Prolonged Grief

Where to After Diagnostic and Statistical Manual of Mental Disorders, 5th Edition?

Richard A. Bryant

Disclosures

Curr Opin Psychiatry. 2014;27(1):21-26. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Although there is much evidence for the construct of prolonged grief, there was much controversy over the proposal to introduce a prolonged grief diagnosis into Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and it was finally rejected as a diagnosis in DSM-5. This review outlines the evidence for and against the diagnosis, and highlights the implications of the DSM-5 decision.

Recent findings: Convergent evidence indicates that prolonged grief characterized by persistently severe yearning for the deceased is a distinct construct from bereavement-related depression and anxiety, is associated with marked functional impairment, is responsive to targeted treatments for prolonged grief, and has been validated across different cultures, age groups, and types of bereavement. Although DSM-5 has rejected the construct as a formal diagnosis, evidence continues to emerge on related mechanisms, including maladaptive appraisals, memory and attentional processes, immunological and arousal responses, and neural circuitry.

Summary: It is most likely that the International Classification of Diseases (ICD-11) will introduce a diagnosis to recognize prolonged grief, even though DSM-5 has decided against this option. It is probable that the DSM-5 decision may result in more prolonged grief patients being incorrectly diagnosed with depression after bereavement and possibly incorrectly treated. The DSM-5 decision is unlikely to impact on future research agendas.

Introduction

There was much fanfare leading up to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) regarding a proposed new diagnosis to describe persistent and severe grief reactions. In the final version of DSM-5, this diagnosis was relegated to the Appendix on the basis that there was insufficient evidence to have it recognized as a separate diagnosis. In this review, we will briefly outline the arguments for and against introducing the diagnosis, and speculate about the various reasons why this diagnosis has had such a difficult journey toward recognition. Then we will consider the impact of the DSM-5 approach, how it impacts on clinical practice and research, and finally how the International Classification of Diseases (ICD-11) is planning to tackle this issue.

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