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Prolonged grief: where to after Diagnostic and Statistical Manual of Mental Disorders, 5th Edition?

Bryant, Richard A.

Current Opinion in Psychiatry: January 2014 - Volume 27 - Issue 1 - p 21–26
doi: 10.1097/YCO.0000000000000031
MOOD AND ANXIETY DISORDERS: Edited by Cornelius Katona and Gordon Parker

Purpose of review: Although there is much evidence for the construct of prolonged grief, there was much controversy over the proposal to introduce a prolonged grief diagnosis into Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and it was finally rejected as a diagnosis in DSM-5. This review outlines the evidence for and against the diagnosis, and highlights the implications of the DSM-5 decision.

Recent findings: Convergent evidence indicates that prolonged grief characterized by persistently severe yearning for the deceased is a distinct construct from bereavement-related depression and anxiety, is associated with marked functional impairment, is responsive to targeted treatments for prolonged grief, and has been validated across different cultures, age groups, and types of bereavement. Although DSM-5 has rejected the construct as a formal diagnosis, evidence continues to emerge on related mechanisms, including maladaptive appraisals, memory and attentional processes, immunological and arousal responses, and neural circuitry.

Summary: It is most likely that the International Classification of Diseases (ICD-11) will introduce a diagnosis to recognize prolonged grief, even though DSM-5 has decided against this option. It is probable that the DSM-5 decision may result in more prolonged grief patients being incorrectly diagnosed with depression after bereavement and possibly incorrectly treated. The DSM-5 decision is unlikely to impact on future research agendas.

University of New South Wales, Sydney, New South Wales, Australia

Correspondence to Richard Bryant, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. Tel: +61 2 9385 3640; fax: +61 2 9385 3641; e-mail: r.bryant@unsw.edu.au

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins