some argue that keeping the Bereavement Exclusion in the DSM could lead to the missing of Major Depressive Disorder. Others argue that removing it from the DSM would lead to missing normal grief response.

Period Between DSM-IV-TR and DSM-V (07:53)

Zampitella discusses Complicated Grief characterizations; it is not a form of depression. Approximately 10% of grievers develop Complicated Grief.; it exists in many cultures, is different from other disorders, and has multiple risk factors.

Complicated Grief Criterion (05:51)

Zampitella discusses Kathy Shear's five levels of diagnostic criteria; a person must be bereaved for at least six months.

Prolonged Grief Disorder (03:12)

Zampitella discusses Holly Prigerson's four levels of diagnostic criteria. Although many aspects overlap with those Shear identifies, the conceptualization of grief response categories is different.

DSM-V and Grief (11:37)

Experts remove the Bereavement Exclusion from Uncomplicated Grief. Zampitella discusses the bereavement disclaimer, the grief footnote, and context. The wording for diagnosing Major Depressive Disorder in the Z-Code changes.

Persistent Complex Bereavement Disorder (10:09)

The DSM committee combines research aspects from Prigerson and Shear to create criteria in the DSM-V; an individual must be bereaved for at least 12 months. Zampitella discusses problems with PCBD and cites diagnostic criterion for Other Specified Trauma and Stressor-Related Disorder.

DSM-V-TR and Grief (06:56)

At the time of this presentation, not all information has been fully disclosed. Changes include the movement of PCBD to Section II and renaming PCBD to Complicated Grief Disorder; Bereavement Exclusion is likely still in the Adjustment Disorder. Zampitella cites diagnostic criteria for Prolonged Grief Disorder.

ICD-11 and Prolonged Grief Disorder (06:29)

The publication includes grief for the first time; it draws from the works of Prigerson, Simon, and Maercker. ICD-11 acknowledges PGD is found worldwide and across the lifespan, and addresses concerns about pathologizing. Clinicians must consider cultural contextual aspects. Zampitella cites PGD diagnostic criteria.

Uncomplicated Grief (08:15)

Zampitella considers recognizing the limit of one's clinical competency and asks if situations look familiar; she shares personal experiences. A sense of emptiness and loss is normal in Uncomplicated Grief; individuals can experience positive emotions and moments of comfort.

Major Depressive Episode (10:06)

Symptoms include an inability to anticipate happiness and marked functional impairment; there is a reduction in dopamine and serotonin. Zampitella discusses overlapping areas with grief, complicated grief therapy, and a case study.

PCBD vs. MDD vs. PTSD (13:55)

Zampitella compares disorder symptoms. Affective symptoms include depressed mood, anhedonia, anxiety, yearning, and guilt. Cognitive behavioral symptoms include difficulty concentrating, preoccupying thoughts, avoidance, proximity seeking, suicidal ideation, and abnormal eating behaviors. Disturbed sleep presents in all three disorders; nightmares may occur.

Existential Experience (04:06)

All of us struggle and experience loss. Clinicians can help support those who are struggling with growth. Zampitella encourages viewers to study various theories about the grieving process and refer out patients who are experiencing Prolonged Grief Disorder.