The Grief Debate, the DSM, and Clinical Practice.

IF 1.3 4区 医学 Q3 PSYCHIATRY
James Phillips
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Abstract

There has been an ongoing debate regarding grief, whether it may be at times pathological, and whether it is different from depression. This article addresses those questions by tracking the changing course of the Diagnostic and Statistical Manuals of Mental Disorders (DSMs) since DSM-III and by reviewing the debate concerning grief and depression. At the time when DSM-III was being prepared in the late 1970s (it was published in 1980), there was a concern that normal bereavement (or grief) was being diagnosed as major depression. To address this concern, the editors of DSM-III added a category of "uncomplicated bereavement." The fourth edition of the DSM (DSM-IV), published in 1994, then followed by a minor change. However, the editors of DSM-5 decided to eliminate the bereavement exclusion entirely. Their concern was simply whether the individual did or did not suffer from major depression. Since an individual might not warrant a diagnosis of major depression but might still be experiencing grief, the DSM discussion leads directly into the question of whether grief-later called prolonged grief disorder-and depression are separate conditions. Advocates for prolonged grief disorder maintained that grief is different from depression but that patients may present with a mix of grief and depressive symptoms that are clinically difficult to distinguish. Advocates of separate conditions have in fact developed an inventory of symptoms that identify prolonged grief disorder. However, inasmuch as a typical grief presentation will include depressive symptoms, the clinical challenge is to distinguish prolonged grief disorder and major depression, as well as to distinguish both from normal grief. Given the temporal limits of an average consultation, this article argues that making the required distinctions is an unrealistic expectation. Finally, researchers have developed specific treatment programs for prolonged grief disorder, but a conflict between the 2 primary researchers involved and the generalities in which the programs are phrased have led to the suggestion of a different approach to treatment that replaces generalities with a person-centered approach.

悲伤辩论、DSM 和临床实践。
关于悲伤、悲伤是否有时是病态的、悲伤与抑郁是否有区别等问题一直存在争论。本文通过追踪《精神疾病诊断与统计手册》(DSMs)自 DSM-III 以来的变化过程,并回顾有关悲伤和抑郁的争论,来探讨这些问题。在 20 世纪 70 年代末编制 DSM-III(1980 年出版)时,人们担心正常的丧亲之痛(或悲伤)会被诊断为重度抑郁症。为了解决这一问题,DSM-III 的编辑们增加了 "非复杂性丧亲 "这一类别。随后,1994 年出版的《 DSM》第四版(DSM-IV)也进行了小幅修改。然而,《DSM-5》的编辑们决定完全取消将丧亲之痛排除在外。他们关注的仅仅是一个人是否患有重度抑郁症。由于一个人可能不需要被诊断为重度抑郁症,但可能仍然在经历悲痛,DSM 的讨论直接引出了一个问题:悲痛(后称长期悲痛症)和抑郁症是否是不同的病症。长期悲伤障碍的倡导者坚持认为,悲伤不同于抑郁,但患者可能会表现出悲伤和抑郁症状的混合,这在临床上很难区分。事实上,主张将悲伤与抑郁症分开的人已经编制了一份症状清单,用以识别长期悲伤障碍。然而,由于典型的悲伤表现会包括抑郁症状,因此临床挑战在于如何区分长期悲伤障碍和重度抑郁症,以及如何将两者与正常悲伤区分开来。考虑到一般咨询的时间限制,本文认为,进行必要的区分是不切实际的期望。最后,研究人员已经针对长期悲伤障碍制定了具体的治疗方案,但两位主要研究人员之间的冲突以及方案措辞的笼统性,导致人们提出了一种不同的治疗方法,即以人为本的方法取代笼统的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.30
自引率
10.50%
发文量
159
审稿时长
>12 weeks
期刊介绍: Journal of Psychiatric Practice® seizes the day with its emphasis on the three Rs — readability, reliability, and relevance. Featuring an eye-catching style, the journal combines clinically applicable reviews, case studies, and articles on treatment advances with practical and informative tips for treating patients. Mental health professionals will want access to this review journal — for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. Journal of Psychiatric Practice combines clinically applicable reviews, case studies, and articles on treatment advances with informative "how to" tips for surviving in a managed care environment.
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