FYI Daily

DSM-5, Grief, and Depression

Last updated:

December 03, 2012

Two tough conditions often lurk behind the lights and tinsel of the holiday season: grief and depression. They often share many of the same symptoms. But are they the same thing? After much debate in the psychiatric world, the ruling is yes: The new DSM-5 mental-health diagnostic guide no longer supports a "grief exclusion" for depression.

That means that someone suffering a loss who shows the signs of depression can be treated as being clinically depressed. Health workers in the past excluded grief as being depression until the severe symptoms persisted longer than two months or made the person functionally impaired.

There are arguments for and against this distinction. For example, some clinicians say that many kinds of stressors can lead to depression, so why not mourning? Some people do experience an extreme form of mourning known as "complicated grief". But other experts worry that wthout the exception, the grief process will be rushed along, swept under a rug as unnatural, or overmedicated.

The Geripal blog on geriatrics and palliative care comes out wishing that well enough had been left alone, noting that the strong emotions of grieving are not a disorder but a healthy and adaptive response to loss. And they take time. In other words, depression is a clinical disorder but grief is a natural process.

Some considerations if you or a loved one feels grief-related blues this holiday season:

  • Don't be surprised if these emotions surface at the holidays, even if your loved one died some time ago -- or is still alive.
    Holidays trigger deep emotions. For those who have a loved one with Alzheimer's, it's natural to experience grieving before death.

  • Realize how broad the definition of "normal" is, when it comes to mourning.
    Learn the five classic stages of grief and a new assessment of the "tasks" a griever goes through on a very individualistic timeline.

  • Know you can help someone who's grieving.
    Good approaches can be as simple as listening, being honest, and not being afraid to talk about the dead. Respect the griever's cues on how to celebrate the holidays.

  • Don't believe many of the myths about grief.
    For example, some people say you can cry too much, or too little. Or that grief should last a set amount of time. (No, no, and no.)

Is grief a form of depression? However the psychiatric community defines it, anyone who has been through it knows that labels can't ease the pain. Time, perspective, and the love of others help do that. Even so, grieving never goes away completely.