History and Status of Prolonged Grief Disorder as a Psychiatric Diagnosis

Abstract

Prolonged grief disorder (PGD) is a diagnostic entity now included in the International Classification of Diseases 11th Revision (ICD-11) and soon to appear in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). A characteristic feature of PGD is distressing, disabling yearning that persists a year or more after the loss. Other characteristic symptoms include disbelief and lack of acceptance of the loss, emotional detachment from others since the loss, loneliness, identity disturbance, and sense of meaninglessness. In this review, we detail psychiatric views on grief and their evolution over the twentieth century. We then discuss the development of diagnostic formulations for disordered grief, which culminated in PGD's status as a mental disorder in the DSM. After summarizing recent evidence that may suggest that PGD is linked to the neural reward system, we suggest further areas of research. In particular, we note the need for studies that extend the evidence base concerning PGD across cultural and sociodemographic boundaries and that investigate novel treatments. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 17 is May 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Prolonged grief disorder in DSM-5-TR: Early predictors and longitudinal measurement invariance

“…Regarding the first aim, we calculated the number of people meeting criteria for probable PGD caseness by considering ICG-R-items with a 4 or 5 response as 'symptom endorsed' and then counting the number of participants endorsing ⩾1 criterion B items, ⩾3 criterion C items and the functional impairment item (cf. Prigerson et al, 2021aPrigerson et al, , 2021b. We used data from Wave 2 considering that DSM-5-TR criteria require a year to pass before the PGD diagnosis can be set.…”

The Synthesis and Decoding of Meaning

“…In the absence of affect meaninglessness arises. Feelings that life is empty and meaningless is a common experience of persons with affective disorders (Nichols et al, 2021;Prigerson et al, 2021;Tolentino and Schmidt, 2018;Vanhooren, 2019). Furthermore, The Diagnostic and Statistical Manual of Mental Disorders-5 requires the presence of one of two major criteria, depressed mood or anhedonia, for a diagnosis of major depressive disorder with the presence of anhedonia shown to be indicative of a more severe case (Tolentino and Schmidt, 2018).…”

“…Furthermore, The Diagnostic and Statistical Manual of Mental Disorders-5 requires the presence of one of two major criteria, depressed mood or anhedonia, for a diagnosis of major depressive disorder with the presence of anhedonia shown to be indicative of a more severe case (Tolentino and Schmidt, 2018). Similarly, the presence of emotional numbness contributes to the diagnosis of prolonged grief disorder (Prigerson et al, 2021). Thus, the affective mental disorders forcefully bear out that meaninglessness is experienced in the presence of anhedonia (clinically, a loss of interest or pleasure) and the presence of emotional numbness (clinically, the absence or marked reduction of emotional experience).…”

Loneliness in Bereavement: Measurement Matters

“…Different sets of criteria for disturbed grief have been proposed (Boelen and Lenferink, 2020 ). In the forthcoming text revision of the 5th edition of the Diagnostic and Statistical Manual for Psychiatric Disorders (DSM-5-TR; American Psychiatric Association and Association, 2013 ; Prigerson et al, 2021 ), “Intense loneliness (i.e., feeling alone or detached from others) as a result of the death” is listed as a symptom among the criteria for Prolonged Grief Disorder (PGD). Similarly, “Loneliness” is one of the four separation distress symptoms of Complicated Grief (CG) proposed by Shear et al ( 2011 ).…”