March 21, 2022 -- At a time when many people are facing extreme loss and pain, the American Psychiatric Association’s diagnostic manual now includes a new disorder: prolonged grief disorder.

The new diagnosis is meant to apply to a small percentage of the population that appears to be crippled by grief, unable to return to previous activities and still overwhelmed a year after a loss, according to The New York Times.

Now that the disorder is part of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5, doctors can bill insurance companies for treatments.

The newly added disorder will likely also expand funding for research into treatments, the newspaper reported. Naltrexone, which is used to treat addiction, is in clinical trials as a form of grief therapy.

The decision marks an end to more than a decade of discussion, with some researchers arguing for medical treatment of intense grief. Although mourning a loss is natural, some people have severe bereavement that leads to isolation.

“They were the widows who wore black for the rest of their lives, who withdrew from social contacts and lived the rest of their lives in memory of the husband or wife who they had lost,” Paul Appelbaum, MD, chair of the steering committee overseeing revisions of the DSM-5, told the Times.

“They were the parents who never got over it, and that was how we talked about them,” he said. “Colloquially, we would say they never got over the loss of that child.”

On the other hand, some critics of the idea have argued against creating a grief-related disorder that could affect a basic part of the human experience. There could be false positives among grieving people who need to heal naturally from their loss but are diagnosed with mental illness instead. People may also feel pressure to take medication for grief.

“I completely, utterly disagree that grief is a mental illness,” Joanne Cacciatore, PhD, an associate professor of social work at Arizona State University, told the newspaper. She has published widely on grief.

“When someone who is an ‘expert’ tells us we are disordered and we are feeling very vulnerable and feeling overwhelmed, we no longer trust ourselves and our emotions,” she said. “To me, that is an incredibly dangerous move and short-sighted.”

The origins of the new diagnosis can be traced back to the 1990s, the Times reported, when Holly Prigerson, PhD, a psychiatric epidemiologist, studied patients being treated for depression. The patients responded well to antidepressants, but their grief remained high. About 4% of bereaved people remained “stuck and miserable” and continued to struggle for a long time.

In 2010, the American Psychiatric Association proposed expanding the definition of depression to include grieving people, which sparked backlash and concerns about overdiagnosis and overmedication of patients.

Since then, researchers have continued to study grief, which appears to be distinct from depression and more closely related to stress disorders, such as posttraumatic stress disorder. Appelbaum, Prigerson, and others worked on guidelines that would distinguish normal grief from a disorder.

Under the DSM-5 definition, the diagnosis can be made a year after a bereavement. Measured at the 1-year mark, the newspaper reported, the criteria should apply to about 4% of bereaved people.

Show Sources

The New York Times: “How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer.”

American Psychiatric Association: “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).”

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