“Prolonged Grief Disorder” to be Considered a New DSM Diagnosis

At their October 2020 meeting, the Board of Trustees of the American Psychiatric Association acknowledged “Prolonged Grief Disorder” as a DSM-diagnosed disorder. It was announced that the diagnosis would be included in the updated version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

Grief Disorder

Grief Disorder was included in the Persistent-Complex Bereavement Disorder (PCBD) category, under the heading “conditions that require further studies”, in the third chapter of the DSM-5. In 2018, based on the new data obtained, a proposal was submitted in order to include this category in the “DSM-diagnosed mental disorders” chapter (Chapter II) of the manual, and the offer was assessed by the DSM Executive Committee and the Committee for Analyzing Internalizing Disorders. In order to reach a consensus regarding the proper criteria for diagnosis, a workshop was held in New York, in June 2019. The criteria were finalized later in 2019, and they were made known publicly in order to receive public comments on the matter, following the approval of the criteria by the DSM Executive Committee in last January. They were eventually approved by the Executive Committee in August.

What is Prolonged Grief Disorder? What Criteria Separate this Disorder from Typical Grief?

Prolonged Grief Disorder was included in the International Classification of Diseases (ICD-11) by the World Health Organization (WHO) in 2018. In order for an individual to be diagnosed with Prolonged Grief Disorder based on the definition given there, one must be showing various reactions of grief as an indicator of the intense emotional pain for at least six months following the loss experienced, and the longing that one has for the deceased, and the cognitive absorption must become permanent and prevalent.

What is Typical Grief?

Grief, though it is a painful situation, is a normal process through which one keeps on living the new period of life without the presence of a loved one. A great many of those left behind manage to survive the worst of their grief, and they keep functioning and finding a meaning in life. Typical grief is not as intense, persistent, damaging, and life-changing as Prolonged Grief Disorder. The one left behind does not experience this situation as a serious threat to his safety or to his hopes for happiness in the future. Even though the state of being mournful is observed in the person left behind for a while, this condition loses its feature of deteriorating daily life in time.

What criteria of Prolonged Grief Disorder are to be included in the current edition of DSM?

1. The fact that at least 12 months have passed following the death of a relative of the person (at least 6 months for children);
2. A permanent reaction of grief that is characterized by one or two of the following symptoms, after the loss; Additionally, reactions occurring almost every day for the past one month at the least:
   • An intense longing for the deceased;
   • Being absorbed in the thoughts and memories of the deceased (in children and adolescents, the absorption can focus on the conditions of death)
3. At least 3 of the following symptoms being present after the death. Additionally, symptoms occurring almost every day for the past one month at the least:
   • Identity disorder occurring after the death (e.g. Feeling like a part of oneself has died)
   • A distinct sense of death-related insecurity
   • Abstaining from recalling the death of the person (in children and adolescents, it can be characterized by the attempts of avoiding reminders)
   • An intense, death-related pain (for instance, anger, pain, sorrow)
   • Difficulties in readapting to the relationships and activities of the person after the death (for instance, problems in establishing relations with friends, problems in pursuing hobbies, or in making plans for the future)
   • An emotional numbness as a result of the death (absence of or an apparent decline in emotional experience)
   • Feeling that life is meaningless as a result of the death
   • An intense loneliness as a result of the death
4. The fact that the disorder causes impairments in social, professional, or other significant fields of functioning.
5. The duration and seriousness of the person’s reaction of grief being higher than the social, cultural, or religious norms of the culture that the person lives in.
6. The fact that the symptoms cannot be explained better with major depressive disorder, post-traumatic stress disorder, or another mental disorder. The fact that it cannot be attributed to the physiological effects of a substance (e.g. drugs, alcohol), or of another medical condition.

What can be the results of Prolonged Grief Disorder being a DSM-diagnosed disorder?

The clinicians, working in the field, are telling that diagnosing the grief problem as per the DSM, would make significant contributions. Researching the prevalence of the disorder in the society, as well as the underlying mechanisms of the problem, and developing practices to prevent or cure the disorder, are some of those contributions. The authors foresee that these studies would improve the limited literature on this subject matter, making it more generalizable at the same time. Even though the diagnosis of an established DSM-5 disorder could pose a risk of stigmatization for the diagnosed individuals, the fact that it encourages the identification and provision of the care aimed for a significant minority of people grieving after a death as well as having the need for help, demonstrates that a systematic diagnosis of Prolonged Grief Disorder could yield social advantages as well.