Complicated Grief: A Conceptual Analysis of the Field (original) (raw)

A case for establishing complicated grief as a distinct mental disorder in DSM-V

Clinical Psychology Review, 2004

In this paper, we contend that complicated grief (CG) constitutes a distinct psychopathological diagnostic entity and thus warrants a place in standardized psychiatric diagnostic taxonomies. CG is characterized by a unique pattern of symptoms following bereavement that are typically slow to resolve and can persist for years if left untreated. This paper will demonstrate that existing diagnoses are not sufficient, as the phenomenology, risk factors, clinical correlates, course, and outcomes for CG are distinct from those of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and adjustment disorder (AD). It is argued that the establishment of CG as a diagnostic entity is essential because its symptoms are associated with enduring mental and physical health morbidity and require specifically designed clinical interventions. We conduct a critical review of all published evidence on this topic to date, demonstrating that the advantages of standardizing the diagnostic criteria of CG outweigh the disadvantages. In addition, recommendations for future lines of research are made. This paper concludes that CG must be established in the current nosology to address the needs of individuals who are significantly suffering and impaired by this disorder. D

The Diagnosis of Complicated Grief as a Mental Disorder: A Critical Appraisal

Psychologica Belgica, 2010

In recent years, research on grief complications has focused on the development and validation of Complicated Grief diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Even though research has shown that complicated grief is a disorder distinct from other psychiatric disorders such as PTSD and MDD, there are still concerns about the validation and conceptualisation of the proposed criteria. In this article, we review findings and different concepts with regard to complicated grief. Key issues are the currently proposed diagnostic criteria, differentiation between traumatic and non-traumatic bereavement, and relational aspects of the grief process.

A Call to the Field: Complicated Grief in the DSM-5

OMEGA--Journal of Death and Dying, 2012

While complicated grief has been addressed in part through some recommendations for modifications in the upcoming fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there remain reasons for substantial concern about its scope therein and within clinical practice. The authors issue a call to the field, reiterating that complicated grief is 251 Ó 2012, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/OM.65.4.a http://baywood.com complicated and cannot be confined to just one syndrome or disorder. Continued research is urged, and specific caveats are identified for exploring the complex dimensions of loss and grief. The authors advocate for ongoing dialogue about and investigation of various potential forms of complicated grief.

An overview of complicated grief terminology and diagnostic criteria

Grief Matters: The …, 2006

This article sets the scene for the current debate on the concept of complicated grief. Issues identified with diagnosis of individuals with complicated grief include concerns about misuse of the term, distinctions between normal and complicated grief and fears regarding stigmatisation associated with potential DSM-V classification of complicated grief. Use of the term as described by Prigerson and colleagues reflects current best evidence, addresses concerns related to definitional error and would assist in progressing research and clinical practice in a more consistent manner if this were used by clinicians, researchers, health policy makers and educators. Such progress will be further assisted when consensus on the diagnostic criteria for complicated grief is achieved.

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

Depression and Anxiety, 2020

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 that 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 identifying this condition. We review the state of diagnostic criteria for DSM-5 and the current ICD-11 diagnostic guideline, highlighting the clinical relevance of making this diagnosis.

Grief and the new DSM-5 clinical category: A narrative review of the literature

Mediterranean Journal of Clinical Psychology, 2019

Aim: Grief is a common reaction to loss and it is considered a physiological and instinctive response. The "normal" grief evolves into an "integrated" phase within one year from death, and it is a non-pathological condition, that does not require specific therapeutic interventions. When this “integrated phase” does not occur, the subject could reach pathological manifestations related to the grief. The Persistent Complex Bereavement Disorder (PCBD) was proposed as a new category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. PCBD is a new clinical category characterized by symptoms related to the detachment and to the post-traumatic distress and it differs from normal and uncomplicated grief, for the disability caused by these reactions and their persistence and pervasiveness. Method: We examined reviews and studies of different researches done in the last twenty years, concerning the issues of loss, "normal" and "compli...

Bereavement, complicated grief, and the rationale for diagnosis in psychiatry

Dialogues in clinical neuroscience, 2012

Recent controversies over the DSM-5 raise a foundational question for all diagnostic classifications: what is their underlying purpose? The author raises this question in the context of the proposed elimination of the "bereavement exclusion" from the DSM-5; and the possible addition of the category called "Complicated Grief." The author argues that our psychiatric diagnostic scheme should not be aimed primarily at establishing boundaries among putative "natural types." Rather, it ought to be guided by the principle of "instrumental validity, " which focuses on reducing the suffering and incapacity of those who seek our care. In so far as the category of "Complicated Grief" helps achieve this goal, it will foster the humane and ethical values that underlie medical practice.

Grief and mourning gone awry: pathway and course of complicated grief

Dialogues in clinical neuroscience, 2012

Complicated grief is a recently recognized condition that occurs in about 7% of bereaved people. People with this condition are caught up in rumination about the circumstances of the death, worry about its consequences, or excessive avoidance of reminders of the loss. Unable to comprehend the finality and consequences of the loss, they resort to excessive avoidance of reminders of the loss as they are tossed helplessly on waves of intense emotion. People with complicated grief need help, and clinicians need to know how to recognize the symptoms and how to provide help. This paper provides a framework to help clinicans understand bereavement, grief, and mourning. Evidence-based diagnostic criteria are provided to help clinicians recognize complicated grief, and differentiate it from depression as well as anxiety disorder. We provide an overview of risk factors and basic assumptions and principles that can guide treatment.

What is complicated grief? A social constructionist answer

Research into complicated grief assumes that it is a psychological disorder of the grieving individual. This article suggests seven other things that complicated grief may also be: a normalizing construct of psychiatric medicine, an operational requirement of bereavement agencies, a concept by which society as a whole and families can discipline mourning members, a label applied to those who actively resist cultural norms about grief, a product of a society obsessed with risk, and the result of negotiation between various parties in the bereavement field. If complicated grief exists, it is much more multi-faceted than is usually acknowledged.