DSM-5 Danger: What Happens to Your Anxious Child when ‘Normal’ Grief becomes Clinical Depression

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Grief as depression

Read our full guide to the 2013 DSM-5 by clicking here.

 

The next time you or your anxious child is grieving for the loss of a loved one – or even a pet – you better make sure to wrap up that grieving within a two week period. Otherwise things can just go downhill from there, thanks to the current ruling in the soon-to-be released DSM-5.

For those not in the know, the DSM-5 is the latest version of the Diagnostic and Statistical Manual of Mental Disorders, also known as the psychiatry “bible.” Classifications within this “bible” dictate what type of conditions qualify as official mental health issues versus “normal” reactions and emotions to everyday living.

The classification of what was once “normal” grief, and may still be normal grief following the loss of a loved one, has been changed to “clinical depression” if the grief lasts more than two weeks. Fourteen days is a heck of a short period of time to halt all bereavement, especially the bereavement of a child already suffering from anxiety. But if the grief is not neatly tucked away after that period, you and your anxious kid may be labeled with clinical depression.

‘The Label’

Freely doling out the clinically depressed label for those undergoing normal bereavement has the power to immediately achieve two ends.

  • It makes people who suffered a loss or trauma and are having a normal emotional response feel abnormal and worse.
  • It bursts the door wide open for pharmaceutical companies to market drugs to people who are simply grieving the loss of a loved one or other tragedy and for docs to prescribe them unnecessarily.

Are you and your anxious son still sad about your departed dog one month after his death? Why not pop a pill, or several hundred, so you can treat this here “clinical depression.”

The Drug Ties

Over-medication is already under fire, especially when it comes to anxious children, and the bereavement ruling in the DSM-5 only serves as one more arena for physicians to engage in it. As The Washington Post reports, the U.S. antidepressant market is already a $10 billion industry, which is a heck of a lot of medications already making the rounds.

The Post additionally points out the American Psychiatric Association, which issues the handbook, relies in part on funding from the industry for its very existence. Key players responsible for the bereavement change also have strong industry affiliations. Although the Institute of Medicine in 2009 recommended limits on the affiliations for the sake of objectivity, The Post notes those limits “far exceed” the recommendation.

In fact, the committee member who actually wrote the scientific justification for the bereavement change doubled as the main author of a study that suggested the antidepressant Wellbutrin is a highly effective means for treating bereavement.

The Post leaves no bones about the dangerous ground the revised classification has appeared to enter: 

“The (Institute of Medicine) limits reflect the fear that patient health could be compromised when diagnostic and treatment guidelines, which are widely used by doctors, are written largely by industry-hired experts and issued by medical societies that depend on industry funding.” 

The Diagnosis 

 Another concern is the labeling of perfectly “normal” reactions as something mentally unsound that requires extensive medication or other treatments – and how to make that determination. Although the DSM-5 and other versions of the handbook do not outline treatment methods that should be used, the mere existence of a condition in the guide gives it a green light as something that should be treated.

Distinguishing between bereavement and depression can be a tough call, as noted by Russell Friedman. As the co-founder of The Grief Recovery Institute Educational Foundation and co-author of two grief recovery books, one involving children, Friedman may have a good handle on the difference between the two. Here’s a quote from him posted at Psychology Today: 

“Not even the best trained clinicians can distinguish grief from mild depression. And a totally untrained and ill-equipped GP, in his 6-8 minute consultation with the new widow or widower, might as well be blindfolded and throw darts at targets marked MDE or Normal Grief, while prescribing unnecessary meds that will bury the griever’s feelings- where they will likely fester.” 

Dangerous ground indeed. 

The Bottom Line 

Being aware of the bereavement change, which will hit doctors’ desks in May when the updated handbook is released, is the first step in protecting yourself and your anxious child from the fall out that may ensue. It may be a tough decision on whether or not to seek outside help if you or your anxious kid is, in fact, having a difficult time coping with a loss, but at least you will know one of the avenues that may await you if you do. Grieving is never straightforward, clear-cut or easy, and the change in the DSM-5 seems to serve as a way to complicate it further.

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{ 2 comments… read them below or add one }

Minibus Hire Hemel Hempstead September 5, 2014 at 9:41 pm

Hey there! This is my 1st comment here so I just
wanted to give a quick shout out and tell you I really enjoy reading through your posts.
Can you recommend any other blogs/websites/forums that cover the same subjects?
Thank you so much!

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Patricia February 18, 2016 at 10:25 pm

if it’s not a death you’re grieving, you liekly have no ritual to support you at all? Thank you for saying that, and for the acknowledgement that sometimes grief is for other reasons. Both of my sons (they are 19 & 21) attempted suicide within 6 weeks of each other this spring. I have been grieving, angry, scared and slowly am become grateful that neither of them succeeded and that they are both moving forward. And that I too can start to move forward again. But very few people understand my need to grieve, and to process the trauma of it. Your writing is beautiful. Thank you for sharing your loss and growth and the story of Benjamin with all of us.

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