Complicated grief and related bereavement issues for DSM-5

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.

Psychologic prediction of duration of inpatient spinal cord injury rehabilitation and performance of self-care

The Beck Depression Inventory (BDI), the Derogatis Symptom Check List (SCL-90) and a short form of the Minnesota Multiphasic Personality Inventory (MMPI-168) were administered to 28 spinal cord injury (SCI) patients on admission to an inpatient rehabilitation program. Of the several psychologic measures derived from this battery of tests, measures of distress/depression predicted both duration of inpatient rehabilitation and performance of self-care of bladder and skin at discharge. Based on follow-up an average of 7 months post-discharge, the best predictor of future self-care behavior seems to be past self-care behavior, augmented by knowledge of personality tendencies. Results emphasize the importance of minimizing patient distress during SCI inpatient rehabilitation and suggest that, for some patients, psychologic intervention following discharge directed at modifying certain personality features may facilitate continued performance of critical self-care behaviors.