New Criteria Can Help Clinicians Diagnose, Treat Prolonged Grief Disorder (2023)

New Criteria Can Help Clinicians Diagnose, Treat Prolonged Grief Disorder (1)

The addition of the diagnostic category prolonged grief disorder to DSM-5-TR is timely and important given the COVID-19 pandemic’s enormous death toll, wrote Holly Prigerson, Ph.D., of Weill Cornell Medicine and colleagues in a Viewpoint article published yesterday in JAMA Psychiatry. It is vital clinicians know how to identify pathological manifestations of grief and connect patients with proven treatments, notes Prigerson and her co-authors, psychiatrists Katherine Shear, M.D., of Columbia University and Charles F. Reynolds III, M.D., of the University of Pittsburgh Medical Center.

“[Prolonged grief disorder] is a serious mental disorder that puts the patient at risk for intense distress, poor physical health, shortened life expectancy, and suicide,” the authors wrote.

“The DSM-5-TR criteria for [prolonged grief disorder] require that distressing symptoms of grief continue for at least 12 months following the loss of a close attachment and that the grief response is characterized by intense longing/yearning for the deceased person and/or preoccupation with thoughts and memories of the lost person to a clinically significant (i.e., impairing) degree, nearly every day for at least the past month,” the authors continued. Patients must also experience symptoms such as feeling as though a part of oneself has died, intense emotional pain, emotional numbness, or feeling that life is meaningless because of the death.

The PG-13 Revised scale—a 13-item questionnaire that asks patients about the length of time since their loved one’s death and their symptoms of grief—can help to determine the severity of grief. A score of 30 or higher on the PG-13 Revised scale is consistent with a prolonged grief disorder diagnosis and may indicate treatment is needed.

Several studies suggest that patients with prolonged grief disorder may respond better to targeted therapy than to other therapies used to treat major depression (including citalopram and interpersonal therapy). Among 641 participants experiencing complicated grief, 71% of those treated with prolonged grief disorder therapy reported improvement on the Clinical Global Impression Scale compared with 44% of those who received either interpersonal psychotherapy or citalopram, the authors wrote.

Prolonged grief disorder therapy works under the central premise that, for patients with prolonged grief disorder, the coping responses typical of early grief—such as self-blame, avoidance, and anger—derail the naturally adaptive process of transforming and integrating grief, according to the authors. Prolonged grief disorder therapy helps the patient learn to accept his or her new reality and restore a sense of autonomy and competence. It includes seven themes, “or healing milestones,” the authors wrote, that are introduced sequentially:

  1. Understanding and accepting grief
  2. Managing grief emotions
  3. Seeing a promising future
  4. Strengthening relationships
  5. Narrating the story of death
  6. Living with reminders
  7. Connecting with memories

“Because of the pandemic, the absolute number of [prolonged grief disorder] cases is likely to increase and the 7% to 10% prevalence rate among … bereaved people may rise,” they wrote. “[C]linicians should learn how to accurately assess, to accurately and differentially diagnose, and to offer or refer patients for treatment.”

For related information, see the Psychiatric News article “Pandemic Takes Toll on Those Who Grieve.”

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What is the criteria for prolonged grief disorder? ›

For a diagnosis of prolonged grief disorder, the loss of a loved one had to have occurred at least a year ago for adults, and at least 6 months ago for children and adolescents.

Is there a new diagnosis called prolonged grief disorder in the DSM-5? ›

In the case of prolonged grief disorder, the duration of the person's bereavement exceeds expected social, cultural or religious norms and the symptoms are not better explained by another mental disorder. Prolonged grief disorder is the newest disorder to be added to the DSM.

What is the ICD 11 criteria for prolonged grief? ›

To meet PGDICD-11 criteria one needs to experience persistent and pervasive longing for the deceased and/or persistent and pervasive cognitive preoccupation with the deceased, combined with any of 10 additional grief reactions assumed indicative of intense emotional pain for at least six months after bereavement.

What is the best treatment for prolonged grief disorder? ›

Psychotherapy. Complicated grief is often treated with a type of psychotherapy called complicated grief therapy. It's similar to psychotherapy techniques used for depression and PTSD, but it's specifically for complicated grief. This treatment can be effective when done individually or in a group format.

What are the DSM-5 criteria for grief disorder? ›

Symptoms of Prolonged Grief Disorder DSM-5

A feeling of disbelief about the death. Avoiding reminders that the individual has passed. Intense emotional pain directly related to the loss. Trouble getting back to normal life.

What is the DSM-5 criteria for complicated grief? ›

DSM V PGD requires the occurrence of a persistent and pervasive grief response characterized by persistent longing or yearning and/or preoccupation with the deceased accompanied by at least 3 of 8 additional symptoms that include disbelief, intense emotional pain, feeling of identity confusion, avoidance of reminders ...

Is prolonged grief disorder billable? ›

F43. 81 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

How many months after the loss can a diagnosis of prolonged grief disorder not be given per the ICD-11? ›

The ICD-11 describes prolonged grief disorder as persistent and pervasive longing for, or preoccupation with, the deceased that lasts at least six months after loss.

What is another name for prolonged grief disorder? ›

Prolonged grief disorder (PGD), or complicated grief, can happen after a person close to you has died within at least 6 months (12 months for children and teens).

What is prolonged grief disorder DSM-5 ICD-11? ›

What is prolonged grief disorder? In the ICD-11, prolonged grief disorder is described as: History of bereavement following the death of a partner, parent, child, or other person close to the bereaved.

What is the ICD-10 code for prolonged grief disorder? ›

ICD-10 code F43. 81 for Prolonged grief disorder is a medical classification as listed by WHO under the range - Mental, Behavioral and Neurodevelopmental disorders .

Is prolonged grief disorder the same as complicated grief? ›

Prolonged Grief Disorder/Complicated Grief

Often these individuals suffer from Prolonged Grief Disorder (PGD) also known as Complicated Grief. Several risk factors have been identified that predispose individuals to developing PGD.

What is the criticism of prolonged grief disorder? ›

Critics say the diagnosis may pathologize normal behaviors like mourning and doesn't provide a solution to the problems that lead to severe grief.

What criteria do psychologists use to differentiate between major depressive disorder and normal grief? ›

DSM-5 criteria emphasize that in grief, the prevailing affect is one of emptiness, while MDD is marked by a long, sustained depressed mood and an inability to ever expect pleasure or happiness. Grief typically comes in waves that lessen in intensity and frequency over time, while a depressed mood is more persistent.

Who can diagnose complicated grief? ›

A healthcare provider will diagnose complicated grief if you experience symptoms of grief that: Affect your physical, mental and social health. Continue for at least one year after the loss happened for adults and six months for children or adolescents.

What is prolonged grief disorder PG 13 revised? ›

By definition, PGD is a maladaptive response to the death of a loved one characterized by a period of at least 12 months of persistent yearning for or preoccupation with the deceased and disabling symptoms such as disbelief about the death, avoidance, emotional numbness, identity disruption, intense emotional pain, ...

What is the difference between F43 81 and F43 89? ›

8, "Other reactions to severe stress," is being subdivided into two new codes — one to capture prolonged grief disorder (F43. 81) and another to capture the rest of what was otherwise reported under F43. 8 (F43. 89, “Other reactions to severe stress”).

What can I use instead of F43 8? ›

Which codes can I use instead of F43. 8? You can use F43. 81 or F43.

How many months are required to pass before prolonged grief disorder can be diagnosed in the DSM-5 TR? ›

In order to be sensitive to the concern expressed in the public commentary about pathologizing normal grieving and diagnosing a grief‐related disorder “too soon” after the death, the DSM‐5‐TR PGD criteria specify that 12 months must elapse since the death.

How long can delayed grief last? ›

Delayed grief occurs when the feelings associated with loss don't come for weeks, months, or even years after the event. Delayed grief can be hard to understand, and it's not often talked about.

How many years does it take to stop grieving? ›

There is no set length or duration for grief, and it may come and go in waves. However, according to 2020 research , people who experience common grief may experience improvements in symptoms after about 6 months, but the symptoms largely resolve in about 1 to 2 years.

How many grieving individuals per year are likely to be eligible for a prolonged grief disorder diagnosis in the US? ›

Prolonged grief disorder was added to the DSM-5 for people who are still grieving one year after experiencing a loss, unable to return to everyday activities. It is expected to apply to around 4% of bereaved people.

What are the physical symptoms of prolonged grief? ›

Extreme Fatigue. Intense exhaustion is a common symptom in early grief, often preventing people from accomplishing even simple tasks. Your body may feel fragile and weak, almost as if you have the flu. Insomnia is also common, but if it becomes a problem, consider consulting a doctor.

What medication is given for grief? ›

Common medications used in grief treatment regimens include antidepressants, anti-anxiety meds and medications to promote sleep.

What is the ICD-10 code for grieving loss of loved one? ›

ICD-10 code Z63. 4 for Disappearance and death of family member is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

What two factors increase the risk of experiencing prolonged grief disorder? ›

Factors that may increase the risk of developing complicated grief include:
  • An unexpected or violent death, such as death from a car accident, or the murder or suicide of a loved one.
  • Death of a child.
  • Close or dependent relationship to the deceased person.
  • Social isolation or loss of a support system or friendships.
Dec 13, 2022

What is the most common response to unresolved grief? ›

In most cases, people with unresolved grief deny or avoid it. They hold onto their loved one and refuse to accept the loss, hindering the healing process.

Which of the following has proven effective in reducing the symptoms of prolonged grief disorder? ›

Grief-focused cognitive behavior therapy (CBT) has been shown to be effective in treating PGD.

What is the difference between complicated grief and prolonged grief? ›

Prolonged grief is the most common form of complicated grief in adults (5). It is different from normal grief in that the immediate grief reactions persist over time with more or less undiminished strength, causing a considerable loss of everyday functioning (2).

What is the difference between persistent complex bereavement disorder and prolonged grief disorder? ›

Persistent complex bereavement disorder (PCBD) is a disorder of grief that newly entered DSM-5. Prolonged grief disorder (PGD) is a disorder of grief included in ICD-11. No prior studies examined and compared the dimensionality, prevalence, and concurrent validity of both conditions among bereaved children.

How many months does a person have to experience criteria of PTSD to be diagnosed with the disorder? ›

Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than 1 month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work.

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