Prolonged Grief Disorder

DEFINITION

• Newly introduced formal diagnosis in ICD-11 in 2018 and DSM-5-TR in 2022
• Prolonged grief disorder (PGD) is a persistent, incapacitating form of complicated grief.
  • Early diagnosis is essential; however, the duration threshold varies as PGD must last at least 12 months after loss based on the DSM-5-TR but only 6 months based on the ICD-11.
• People with PGD often experience life-altering effects, including:
  • Persistent yearning/longing for the deceased
  • Intense emotional pain (such as sadness, guilt, and anger)
  • Preoccupation with the deceased
  • Preoccupation with the circumstances of the death
  • Inability to experience a positive mood and difficulty engaging in social or regular activities
• PGD is distinct from bereavement-related depression or anxiety and grief due to symptoms’ intensity and frequency (e.g., most of the day, nearly every day for months).
  • Most bereaved individuals eventually cope effectively with loss and do not experience adverse bereavement-related health effects in the long term.
    • A period of acute grief that peaks in the 6 months after the death, followed by integrated grief (acceptance and adaption to the loss), is common.[1]
    • However, a significant minority experiences intense, chronic, and disabling grief lasting several months or years.
  • Importantly, grief is a normal reaction/process to irrevocable loss, including the death of a loved one.[2]
    • Grief is multidimensional, with physical, behavioral, and meaning/spiritual components, and is characterized by a complex set of cognitive, emotional, and social adjustments that follow the loss.
    • The intensity of grief, its duration, and its expression are often intertwined with cultural and societal norms or expectations. Common elements include distress, anxiety, yearning, sadness, and preoccupation.
• Intense, prolonged grief is a severe threat to the survivor’s ability to function in everyday life and may lead to:
  • Clinically significant distress and impairment in work and social functioning
  • Sleep disturbance
  • Disruption in daily activities
  • Suicidal thinking, and behavior
  • Impairment in relationship functioning
  • Increased use of tobacco, alcohol, or other substances