New diagnostic criteria for prolonged grief disorder (PGD) have been presented in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). PGD not only places patients at risk for intense distress, but also poor physical health, shortened life expectancy, and suicide. The estimated prevalence of PGD is likely to increase beyond previous estimates of 9.8% due to the death toll of the COVID-19 pandemic. Therefore, it is critical that clinicians be knowledgeable about grief reactions, including pathological manifestations of grief, and how to treat them. DSM-5-TR criteria for PGD require distressing symptoms of grief to continue for at least 12 months following the death of a close attachment. The grief response must be characterized by intense longing/yearning for the deceased person and/or preoccupation with thoughts and memories of the lost person to an impairing degree nearly every day for at least the past month. Three of eight symptoms must be experienced to a clinically significant degree for a PGD diagnosis (see Table 1).

The PG-13-Revised (PG-13-R) scale is a useful self-report measure of PGD that can be used to screen for diagnosis and estimate its severity. A summary score of 30 or greater is consistent with a diagnosis of PGD, indicating further evaluation and treatment. An effective treatment for PGD includes prolonged grief disorder therapy (PGDT). The goals of PGDT are to 1) facilitate adaptation through which grief is transformed and integrated and 2) address any derailing symptoms of the early grief coping response (i.e., protest, self-blame, anger, counterfactual thinking, and avoidance). Adapting to loss involves accepting the new reality and restoring the capacity for well-being. See Table 2 for healing milestones of PGDT.

Reference:

Prigerson HG et al. JAMA Psychiatry 2022; Epub ahead of print. Abstract