how quickly we forget…

Posted on Saturday 25 February 2012

Were I reading this, I might think, "There he goes again, being boring, talking against removing the bereavement exclusion from the MDD criteria in the DSM-5. Hasn’t he said enough about that?!" But then I’d look at who wrote these articles, and it would be a lot clearer why they’re posted here:
Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses.
by Prigerson HG, Frank E, Kasl SV, Reynolds CF 3rd, Anderson B, Zubenko GS, Houck PR, George CJ, and Kupfer DJ.
American Journal of Psychiatry. 1995 152[1]:22-30.

OBJECTIVE: This study sought to determine whether a set of symptoms interpreted as complicated grief could be identified and distinguished from bereavement-related depression and whether the presence of complicated grief would predict enduring functional impairments.
METHOD: Data were derived from a study group of 82 recently widowed elderly individuals recruited for an investigation of physiological changes in bereaved persons. Baseline data were collected 3-6 months after the deaths of the subjects’ spouses, and follow-up data were collected from 56 of the subjects 18 months after the baseline assessments. Candidate items for assessing complicated grief came from a variety of scales used to evaluate emotional functioning [e.g., the Hamilton Depression Rating Scale, the Brief Symptom Inventory]. The outcome variables measured were global functioning, medical illness burden, sleep, mood, self-esteem, and anxiety.
RESULTS: A principal-components analysis conducted on intake data [N = 82] revealed a complicated grief factor and a bereavement-depression factor. Seven symptoms constituted complicated grief: searching, yearning, preoccupation with thoughts of the deceased, crying, disbelief regarding the death, feeling stunned by the death, and lack of acceptance of the death. Baseline complicated grief scores were significantly associated with impairments in global functioning, mood, sleep, and self-esteem in the 56 subjects available for follow-up.
CONCLUSIONS: The symptoms of complicated grief may be distinct from depressive symptoms and appear to be associated with enduring functional impairments. The symptoms of complicated grief, therefore, appear to define a unique disorder deserving of specialized treatment.
Consensus criteria for traumatic grief. A preliminary empirical test.
by Prigerson HG, Shear MK, Jacobs SC, Reynolds CF 3rd, Maciejewski PK, Davidson JR, Rosenheck R, Pilkonis PA, Wortman CB, Williams JB, Widiger TA, Frank E, Kupfer DJ, and Zisook S.
British Journal of Psychiatry. 1999 174:67-73.

BACKGROUND: Studies suggest that symptoms of traumatic grief constitute a distinct syndrome worthy of diagnosis.
AIMS: A consensus conference aimed to develop and test a criteria set for traumatic grief.
METHOD: The expert panel proposed consensus criteria for traumatic grief. Receiver operator characteristic (ROC) analyses tested the performance of the proposed criteria on 306 widowed respondents at seven months post loss.
RESULTS: ROC analyses indicated that three of four separation distress symptoms (e.g. yearning, searching, loneliness) had to be endorsed as at least ‘sometimes true’ and four of the final eight traumatic distress symptoms (e.g. numbness, disbelief, distrust, anger, sense of futility about the future) had to be endorsed as at least ‘mostly true’ to yield a sensitivity of 0.93 and a specificity of 0.93 for a diagnosis of traumatic grief.
CONCLUSIONS: Preliminary analyses suggest the consensus criteria for traumatic grief have satisfactory operating characteristics, and point to directions for further refinement of the criteria set.
You guessed it! They were written by Dr. David Kupfer, head of the DSM-5 Revision Task Force – the very group that is trying to remove the bereavement exclusion. And it wasn’t that long ago. How quickly we forget saner days…
Hat Tip to Secret Santa
    February 25, 2012 | 4:47 PM

    Can’t help but wonder if Dr. Kupfer has ever had to endure a traumatic bereavement; wonder if he’d want to be “treated”.

    Joel Hassman, MD
    February 25, 2012 | 7:23 PM

    Maybe psychiatry is just projecting it’s own grief how far down the profession has tumbled and just trying to validate it at the expense of the public it was supposed to serve. Well, let’s look at Kubler Ross’s process, shall we:
    Shock, denial, rage/anger, depression, and then acceptance, if I am correct.

    Only, the profession is just stuck in the denial stage, endless loop. Would love to see some of that rage/anger, but, that could be ugly with some of the folk we have as alleged leaders, eh?

    Joel Hassman, MD
    February 25, 2012 | 10:32 PM

    Forgot bargaining per the K-R process, my mistake. Maybe that was a freudian slip on my part, after all, aren’t my colleagues trying to bargain their way out of dealing with loss? Man, how many more times will they think they can just write for a magic pill?

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