Grief, Bereavement, and Coping With Loss (PDQ®): Supportive care - Health Professional Information [NCI] - Types of Grief Reactions
In addition to these theoretical and empirically supported patterns of grief reactions, much emphasis has been placed on distinguishing normal grief from complicated grief. Most clinicians will be focused on understanding the differences between normal and complicated grief reactions: What is the difference? Under what circumstances should I refer a patient/family member for grief therapy?
Prolonged or Complicated Grief as a Mental Disorder
The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) includes bereavement as a diagnosable code to be used when bereavement is a focus of clinical attention following the death of a loved one. In current form it does not consist of formal diagnostic criteria and is generally considered a normal reaction to loss via death. In an attempt to clearly distinguish between normal grief and complicated grief, a consensus conference  has developed diagnostic criteria for a mental disorder referred to as prolonged grief disorder, proposing that it be included in the next revision of the DSM.
Following are the proposed diagnostic criteria for complicated grief:
- Criterion A: Person has experienced the death of a significant other, and response involves three of the four following symptoms, experienced at least daily or to a marked degree:
- Intrusive thoughts about the deceased.
- Yearning for the deceased.
- Searching for the deceased.
- Excessive loneliness since the death.
- Criterion B: In response to the death, four of the eight following symptoms are experienced at least daily or to a marked degree:
- Purposelessness or feelings of futility about the future.
- Subjective sense of numbness, detachment, or absence of emotional responsiveness.
- Difficulty acknowledging the death (e.g., disbelief).
- Feeling that life is empty or meaningless.
- Feeling that part of oneself has died.
- Shattered worldview (e.g., lost sense of security, trust, control).
- Assumption of symptoms or harmful behaviors of, or related to, the deceased person.
- Excessive irritability, bitterness, or anger related to the death.
- Criterion C: The disturbance (symptoms listed) must endure for at least 6 months.
- Criterion D: The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
These criteria have not been formally adopted, and thus there is no formal diagnostic category for prolonged grief disorders in the DSM. However, these criteria help in specifying symptoms, the severity of symptoms, and how to distinguish complicated grief from normal grief. Not all health care professionals agree that the duration of "at least 6 months" is the most accurate number, suggesting that the time period may be too short and that 6 months to 2 years may be more accurate.
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