What’s New in Psychology?
Psychiatric Diagnosis Causes Controversy
Jim Windell
When the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) was published in 2022, a new diagnosis was added. That diagnosis was PGD – or prolonged grief disorder.
According to the DSM-5-TR, PGD – previously referred to as complicated grief and persistent complex bereavement disorder – is characterized by intense and disabling yearning for or preoccupation with a deceased person that lingers for at least 12 months after the loss. Although missing a loved one in the initial months following their death is normal, and bereaved people often temporarily lose interest in usual activities, to yearn intensely and constantly for the deceased person after a year is rare and people who exhibit these thoughts and feelings should be evaluated for PGD.
It all sounds straightforward enough. However, including PGD in the DSM has triggered controversy. On one side, some mental health professionals argue that PGD pathologizes a normal human experience and some take issue with setting a precise timeline for grief. Others cite the difficulties in distinguishing PGD from depression and normal bereavement. Some fear the diagnosis could lead to the medicalization of mourning. Still others feel grieving people need validation and implying their response is dysfunctional could cause more harm than good.
Holly G. Prigerson, Ph.D., and Paul K. Maciejewski, Ph.D., both with Weill Cornell Medical College, New York City, noted in a recent article in World Psychiatry that PGD is “a serious mental disorder that puts the patient at risk for intense distress, poor physical health, shortened life expectancy, and suicide.”
As indicated in the DSM-5-TR, the diagnostic criteria for PGD are the development of a persistent grief response lasting longer than one year in adults and six months in children and adolescents. The disorder is characterized by the presence of at least three of the following symptoms to a clinically significant degree on most days for the past month:
- Intense yearning/longing for the deceased person
- Preoccupation with thoughts or memories of the deceased person
- Identity disruption
- Marked sense of disbelief about the death
- Avoidance of reminders that the person is dead
- Intense emotional pain related to the death
- Difficulty reintegrating into one's relationships and activities after the death
- Emotional numbness
- Feeling that life is meaningless as a result of the death
- Intense loneliness as a result of the death
Prigerson and her colleagues have developed and validated several tools to screen for PGD, including a self-report tool called PG-13-Revised. In this questionnaire, patients respond to 13 questions that seek to determine whether they meet the DSM criteria. Responses range from 1 (not at all) to 5 (overwhelmingly), and a summary score ≥ 30 is consistent with a diagnosis of PGD.
Other diagnostic tools include the Structured Clinical Interview for Diagnosing Prolonged Grief Disorder, which was also developed at Cornell, and the Brief Grief Questionnaire that comes from Columbia University's Center for Prolonged Grief.
Currently, there are no official guidelines for treatment of PGD, however, differentiating between normal grief and PGD is critical, says Rita Rosner, Ph.D., with Catholic University of Eichstätt-Ingolstadt, Germany. “If patients do meet criteria for PGD, psychotherapy is helpful,” Rosner says. “Below the clinical threshold, counseling and supportive groups might be helpful.”
Several randomized controlled trials have shown that PGD can be successfully treated, with grief-focused cognitive behavioral therapies (CBTs) having the strongest evidence to support their use in treating PGD.
To read the article that this blog was based on, find it with this reference:
Brooks, M. (Nov. 27, 2024). Debate Continues Over Prolonged Grief Disorder. Medscape.