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The Case of Mr A Mr A is a 73-year-old man whose wife of 50 years died 5 weeks previously. He has no appetite, has lost 8 lb in the past month, consistently awakens at 4 am, “can’t think straight,” and no longer takes any pleasure in customary activities. He denies feelings of guilt or worthlessness. Although he denies suicidal intent, he confides that he wishes to join his dearly departed wife. When discussing his wife, he shows moderate psychomotor agitation and spends most days mindlessly sitting in front of his television. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR),1 Mr A does not have a psychiatric condition; consequently, treatment with antidepressants or formal psychotherapy is not indicated. Mr A would be assigned the V-code, bereavement, and reassured that nothing is wrong. However, according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10),2 Mr A has major depressive disorder (MDD). Ostensibly, decisions about treatment would be made just as they would after any other, non–bereavement-related, episode of MDD. The question to be addressed in the following discussion is whether the best available evidence more strongly supports the DSM-IV-TR or the ICD-10.

Bereavement, Complicated Grief, and DSM, Part 1: Depression