When Grief Becomes a Syndrome

Researchers study data from National Institute of Mental Health studies to better understand diagnosing and treating patients with “persistent impairing grief.”


Some patients who experience long-term grief may be slipping through the health care net. With data collected in 2 National Institute of Mental Health-funded treatment studies, researchers used proposed criteria from DSM-5 to identify patients with a stress-response syndrome of “persistent impairing grief”—that is, persistent complex bereavement disorder (PCBD), prolonged grief disorder (BGD) and complicated grief (CG). They studied 2 groups of patients in university-based psychiatric research clinics: 240 grief-treatment seeking participants scored ≥ 30 on the Inventory of Complicated Grief (ICG), and 86 bereaved adults scored < 20 on the ICG.

The PCBD criteria diagnosed 70% of the first group, PGD criteria identified 59.6%, and CG criteria identified 99.6%. None of the 3 proposed criteria identified cases in the bereaved comparison group. Only the CG criteria produced rates of case identification sufficient to be of clinical utility, the researchers say.

Their findings are “virtually identical” with those of the community-based National Military Family Bereavement Study, the researchers say, in which all 3 criteria sets identified < 2% of the bereaved military family survey population that scored < 20 on the ICG.

There are treatments specific to grief, the researchers note. But as of yet there is no gold standard for diagnosing persistent impairing grief. The researchers say the solution could lie in using the CG criteria set and modifying decision rules for CBD or PGD criteria or developing a new group of symptoms and decision rules. However it’s done, the researchers conclude, they see a “pressing need” to establish criteria that can lead to correct diagnosis and targeted treatment.

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