When the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released, it no longer included a “bereavement exclusion” for the diagnosis of major depressive disorder (MDD). Clinicians acknowledged that though there is such a thing as “normal grief”, or “uncomplicated bereavement”, that doesn’t mean grief can’t influence the onset of depression. There was no reason for excluding it, other than that clinicians worried that they would seem to be “medicalizing” the normal grieving process. Uncomplicated bereavement is not a mental illness.
Though uncomplicated bereavement can involve many of the same feelings as depression, it is a very different condition. It’s not considered pathological. In fact, it gets a V code (specifically V62.82) in the DSM-5, meaning it’s not a mental health disorder, according to the American Psychiatric Association. The International Classification of Diseases (ICD-10) gives uncomplicated bereavement a Z code (specifically Z63.4), which also doesn’t qualify it for the status of a mental disorder. Normal grief also differs from prolonged grief disorder (PGD), a diagnosis included in the DSM-5-TR (Text Revision) of 2022. Let’s take a closer look at how uncomplicated grief and PGD differ.
Definition of Uncomplicated Bereavement DSM-5
Grief/bereavement is a normal human response to the pain of losing someone. It is the feeling of pain and sorrow, not necessarily the cultural act of mourning. Grief can be brutal, anguished, disorienting, maddening, enraging, lonely. It can sometimes feel meaningless. It can sometimes feel unsurvivable. The symptoms of uncomplicated grief may resemble those of a major depressive episode. Grief can even resemble a physical disease.
But people do emerge from normal grief. They may feel forever changed, but they will find meaning in their lives again. If someone’s disabling grief persists for longer than six months, as it does in about 10% of cases, it might be considered an adjustment disorder or prolonged grief disorder (PGD), also known as complicated grief.
Uncomplicated Bereavement Vs. Prolonged Grief Disorder
Most people can effectively deal with the loss of a loved one with the help of family, friends, and their personal belief systems. Their grieving process may include feelings of sadness, anger, and guilt, as well as insomnia and lack of appetite. However, others have a more difficult time processing this degree of loss in the long-term and find it impossible to continue life as they knew it.
Those at a greater risk of developing prolonged grief disorder (PGD) include those who have a history of mental health issues. And for those who have suffered with a substance use disorder, bereavement may be a trigger—this loss could potentially increase their risk of relapsing.
In addition to the above risk factors, the circumstances surrounding the death of a loved one as well as the grieving person’s relationship to the deceased individual can both have a major effect on how one handles the loss. For example, it may be particularly hard for an individual to process an unexpected or sudden death, or a suicide, just as it is extraordinarily difficult for a child to grieve the loss of a parent, a spouse to grieve the loss of their partner, and a parent to grieve the loss of a child, including through miscarriage.
Symptoms of Prolonged Grief Disorder DSM-5
Prolonged grief disorder is characterized by “persistent and pervasive” grief that involves a preoccupation with the deceased individual most of the day, every day, for at least a month, as well as at least 3 of the following symptoms:
- Longings for the deceased
- Acute emotional pain
- Identity confusion–feeling as if part of you has died
- Avoidance of reminders of the deceased
- Significant impairment in functioning
- Intense loneliness
- Difficulty engaging with life/reintegrating
Treating Uncomplicated Bereavement
Grief is a difficult, yet necessary and unavoidable part of life. When we grieve, we illustrate the degree of our love for the person lost. We can also learn to continue on with our lives while preserving the memories and legacy of our loved one. “Grief work” includes a few stages: separating oneself from the person who died, learning how to readjust to a world without the individual, and working to create new relationships.
Unfortunately, some of us are left more broken than others and need some extra care and guidance to heal from the pain of losing a loved one. In such cases, individuals can seek professional help through grief counseling or therapy. Grief counseling helps the bereaved manage their reactions to the loss, without letting go of their loved one. This type of therapy can do the following:
- Psychoeducate about the normal stages of grieving
- Encourage the individual to talk about the loss and express their emotions
- Identify coping issues and recommend more productive pathways
- Help the bereaved shift focus from the deceased individual to their own life
- Provide constant emotional support
Targeted grief treatment is different from depression treatment, and evidence suggests that the former is more effective in helping bereaved individuals. Depression tends to be more of a “free-floating”, nonspecific sadness, whereas grief is characterized by preoccupation with a particular person.
3 Popular Movies That Tackle the Difficult Subject of Loss and Grief
P.S. I Love You: In this film, the main character, Holly, loses her husband and has an extremely difficult time dealing with his death. The movie follows her as she searches for and discovers 10 messages that her late husband left behind. These messages, along with the undying love of her friends and family, help Holly come to terms with the loss.
Extremely Loud and Incredibly Close: This movie, which is based on a renowned novel of the same name, follows a young boy as he journeys through New York City to find a lock—a lock for a key left behind by his dad, who died in the attack on the World Trade Center on September 11. Unsure how to deal with his grief and loss, Oskar obsesses over finding this lock, but finally learns to confront his feelings with the help of all the New York City dwellers he meets.
Marley and Me: The movie that made even the toughest people tear up—Marley and Me. This film is based on an autobiography of the same name, which follows a family as they maneuver through life with a crazy Labrador Retriever, Marley. By the end of it, the family has experienced some significant ups and downs, but they have to face the hardest down yet in the closing scene: the loss of Marley. The kids draw pictures and write letters to Marley, which they bury with him in the backyard, and the parents reflect on the memories that began 13 years ago. This reminiscing ultimately helps the family come to terms with Marley’s death and their great loss.
*An earlier version of this article included incorrect ICD-10 and DSM-5 codes for uncomplicated bereavement.
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