— And When Is It Prolonged Grief Disorder?
By Markham Heid
Four years after her husband’s death, a 68-year-old woman visits her doctor because she’s having trouble sleeping.
While talking with her doctor, the woman reveals that she’s been sleeping on her couch because sleeping in the bed she and her husband shared makes her miss him too much. She still blames herself and her husband’s medical team for his death, and she thinks about him “constantly” — often wishing to die so that she can be with him again.
The woman’s experiences are detailed in a 2015 article in The New England Journal of Medicine, which explains what complicated grief is and how it should be managed.
Complicated grief is defined as grief that is “unusually severe and prolonged” and impairs a person’s ability to live a normal life, according to the article.
Psychologists estimate that approximately 10 to 20 percent of people who are grieving will develop complicated grief, according to another review on the topic.
“Complicated grief is now called ‘prolonged grief disorder,’” says M. Katherine Shear, MD, the author of the study in The New England Journal of Medicine and the Marion E. Kenworthy professor of psychiatry at Columbia University in New York, who studies grief and bereavement. “The difference between normal or healthy grief and prolonged grief is related to whether certain defensive responses that are a normal part of early grief become persistent and overly influential in mental functioning.”
Grief, briefly defined, is the emotional reaction a person has following a loss. During the weeks and months following a loss — such as the death of a spouse or parent — almost any reaction is considered “normal.”
But at a certain point, if the grief continues to interfere with a person’s life, it may be considered a diagnosable disorder.
What Is Complicated Grief? Prolonged Grief Disorder by Definition
Based in large part on Dr. Shear’s work with people who have experienced complicated grief (Shear is also the founding director of the Center for Complicated Grief at Columbia School of Social Work), in March 2022 prolonged grief disorder was added to the next update of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, or DSM-5-TR — the formal guide that psychiatrists use to identify and diagnose mental health problems.
According to the DSM-5-TR, prolonged grief disorder is defined by someone experiencing the following six criteria:
1. A death — at least 12 months ago for adults, and at least six months ago for kids — of a person who was close to the bereaved.
2. Since the death, there has been a grief response characterized by one or both of the following nearly every day for at least the last month:
- Intense yearning or longing for the deceased person
- Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation may focus on the circumstances of the death)
3. As a result of the death, at least three of the following eight symptoms have been experienced nearly every day for at least the last month:
- Identity disruption (such as feeling as though part of oneself has died)
- Marked sense of disbelief about the death
- Avoidance of reminders that the person is dead
- Intense emotional pain (such as anger, bitterness, or sorrow) related to the death
- Difficulty with reintegration into life after the death (including problems engaging with friends, pursuing interests, or planning for the future)
- Emotional numbness (for example, an absence or marked reduction in the intensity of emotions, or feeling stunned) as a result of the death
- Feeling that life is meaningless as a result of the death
- Intense loneliness (such as feeling alone or detached from others) as a result of the death
4. The loss causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
5. The duration and severity of the bereavement reaction clearly exceeds expected social, cultural, or religious norms for the individual’s culture and context.
6. The symptoms of grief are not better explained by major depressive disorder, post-traumatic stress disorder, or another mental disorder, or attributable to the physiological effects of a substance (such as medication or alcohol) or another medical condition.
Shear adds that complicated grief or prolonged grief disorder is by and large defined by the extent to which grief affects someone’s life. “It’s when grief is continuing to dominate someone’s life, getting other people frustrated, and it feels like they can’t come to terms with the new reality or restore their ability to thrive,” she says.
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