Commentary on evidence in support of a grief‐related condition as a DSM diagnosis

Abstract

The death of a loved one is one of life's greatest stressors. Most bereaved individuals experience a period of acute grief that diminishes in intensity as they adapt to the changes brought about by their loss. Over the past four decades a growing body of research has focused on a form of prolonged grief that is painful and impairing. There is a substantial and growing evidence base supports the validity and significance of a grief-related disorder, including the clinical value of being able to diagnose it and provide effective targeted treatment. ICD-11 will include a new diagnosis of Prolonged Grief Disorder (PGD). DSM-5 called this condition Persistent Complex Bereavement Disorder (PCBD) and included it in Section III, signaling agreement that a diagnosis is warranted while further research is needed to determine the optimal criteria. Given the remaining uncertainties, reading this literature can be confusing. There is inconsistency in naming the condition (including complicated grief as well as PGD and PCBD) and lack of uniformity in identifying it, with respect to the optimal threshold and timeframe for distinguishing it from normal grief. As an introductory commentary for this Depression and Anxiety special edition on this form of grief, the authors discuss the history, commonalities, and key areas of variability in

ICD-11 Prolonged Grief Disorder Criteria: Turning Challenges Into Opportunities With Multiverse Analyses

“…For example, it is unclear if a higher item-score threshold should be used to indicate that someone experiences persistent and pervasive longing, as it is the most frequently reported experience in bereavement (22), and, as a consequence, one of the least sensitive criteria in distinguishing those with and without disturbed grief (14). Preoccupation with the deceased is also already being interpreted differently by influential researchers in the grief field, with some viewing it as intrusive images about the death (23), and others as a process similar to grief rumination (24). While imagery and rumination are related processes, they are dissimilar in phenomenal characteristics, such as their duration, sensory experiences, and emotional correlates (25).…”

“…For future research, we recommend multiverse analyses varying not only the algorithm, but additionally symptom interpretations of single-item criteria and cognitive preoccupation and cut-offs for the presence of the longing criterion. We also advise to substantially expand the current focus of multiverse analyses of PGD ICD-11 to establish the robustness of clinically-relevant findings (e.g., on treatment efficacy) and the variety of other aspects relevant to the validity of a diagnosis [for reviews: ( 13 , 24 )]. The latter includes - but is not limited to: reliability of classification [e.g., ( 31 )], the structure of symptoms [e.g., ( 32 )], distinctiveness from related disorders [e.g., ( 33 )], and relationships with functional impairment [e.g., ( 34 )].…”

Rising tide: Responding to the mental health impact of the COVID‐19 pandemic

“…For this pandemic, the phases will overlap for individuals depending on their roles and specific impacting traumatic exposures (traumatic loss of significant others, exposure to death at work, etc.). Further, grief responses generally occur on a longer timeline with current iterations of prolonged or complicated grief utilizing a 6‐ or 12‐month minimum for diagnosis to account for broad individual, cultural and religious variability in usual acute grief and its evolution to more integrated forms of grief (e.g., for recent commentary and treatment approaches see (Iglewicz et al, 2020; Simon et al, 2020).…”

Grief and Posttraumatic Growth Among Chinese Bereaved Parents Who Lost Their Only Child: The Moderating Role of Interpersonal Loss

“…Additionally, compared with a prevalence of PGD of about 10% in general bereaved people ( Lundorff et al, 2017 ), the prevalence rate in shidu parents was 35.5% ( Zhou et al, 2020 ). Although grief intensity may vary over time, grief would not go away entirely throughout shidu parents’ whole life ( Wei et al, 2016 ; Simon et al, 2020 ).…”