Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity. (original) (raw)
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Journal of Abnormal Psychology
There is growing interest in complicated grief reactions as a possible new diagnostic category for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. However, no research has yet shown that complicated grief has incremental validity (i.e., predicts unique variance in functioning). The authors addressed this issue in 2 studies by comparing grief, depression, and posttraumatic stress disorder (PTSD) symptoms with different measures of functioning (interviewer ratings, friend ratings, self-report, and autonomic arousal). The 1st study (N ϭ 73) used longitudinal data collected at 4 and 18 months postloss, and the 2nd study (N ϭ 447) used cross-sectional data collected 2.5-3.5 years postloss. With depression and PTSD controlled, grief emerged as a unique predictor of functioning, both crosssectionally and prospectively. The findings provide convergent support for the incremental validity of complicated grief as an independent marker of bereavement-related psychopathology.
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 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
Complicated grief as a stress response disorder: evaluating diagnostic criteria in a German sample
Journal of Psychosomatic Research, 2005
Background: Complicated grief has been described as a diagnosis candidate for DSM-V. On the basis of the stress response theory, Horowitz et al. [Am J Psychiatry 154 (1997) 904 -10] characterized complicated grief as a combination of sustained intrusion, avoidance, and maladaptation symptoms following the loss of a close person. This study aimed at evaluating diagnostic criteria based on the stress response model of complicated grief. Methods: We administered a symptom list derived from Horowitz et al.'s operationalization to a sample of bereaved persons and evaluated the psychometric properties of the symptom criteria and symptom category subscales. Using this symptom list and other self-report measures of psychopathology and normal grief reactions, we examined a German sample consisting of 75 participants who had lost either siblings, children, parents, or spouses, on average, 5.4 years prior to the study. Results: Analyses confirmed the classification of symptoms into intrusion, avoidance, and failure-to-adapt categories with only minimal reordering (two symptom criteria). The symptom category subscales showed favourable psychometric characteristics, receiver operating characteristic ( ROC) analyses indicated high diagnostic accuracy of the symptom criteria, and predictive validation revealed a meaningful correlational pattern to standard measures of divergent psychopathology and normal grief reactions. Conclusions: The application of a stress response operationalization of complicated grief is supported. D
The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief
Comprehensive Psychiatry, 2007
Background: Complicated grief (CG), variously called pathological or traumatic grief, is a debilitating syndrome that is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) nomenclature. One issue that remains under debate is whether this condition can be clearly distinguished from other psychiatric disorders, such as major depression and posttraumatic stress disorder, with which CG frequently coexists. Methods: Using a structured clinical interview for CG and the Structured Clinical Interview for DSM-IV, trained experienced raters conducted careful diagnostic assessments of individuals seeking treatment of bereavement-related distress. All study participants met criteria for a current CG syndrome. Liberal criteria were used to diagnose DSM-IV disorders, making no attempt to decide if symptoms could be explained by grief. Results: Of 206 who met the criteria for CG, 25% had no evidence of a current DSM-IV Axis I disorder. When present, psychiatric comorbidity was associated with significantly greater severity of grief; however, even after adjustment for the presence of comorbidity, severity of CG symptoms was associated with greater work and social impairment. Limitations: It is likely that our study underestimated the rate of CG without comorbidity because fewer DSM diagnoses would have been made if a judgment about grief had been taken into consideration. Conclusions: Our data provide further support for the need to identify CG as a psychiatric disorder.
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.
Prevalence and determinants of complicated grief in general population
2010
Background: Few epidemiological studies have examined complicated grief in the general population, especially in Asian countries. Therefore, this study aimed to explore the prevalence and predictors of complicated grief among community dwelling individuals in Japan. Methods: A questionnaire survey regarding grief and related issues was conducted on community dwelling individuals aged 40-79 who were randomly sampled from census tracts. Complicated grief was assessed using the Brief Grief Questionnaire. Stepwise logistic regression analysis was conducted in order to identify predictors of complicated grief. Results: Data from 969 responses (response rate, 39.9%) were subjected to analysis. The analysis revealed 22 (2.4%) respondents with complicated grief and 272 (22.7%) with subthreshold complicated grief. Respondents who were found to be at a higher risk for developing complicated grief had lost their spouse, lost a loved one unexpectedly, lost a loved one due to stroke or cardiac disease, lost a loved one at a hospice, care facility or at home, or spent time with the deceased everyday in the last week of life. Limitations: Limitations of this study include the small sample size, the use of self-administered questionnaire, and the fact that the diagnoses of complicated grief were not based on robust diagnostic criteria. Conclusions: The point prevalence of complicated grief within 10 years of bereavement was 2.4%. Complicated grief was maintained without significant decrease up to 10 years after bereavement. When subthreshold complicated grief is included, the prevalence of complicated grief boosts up to a quarter of the sample, therefore, routine screening for complicated grief among the bereaved is desired. Clinicians should pay particular attention to the bereaved families with abovementioned risk factors in order to identify people at risk for future development of complicated grief.
Diagnostic criteria for complicated grief disorder
The American journal of psychiatry, 1997
Some prolonged and turbulent grief reactions include symptoms that differ from the DSM-IV criteria for major depressive disorder. The authors investigated a new diagnosis that would include these symptoms. They developed observer-based definitions of 30 symptoms noted clinically in previous longitudinal interviews of bereaved persons and then designed a plan to investigate whether any combination of these would serve as criteria for a possible new diagnosis of complicated grief disorder. Using a structured diagnostic interview, they assessed 70 subjects whose spouses had died. Latent class model analyses and signal detection procedures were used to calibrate the data against global clinical ratings and self-report measures of grief-specific distress. Complicated grief disorder was found to be characterized by a smaller set of the assessed symptoms. Subjects elected by an algorithm for these symptoms patterns did not significantly overlap with subjects who received a diagnosis of maj...