Brooklyn College of the City University of New York, NY 11210, USA.
Omega (Westport). 2011;63(3):199-220. doi: 10.2190/OM.63.3.a.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is being revised. A proposed revision hotly debated is to remove what is known as the exclusionary criterion and allow clinicians to diagnose a person with a major depressive episode within the early days and weeks following a death. The Executive Committee of the Association for Death Education and Counseling (ADEC) commissioned its Scientific Advisory Committee (SAC) to examine the debate over removing the exclusionary criterion and provide a written report. The DSM-IV-TR classifies bereavement as a clinical condition that is not a mental disorder. The exclusionary criterion states that within the first 2 months of the onset of bereavement a person should not be diagnosed as having major depression unless certain symptoms not characteristic of a normal grief reaction are present. We note these symptoms when discussing the exclusionary criterion. In the report we identify the features that comprise the exclusionary criterion, examine reasons (including research conclusions and clinical concerns) given for retaining and for eliminating the exclusionary criterion, offer extensive comments from experienced licensed clinicians about the issues involved, discuss diagnostic and treatment implications, and offer specific recommendations for ADEC to implement.
《精神障碍诊断与统计手册（第四版修订本）》（DSM-IV-TR）正在修订中。其中一个备受争议的拟议修订是删除所谓的排除标准，允许临床医生在一个人死亡后的早期和数周内诊断其患有重度抑郁发作。死亡教育与咨询协会（ADEC）的执行委员会委托其科学咨询委员会（SAC）审查关于删除排除标准的争论，并提供书面报告。DSM-IV-TR 将丧亲之痛归类为一种不属于精神障碍的临床状况。排除标准规定，在丧亲之痛开始后的头 2 个月内，除非出现某些不符合正常悲伤反应的特征性症状，否则不应诊断为患有重度抑郁症。我们在讨论排除标准时会注意到这些症状。在报告中，我们确定了构成排除标准的特征，检查了保留和删除排除标准的理由（包括研究结论和临床关注），提供了经验丰富的持照临床医生对所涉问题的广泛意见，讨论了诊断和治疗的影响，并提出了 ADEC 实施的具体建议。
