DSM–5

View and Comment on Recently Proposed Changes to DSM–5

The following proposal was approved by the DSM Steering Committee and is being posted for a 45-day public comment period.

Comment Period Opens: April 6, 2020

Comment Period Closes: May 20, 2020

Comment on Proposal

Addition of a New Diagnosis, "Prolonged Grief Disorder," to the Depressive Disorders Chapter

Background to the Proposal

A proposal was received to modify the criteria for Persistent Complex Bereavement Disorder currently in Section 3 under Conditions for Further Study and incorporate the revised category into Section 2, thus recognizing it as a formal DSM diagnosis. The proposal was extensively reviewed by the Internalizing Disorders Review Committee, chaired by Roberto Lewis-Fernandez, MD. On the basis of that review, a decision was made to host a workshop in June 2019 at the which the major research groups involved in studying this condition would present their data on the validity of the disorder, the reliability with which it could be diagnosed, and its clinical utility. Research groups led by Katherine Shear, MD (Columbia) and Charles Reynolds, MD (Pitt); Holly Prigerson, PhD and Paul Maciejewski, PhD (Cornell); and Christopher Layne, PhD and Robert Pynoos, MD (UCLA) sent data in advance and were present at the meeting. An expert panel, chaired by David Brent, MD, was convened to review the data, listen to the presentations, probe the conclusions, and identify areas of disagreement that required resolution.

By the end of the workshop, the research groups involved had reached agreement on a set of draft criteria for the disorder. They were asked to test the criteria in their existing data sets to determine the optimal number of items that should be required in Criterion C (i.e., optimizing both specificity and sensitivity), the items that best predicted future symptoms and impairment, the reliability with which the diagnostic criteria could be applied, and the discriminant validity of the proposed criteria. In the fall of 2019, data were received from both the Shear/Reynolds and Prigerson/Maciejewski groups and were reviewed by the expert panel. The panel concluded that there was strong evidence that: the proposed category met the definition of a mental disorder; it manifested substantial evidence of validity; there was strong evidence of clinical utility; it had good discriminant validity; and it appeared that the individual criteria could be applied with good test-retest reliability. In addition, the panel found that the data strongly supported a cut-off of 3/8 symptoms for Criterion C, and that a duration of 12 months after the bereavement was indicated before the diagnosis was made. It was agreed that the text accompanying the criteria set would include notes regarding the ways in which presentations might differ in children.

The report of the expert panel was then reviewed by the Internalizing Disorders Review Committee, which endorsed the report in full. The proposed criteria set was reviewed and approved by the DSM Steering Committee and is now posted for public comment. At the close of the comment period, comments received will be reviewed by the Internalizing Disorders Review Committee and the DSM Steering Committee, which will determine whether changes are required.

Proposed Diagnostic Criteria: Prolonged Grief Disorder

  1. The death of a person close to the bereaved at least 12 months previously.
  2. Since the death, there has been a grief response characterized by intense yearning/longing for the deceased person or a preoccupation with thoughts or memories of the deceased person. This response has been present to a clinically significant degree nearly every day for at least the last month.
  3. As a result of the death, at least 3 of the following symptoms have been experienced to a clinically significant degree, nearly every day, for at least the last month:
    1. Identity disruption (e.g., feeling as though part of oneself has died)
    2. Marked sense of disbelief about the death
    3. Avoidance of reminders that the person is dead
    4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death
    5. Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future)
    6. Emotional numbness
    7. Feeling that life is meaningless
    8. Intense loneliness (i.e., feeling alone or detached from others)
  4. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  5. The duration of the bereavement reaction clearly exceeds expected social, cultural or religious norms for the individual's culture and context.
  6. The symptoms are not better explained by another mental disorder.

 

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