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

Conclusion

What are the key directions for future research in prolonged grief? As research into the condition is relatively new, there is much we do not know. At a phenomenological level, we need to acknowledge that yearning may not be at the core for all cases of prolonged grief. One study suggests that 11.5% of distressed bereaved people do not report yearning,[44] and so further work is needed to understand the variability, and possibly subtypes, of prolonged grief. There is also a need to understand the relative roles of avoidance and approach in prolonged grief. Whereas traditional views of grief mourning have argued that avoidance is inherently maladaptive, more recent findings suggest that avoiding may be beneficial for grieving.[45] In terms of distinguishing the mechanisms of prolonged grief and avoidance-based anxiety disorders, understanding the role of avoidance is critical. We also understand little about genetic influences, development differences across the lifespan, and neural circuitry. Recent models of prolonged grief have recognized the broad variety of factors that can contribute to prolonged grief, as well as the factors that are lacking in the current evidence base.[46] Finally, there is an urgent need to optimize the treatment of prolonged grief. Although there is tentative evidence for the efficacy of antidepressants in ameliorating the bereavement-related depression and grief symptoms, we still lack randomized controlled trials for evidence of pharmacological treatment of prolonged grief.[47,48] Considering the documented impairments associated with prolonged grief, it is important that these research agendas continue despite the current lack of diagnostic guidance.

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