Grief: Officially a Mental Health Disorder By Dr Bill Webster
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s of March 2022, grief is now officially recognized as a mental health disorder, and not everyone is happy about it. “Prolonged grief disorder” (PGD) is the newest disorder to be added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a handbook published by the American Psychiatric Association that defines and classifies mental disorders. Researchers have made a convincing case that prolonged grief is a disorder distinct from the normal grieving process. But there are still disagreements in the field in several areas, such as the diagnostic criteria for the disorder, the point at which normal grieving becomes a disorder’ and even what to call it. Over several decades, Holly Prigerson, PhD, and colleagues have demonstrated that bereavement-related depression was different from what was termed “complicated grief” ( The American Journal of Psychiatry, Vol. 152, No. 1, 1995). Some researchers still use that name, though “persistent grief” and “prolonged grief” have emerged as the favoured terms. Seeking a compromise between these definitions of complicated and prolonged grief, DSM5 created yet another condition: persistent complex bereavement disorder. In 2009, eminent British psychiatrist and author Dr. Colin Murray Parkes and Dr. Prigerson collaborated in a book entitled “Bereavement: Studies of Grief in Adult Life”, (Fourth Edition) in which they proposed a set of criteria for prolonged grief disorder. Those criteria differed somewhat from previous definitions of complicated grief and described the primary experience of yearning, as well as several other symptoms: feeling emotionally numb, stunned or that life is meaningless; experiencing mistrust;
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bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; and difficulty moving on with life. In prolonged grief disorder, the bereaved individual may experience intense longings for the deceased; preoccupation with thoughts of the deceased; or in children and adolescents, with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning. In cases of prolonged grief disorder, the duration of the person’s bereavement exceeds expected social, cultural or religious norms and the symptoms are not better explained by another mental disorder. The diagnosis set 12 months as the threshold after which normal grief may become disordered. The World Health Organization describes prolonged grief disorder as “persistent and pervasive longing for, or preoccupation with, the deceased that lasts at least six months after loss. In addition, people with the disorder often experience intense emotional pain (such as sadness, guilt or anger), difficulty accepting the death, emotional numbness, a feeling that part of them has been lost, an inability to experience positive mood and difficulty engaging in social activities.” But there are others, including myself, who would say, in non-clinical terms, “Six Months? Twelve months? … Are you kidding me?” How in that time-frame do we distinguish between the symptoms of what we would call the “normal” grief process, and these more complicated symptoms which move grief into the category of “a disorder”.
