Complicated grief (CG), variously called pathological or traumatic grief, is a debilitating syndrome that is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) nomenclature. One issue that remains under debate is whether this condition can be clearly distinguished from other psychiatric disorders, such as major depression and posttraumatic stress disorder, with which CG frequently coexists.
Using a structured clinical interview for CG and the Structured Clinical Interview for DSM-IV, trained experienced raters conducted careful diagnostic assessments of individuals seeking treatment of bereavement-related distress. All study participants met criteria for a current CG syndrome. Liberal criteria were used to diagnose DSM-IV disorders, making no attempt to decide if symptoms could be explained by grief.
Of 206 who met the criteria for CG, 25% had no evidence of a current DSM-IV Axis I disorder. When present, psychiatric comorbidity was associated with significantly greater severity of grief; however, even after adjustment for the presence of comorbidity, severity of CG symptoms was associated with greater work and social impairment.
It is likely that our study underestimated the rate of CG without comorbidity because fewer DSM diagnoses would have been made if a judgment about grief had been taken into consideration.
Our data provide further support for the need to identify CG as a psychiatric disorder.
"Several previous studies from our group documented an association between CG and PD. Simon et al. (2007) found that among 206 treatment-seeking individuals with CG, 63% met diagnostic criteria for a comorbid anxiety disorder, including 14% for PD. We also reported that individuals with CG exhibited higher levels of lifetime panic-spectrum symptoms, than otherwise healthy bereaved individuals, even after controlling for current PD diagnosis (Bui et al., 2013). "
[Show abstract][Hide abstract] ABSTRACT: Background Although Complicated Grief (CG) has been associated with comorbid Panic Disorder (PD), little is known about panic attacks in CG, and whether panic symptoms may be grief-related. The present study examines the presence and impact of grief-related panic symptoms in CG. Methods Individuals with CG (n=146, 78% women, mean (SD) age=52.4(15.0)) were assessed for CG, DSM-IV diagnoses, work and social impairment, and with the Panic Disorder Severity Scale modified to assess symptoms "related to or triggered by reminders of your loss" and anticipatory worry. Results Overall, 39.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and 32.2% reported some level of anticipatory worry about grief-related panic. Of interest, 17% met DSM criteria for PD. Among those without PD, 34.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and this was associated with higher CG symptom severity (t=-2.23, p<0.05), and functional impairment (t=-3.31, p<0.01). Among the full sample, controlling for CG symptom severity and current PD, the presence of at least one full or limited-symptom grief-related panic attack was independently associated with increased functional impairment (B(SE)=4.86(1.7), p<0.01). Limitations Limitations include a lack of assessment of non-grief-related panic symptoms and examination of a sample of individuals seeking treatment for CG. Conclusions Grief-related panic symptoms may be prevalent among individuals with CG and independently contribute to distress and functional impairment.
"Finally, although comorbidity is common, PGD can occur in isolation. In one sample of individuals diagnosed with PGD, approximately half also had current depression, and about half had current PTSD, but in 80% of these cases, the depression or PTSD predated the PGD, and in one quarter of patients with PGD there were no co-occurring DSM–IV Axis I disorders (Simon et al., 2007). "
[Show abstract][Hide abstract] ABSTRACT: Normative bereavement reactions are contrasted with prolonged grief disorder (PGD). Diagnostic criteria for PGD are reviewed. PGD is distinguished from other problems occurring after loss, namely depression and PTSD. Assessment approaches are described. Recent clinical trials are reviewed, and recommendations for the psychotherapeutic treatment of PGD are developed. Consideration of medication referral is also recommended, especially in the case of co-occurring depression. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
Professional Psychology Research and Practice 06/2014; 45(3):180. DOI:10.1037/a0036836 · 1.34 Impact Factor
"Prolonged Grief Disorder (PGD), variously referred to as " complicated grief " (Prigerson et al., 1995a; Boelen and van den Bout, 2005) and " traumatic grief " (Prigerson et al., 1997; Melhem et al., 2001), has been proposed for inclusion in DSM-5 and ICD-11 as a chronic bereavement-related disorder (Prigerson et al., 2009). However, individuals with PGD often show co-morbidity with DSM-IV axis I disorders such as major depressive disorder (MDD), posttraumatic stress disorder (PTSD), or anxiety disorder (Melhem et al., 2001; Neria et al., 2007; Simon et al., 2007). In order to determine whether PGD should be considered an independent nosological entity, researchers have examined its distinctiveness against other axis I disorders. "
[Show abstract][Hide abstract] ABSTRACT: Prolonged Grief Disorder (PGD) has been proposed for diagnostic classification as an independent psychiatric disorder. Previous research has investigated it in relation to other axis I disorders in order to determine whether it could be considered an independent nosological entity. The distinctiveness of this condition was apparent in cases of ordinary bereavement and in those following human-made disasters. However, this disorder may be expanded to include bereavement resulting from natural disasters. The present study aims to explore the differences between this disorder and posttraumatic stress disorder or major depressive disorder as experienced after the Great East Japan Earthquake and Tsunami. The subjects were 82 hospital workers. Each type of disorder was assessed by means of the Inventory of Complicated Grief, the Impact of Event Scale-Revised, and the Center for Epidemiological Studies Depression Scale. Exploratory factor analysis showed 3 dimensions, with PGD items independently clustering in the same dimension. Our findings support the uniqueness of PGD even in a post-natural disaster situation in a non-Western culture and warrant grief intervention for high-risk bereaved survivors.
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