Last week, the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the first since 2013 – was released, offering new considerations for a swiftly evolving world, including finally recognizing prolonged grief disorder.
The revision also integrates considerations for the impact of racism and discrimination on mental health disorders and clarifies the language related to gender identity.
The American Psychiatric Association has been working on the DSM-5-TR, a text revision of the DSM-5, for a few years now. Typically revisions are published every five to seven years.
“Desired gender” is now “experienced gender.” “Gender-affirming medical procedure” replaces “cross-sex medical procedure.” They have also put words and criteria to a new disorder: prolonged grief disorder.
People who meet the criteria for prolonged grief disorder – specifically grief that incapacitates a person six months or longer after a loss – are encouraged to seek the appropriate medical help. While some are happy that the new disorder will allow medical access to the long-suffering, critics of the announcement claim that a diagnosis of prolonged grief could have a destabilizing effect.
“Grief turns out to be a place none of us know until we reach it,” writes Joan Didion in The Year of Magical Thinking, her bestselling meditation on death written about her late husband. “We do not expect the shock to be obliterative,” she says, “dislocating to both body and mind. We might expect that we will be prostrate, inconsolable, crazy with loss. We do not expect to be literally crazy.”
“The diagnosis of prolonged grief disorder is not intended to pathologize grief,” the APA explains.
What Does it Mean for You and Your Loved Ones?
“Individuals who meet the criteria for prolonged grief disorder experience something dramatically different from the grief normally experienced by anyone who loses a loved one,” says the APA.
They continue, “People whose symptoms meet the criteria for prolonged grief disorder need and deserve to get appropriate care.” A diagnosis opens up medical treatments covered by insurance, which the grieving had not had access to before.
The DSM has often been called the Psychiatrist’s Bible. In the first DSM, published in 1952, homosexuality was classified as a deviant personality disorder, a classification that was modified in the wake of the Stonewall Riots.
Similarly, major depressive disorder was not recognized until the publishing of the DSM-3 in 1980. This latest DSM is the first revision published in a pandemic world.
What are the risks of classifying grief as a disorder?
The ability to diagnose prolonged grief means more people will have access to the help they need. However, the FDA will see competition as newly developed treatment options fight for approval.
Currently, the addiction treatment drug Naltrexone has been put through clinical trials as a potential treatment for grief. “Naltrexone may augment psychotherapy to promote PGD symptom grief resolution,” according to this trial.
What Do the Critics Have to Say?
Those already working in the grief treatment world are some of the most outspoken against the APA’s decision. “When someone who is a quote-unquote expert tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions,” cautions Joanna Cacciatore.
The PhD and bestselling author of Bearing the Unbearable and Grieving is Loving believes prolonged grief disorder “is an incredibly dangerous move, and short-sighted.”
The decision to include grief in the DSM has been hotly debated for years. The APA considered including a grief disorder twelve years ago but faced too much backlash from critics who believe a diagnosis of grief would lead to the overmedication of patients.
While grief may mirror symptoms of depression, psychiatrists see more of a similarity between grief and stress disorders, particularly post-traumatic stress disorder. According to the DSM-5 criteria, a diagnosis can be made a year after the death of a loved one, and it’s estimated that 4% of the population will meet those criteria.
A diagnosis of prolonged grief could provide a person with the answers they need during a period of suffering and confusion. If Didion is correct in her estimations that we don’t know grief until we experience it, a diagnosis could provide knowledge and assistance on a difficult journey of recovering. It would be a reminder to all those who suffer that they are not alone.
“The duration and severity of the bereavement reaction must clearly exceed what is expected based on standards related to the individual’s social, cultural, or religious background. This does not mean that people feeling grief periodically one year or more after the loss of a loved one have the disorder. However, those with intense and impairing grief after one year may be considered for the diagnosis,” explains the APA.
With advances in gender identity language and acknowledging the impact of racism on mental health, this latest DSM revision reflects a more understanding and compassionate world, serving as a nationwide reminder that mental health matters.
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Justin McDevitt is a playwright and essayist from New York City. His latest play HAUNT ME had its first public reading at Theater for the New City in September. He is a contributor for RUE MORGUE where he lends a queer eye to horror cinema in his column STAB ME GENTLY.