Prolonged Grief: Where to After DSM-5

Prolonged Grief in ICD-11

In contrast to the view taken by DSM-5, ICD-11 is proposing a separate diagnosis that recognizes prolonged grief. This diagnosis, tentatively termed prolonged grief disorder, is defined as persistent and severe yearning for the deceased, and can be associated with difficulty accepting the death, feelings of loss of a part of oneself, anger about the loss, guilt or blame regarding the death, or difficulty in engaging with new social or other activities due to the loss. To meet diagnostic criteria, the symptoms need to persist beyond 6 months after the death and lead to functional disturbance.^[40] It is important to note that ICD-11 has a wider audience than DSM-5 insofar as medical and psychiatric policy and practice in most countries in the world is influenced more by the WHO's system than by that of the American Psychiatric Association. Grief is of special concern to the mission of the WHO because many countries who rely on ICD are frequently affected by disaster, war, conflict, and widespread disease and mortality. Accordingly, a system by which affected individuals can be identified and assisted is highly relevant to these settings. It is also likely that if ICD-11 does formally introduce this new diagnosis (due for confirmation and release in 2015), researchers and clinicians will rely more on ICD-11 than DSM-5 in terms of standardizing the international definition of prolonged grief.

In terms of impacting clinical practice, it is likely that the dissemination of the PGD diagnosis via ICD-11 will promote accurate identification of distressed bereaved people whose primary disturbance arises from persistent yearning for the deceased. At present, it is probable that many of these people are incorrectly diagnosed with depression or anxiety conditions. By facilitating accurate classification of these cases as PGD, it may both promote the need for these people to receive treatment and also direct them to appropriate treatments. As noted above, there is initial evidence that antidepressant medication does not address the symptoms of grief effectively; in contrast, there is increasing evidence that grief-focused psychotherapy can be effective. The greater use of the PGD may both limit inappropriate antidepressant use and also facilitate targeted psychotherapeutic interventions that can assist people in resolving their persistent grief reactions.