After a years-long debate within the mental health field, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) now includes "prolonged grief disorder" as an official diagnosis.
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'Prolonged grief disorder' as a diagnosis
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.
The inclusion of prolonged grief disorder in the DSM-5 means that clinicians will now be able to bill insurance companies for treating patients diagnosed with the condition. It will also likely prompt funding for research into treatments and set off competition for FDA approval of these treatments, the New York Times reports.
The new diagnosis can be traced back to research from the 1990s. Holly Prigerson, a psychiatric epidemiologist, gathered data on the effectiveness of depression treatments in a group of elderly patients, the Times reports.
While many of the patients were responding to the antidepressant medications, Prigerson noticed that their grief—measured by a set of standardized questions—remained high despite their positive response to depression treatments. However, many psychiatrists seemed uninterested in her findings at the time.
"Grief is normal," Prigerson recalled being told by other psychiatrists. "We're psychiatrists, and we don't worry about grief. We worry about depression and anxiety." In response, Prigerson asked, "Well, how do you know that's not a problem?"
As Prigerson continued to gather data, she concluded that signs of intense grief, including "yearning and pining and craving," differed from depression. In addition, she determined that these symptoms were predicative ofnegative outcomes, including high blood pressure and suicidal ideation.
Among most of Prigerson's patients, symptoms of griefpeaked within six monthsof loss. However, there was agroup of outliers who remained "stuck and miserable," and continued to struggle with mood, day-to-day functioning, and sleep over an extended period of time.
Commentary
In 2010, the American Psychiatric Association (APA) proposed expanding the definition of depression to encompass bereaved individuals—a move that resulted in backlash from expertsarguing that mental health professionals were overdiagnosing and overmedicating their patients.
Although many experts agree that they could reasonably identify prolonged grief disorder six months after a loss or bereavement, Prigerson said the APA "begged and pleaded" to define the disorder more conservatively at one year to avoid public backlash.
APA's concern was that the public was "going to be outraged, because everyone feels because they still feel some grief — even if it's their grandmother at six months, they are still missing them," she added. "It just seems like you're pathologizing love."
Joanne Cacciatore, an associate professor of social work at Arizona State University who has published widely on grief, is concerned that drug companies will try to persuade the public that they need medical treatment to emerge from mourning.
"When someone who is a quote-unquote expert tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions. To me, that is an incredibly dangerous move, and short sighted," she said.
However, the new diagnosis creates an opportunity for tailored treatments for intensely grieving individuals, the Times reports.
"It's sort of an official blessing in the world," said Kenneth Kendler, a professor of psychiatry at Virginia Commonwealth University. "If we were on the planetary committee of the American Astronomical Society deciding what is a planet or not — this one's in, and Pluto we kicked out."
According to M. Katherine Shear, a psychiatry professor at Columbia University, who developed a 16-week program of psychotherapy that relies on exposure techniques to help trauma victims, it is difficult to predict what treatments could emerge for the disorder.
If the diagnosis becomes common in the mental health field, it is likely to popularize Shear's treatment, according to the Times. In addition, there could be a range of new treatments that target the disorder, including drug treatments and online interventions.
"I don't really have any idea, because I don't know when the last time there was a really brand-new diagnosis," Shear said.
"I really am in favor of anything that helps people, honestly," she added.
Ultimately, the inclusion of the disorder in the DSM-5 "mean[s] that mental health clinicians and patients and families alike share an understanding of what normal grief looks like and what might indicate a long-term problem," said APA CEO Saul Levin.(Reed, Axios, 3/21; Barry, New York Times, 3/18)
FAQs
The DSM-5 adds a new diagnosis: Prolonged grief disorder? ›
Prolonged grief disorder was added to Section 2, trauma- and stressor-related disorders chapter. DSM-5 included a category of persistent complex bereavement disorder as a “condition for further study” in Section 3 of the manual.
Is there a new diagnosis called prolonged grief disorder in the DSM-5? ›'Prolonged grief disorder' as a diagnosis
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.
DSM-5 PGD is present when, after the death of someone close at least 12 months earlier (Criterion A), a person experiences intense yearning or preoccupation (Criterion B), plus at least 3 of 8 symptoms of identity disruption, disbelief, avoidance, emotional pain, difficulties moving on, numbness, a sense that life is ...
When was prolonged grief disorder added to the ICD? ›ICD-10-CM F43. 81 is a new 2023 ICD-10-CM code that became effective on October 1, 2022.
What is the DSM-5 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 .
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).
Why was bereavement removed from the DSM-5? ›The bereavement exclusion was eliminated from the DSM-5 for two main reasons: 1) there have never been any adequately controlled, clinical studies showing that major depressive syndromes following bereavement differ in nature, course, or outcome from depression of equal severity in any other context—or from MDD ...
Is prolonged grief disorder classified as a psychiatric disorder according to the DSM V? ›Prolonged grief disorder was recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a volume published by the American Psychiatric Association (APA) that defines and classifies mental disorders.
What does the DSM-5 say about bereavement? ›Most people grieving the death of a loved one do not develop a major depressive episode. Nevertheless, DSM-5 makes it clear that grief and major depression may exist “side by side.” Indeed, the death of a loved one is a common “trigger” for a major depressive episode — even as the bereaved person continues to grieve.
What is the criteria for prolonged grief disorder ICD 11? ›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.
Which diagnosis was returned to the DSM-5 TR after being removed in DSM-5? ›
Unspecified Mood Disorder: A diagnosis that was reinstated in the DSM-5-TR. It refers to symptoms characteristic of Bipolar Related Disorders and/or Depressive Disorders but do not meet the full criteria for any of the disorders under those classes.
What is code for prolonged grief disorder ICD-10? ›Code F43. 8, Other reactions to severe stress, has been expanded, and two new codes have been created:F43. 81, Prolonged grief disorder F43.
Is complicated bereavement in the DSM-5? ›Persistent complex bereavement disorder is included in the DSM-5 chapter that outlines areas for further study. Bereavement is the period of time spent adjusting to loss.
What category is persistent complex bereavement disorder in the DSM-5? ›The DSM-5 includes Persistent Complex Bereavement Disorder in the section on Conditions for Further Study with an estimated prevalence of 2.4-4.8%. Colloquially, this is often referred to as prolonged grief. In children, persistent complex bereavement can be diagnosed after 6 months of symptoms (12 months in adults).
Is prolonged grief disorder new? ›Prolonged Grief Disorder in the DSM
Prolonged grief disorder is the newest disorder to be added to the Diagnostic and Statistical Manual of Mental Disorders (DSM).
“Prolonged grief disorder” and “persistent complex bereavement disorder”, but not “complicated grief”, are one and the same diagnostic entity: an analysis of data from the Yale Bereavement Study.
What are the two new depressive disorder diagnoses included in the DSM-5? ›- disruptive mood dysregulation disorder (DMDD)
- premenstrual dysphoric disorder (PMDD)
Definition of Uncomplicated Bereavement DSM-5
If someone's disabling grief persists for longer than 6 months to a year, as it does in about 10% of cases, it might instead be considered an adjustment disorder or prolonged grief disorder (PGD), also known as complicated grief.