Columbia University School of Social Work, New York, New York, USA.
Depress Anxiety. 2011 Feb;28(2):103-17. doi: 10.1002/da.20780.
Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders.
丧亲是一种严重的应激源，通常会引发痛苦和虚弱的急性悲伤症状，这些症状通常会逐渐恢复到满意的状态（即使生活发生了改变）。通常情况下，悲伤不需要临床干预。然而，有时急性悲伤可能会站稳脚跟，变成一种慢性衰弱的疾病，称为复杂悲伤。此外，丧亲带来的压力，就像其他应激源一样，会增加其他身体或精神障碍发作或恶化的可能性。因此，一些丧亲的人需要被诊断和治疗。评估丧亲者的临床医生有过度诊断和漏诊的风险，要么将正常情况病态化，要么忽视治疗有损害的障碍。DSM-IV 的作者主要关注过度诊断的问题，并因证据不足而忽略了复杂悲伤。我们根据新的研究结果重新审视丧亲的考虑因素。本文主要讨论在新诊断和复杂悲伤的维度评估方面可能的纳入，并讨论在重大抑郁和其他障碍中修改丧亲 V 编码和细化丧亲排除。
