Highlights of Changes From DSM-IV to DSM-5 811
“with mixed features.” In DSM-IV, there was an exclusion criterion for a major depressive ep-
isode that was applied to depressive symptoms lasting less than 2 months following the death
of a loved one (i.e., the bereavement exclusion). This exclusion is omitted in DSM-5 for several
reasons, including the recognitio n that bereavement is a severe psychosocial stressor that can
precipitate a major depressive episode in a vu lnerable individual, generally beginning soon
after the loss, and can add an additional risk for suffering, feelings of worthlessness, suicidal
ideation, poorer medical health, and worse interp ersonal and work functioning. It was critical
to remove the implication that bereavement ty pically lasts only 2 months, when both physi-
cians and grief counselors recognize that the duration is more commonly 1–2 years. A detailed
footnote has replaced the more simplistic DSM- IV exclusion to aid clinicians in making the
critical distinction between the symptoms characteristic of be reavement and those of a major
depressive disorder. Finally, a new specifier to  indicate the presence of mixed symptoms has
been added across both the bipo lar and the depressive disorders.
Anxiety Disorders
The chapter on anxiety disorders no longer includes obsessive-compulsive disorder (which
is in the new chapter “Obsessive-Compulsiv e and Related Disorders”) or posttraumatic
stress disorder (PTSD) and acut e stress disorder (which are in the new chapter “Trauma-
and Stressor-Related Disorders”). Changes in criteria for specific phobia  and social anxiety
disorder (social phobia)  include deletion of the requirement that individuals over age 18
years recognize that their anxiet y is excessive or unreasonable . Instead, the anxiety must be