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Historical precedents for the DSM-III bereavement exclusion criteria for major depression

Published online by Cambridge University Press:  20 March 2018

Kenneth S. Kendler
Kenneth S. Kendler*
Affiliation:
Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral Genetics, and Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA
*
Author for correspondence: Kenneth S.Kendler, E-mail: Kenneth.Kendler@vcuhealth.org
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Abstract

Background

I review the historical antecedents of the two key features of the bereavement exclusion (BE) for major depression (MD) criteria initially proposed in DSM-III: (i) a context-dependent approach to the evaluation of MD which required that the diagnosis be given only when course, symptoms and signs are ‘out of proportion’ to experienced adversities, and (ii) bereavement is the sole adversity for which this context-dependent approach should be utilized.

Methods

A review of 49 textbook and review articles on depression or melancholia published 1880–1960.

Results

Seventeen (35%) of the 49 texts advocated for a context-dependent approach to the diagnosis of MD. Most advocates relied on an intuitive clinical understanding of when the depressive features were v. were not commensurate with the experienced adversities. Several authors suggested that specific symptoms or course of illness could differentiate MD from ‘normative’ sadness. Others noted that patient reports of psychological causes of their depression should be treated skeptically. While death of loved ones was the most frequently noted specific adversity associated with MD, no author considered it qualitatively different from other stressors or suggested that it alone should be considered when diagnosing MD in a context-dependent manner.

Conclusions

A key underlying assumption of the BE criteria – a context-dependent approach to the diagnosis of MD– was advocated by a significant minority of earlier psychiatric diagnosticians, although problems in its clinical implementation were sometimes noted. No historical precedent was found for the application of the context-dependent approach only to bereavement, as proposed in DSM-III.

Keywords

Bereavement exclusion criteriadepressionDSM-IIIhistory
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 16 , December 2018 , pp. 2794 - 2803
Copyright
Copyright © Cambridge University Press 2018 

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