Official Diagnostic Criteria

The most recent versions of standard official diagnostic guidelines include a diagnosis  of “Prolonged Grief Disorder" in ICD11 and “Persistent Complex Bereavement Disorder” in DSM 5.

ICD11, expected to be approved by The World Health Organization in 2018, includes a new diagnosis of Prolonged Grief Disorder. Guidelines for this diagnosis include the occurrence of a “persistent and pervasive grief response characterized by longing for the deceased or persistent preoccupation with the deceased accompanied by intense emotional pain (e.g. sadness, guilt, anger, denial, blame, difficulty accepting the death, feeling one has lost a part of one’s self, an inability to experience positive mood, emotional numbness, difficulty in engaging with social or other activities)”. You can find the full guideline here.

DSM 5, published in 2013, includes a condition of Persistent Complex Bereavement Disorder (PCBD) codable as a “severe and persistent grief and mourning reaction” in “Other Specified Trauma- and Stressor-Related Disorder” 309.89 (F43.8). You can find this on page 289. Additionally, provisional criteria for PCBD are provided in Section III, “Conditions for Further Study.” However, we have evidence that these criteria need modification. For the present, we suggest clinicians use the DSM code and the ICD 11 guidelines for diagnosis.

Differential diagnosis. CG is most often confused with depression. There is solid evidence that treatment for depression is far less helpful than targeted CG treatment so this difference is important.  Core symptoms of CG are persistent yearning and preoccupation with the deceased whereas core symptoms of depression are pervasive “free-floating” sadness and loss of interest and pleasure.  These differences can help you distinguish grief from depression.

Tens of millions of people worldwide are struggling with CG

Intense grief is typical after we lose someone close. Grief remains intense until we adapt to the loss.  For an estimated 10-15% of bereaved people in the general population, adapting is problematic.  Rates are higher when the death is sudden, unexpected or violent and when a young person dies.  Risk factors for CG include a prior history of mood or anxiety disorders. Women are at higher risk than men.

An estimated 20% of people receiving mental health treatment have unrecognized CG.