Content overlap analyses of ICD-11 and DSM-5 prolonged grief disorder and prior criteria-sets

Abstract

Background The International Classification of Diseases eleventh edition (ICD-11) has recently included prolonged grief disorder (PGD), a diagnosis characterized by severe, persistent, and disabling grief. The text revision of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5-TR) is scheduled to include a similar but distinct diagnosis, also termed PGD. Concerns have been raised that these new diagnoses are qualitatively different from both prior proposed diagnoses for pathological grief and each other, which may affect the generalizability of findings obtained with different criteria sets. Objective We conducted a content overlap analysis of PGD ICD-11 , PGD DSM-5-TR , and previous proposals for pathological grief diagnoses (i.e. PGD 2009; complicated grief (CG), PGD ICD-11 beta draft, persistent complex bereavement disorder (PCBD) per DSM-5). Methods Using the Jaccard’s Index, we established the degree of content overlap between core and accessory symptoms of PGD ICD-11 , PGD DSM-5-TR , and prior proposals for pathological grief diagnoses. Results Main findings are that PGD ICD-11 and PGD DSM-5-TR showed moderate content overlap with each other and with most prior proposed diagnoses for pathological grief. PGD ICD-11 and PGD DSM-5-TR showed the strongest content overlap with their direct predecessors, PGD ICD-11 beta draft and PCBD, respectively. Conclusions Limited content overlap between PGD ICD-11 and PGD DSM-5-TR and preceding criteria sets may threaten generalizability of past research on phenomenological characteristics of pathological grief to current criteria sets. Similarly, findings obtained with instruments to assess PGD ICD-11 may not generalize to PGD DSM-5-TR and vice versa. Researchers should aim to determine under which circumstances criteria sets for PGD yield similar or distinct characteristics. Convergence of criteria sets for PGD remains an important goal for the future.

Prolonged grief disorder in ICD-11 and DSM-5-TR: Challenges and controversies

“…However, the history of PGD is non-linear: past proposals did not systematically build on each other to logically culminate in current diagnoses. Instead, previous proposals show substantial differences in symptom count and content, time (since loss) criteria and diagnostic algorithms compared to current PGD criteria sets (Eisma et al, 2020(Eisma et al, , 2022Lenferink et al, 2021;Stelzer et al, 2020b). Consequently, frequently used measures for prolonged grief symptoms, such as the Inventory of Complicated Grief (ICG) and the Prolonged Grief Scale 13 (PG-13), do not comprehensively assess PGD per ICD-11 or DSM-5-TR (Lenferink et al, 2022;O'Connor et al, 2020;Treml et al, 2020).…”

Co-occurrence of approach and avoidance in prolonged grief: a latent class analysis

“…While these diagnoses share certain similarities with prior proposed grief disorders and each other, they are also qualitatively different (for discussions: e.g. Boelen et al, 2020 ; Eisma et al, 2020a , 2022 ; Lenferink et al, 2021 ). For example, core symptoms of both versions of PGD are severe and persistent yearning and cognitive preoccupation with the deceased, but accessory symptoms show similarities and differences.…”

“…We considered symptoms of both types of PGD as a type of sensitivity analysis, since there are some differences between the two current versions of PGD (e.g. in number of symptoms and symptom content), which may imply that their phenomenological characteristics differ (Eisma et al, 2022 ).…”

Do early symptoms of prolonged grief disorder lead to symptoms of posttraumatic stress disorder and depression? A longitudinal register-based study of the two first years of bereavement.

“…PGD is characterized by intense yearning/longing for and persistent preoccupation with the deceased in an atypically long period following the loss, which is defined as more than 6 months in the 11th revision of the International Classification of Diseases (ICD-11; World Health Organization, 2023) and more than 12 months in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (Prigerson et al, 2021). Although different diagnostic criteria set for PGD exist, they include the same core symptoms (e.g., yearning) but with some variations in associated symptoms (Eisma et al, 2022). The present study focuses on the ICD-11 conceptualization of PGD, which consists of core symptoms and associated emotional pain related to the loss (e.g., guilt, anger; World Health Organization, 2023).…”