Grief and the new DSM-5 clinical category: A narrative review of the literature.

Antonio Bruno, Fiammetta Iannuzzo, Roberto Lo Presti, Gianluca Pandolfo, Clemente Cedro, Nicola Pangallo, Rocco Antonio Zoccali, Maria Rosaria Anna Muscatello

Abstract


Aim: Grief is a common reaction to loss and it is considered a physiological and instinctive response. The "normal" grief evolves into an "integrated" phase within one year from death, and it is a non-pathological condition, that does not require specific therapeutic interventions. When this “integrated phase” does not occur, the subject could reach pathological manifestations related to the grief.


The Persistent Complex Bereavement Disorder (PCBD) was proposed as a new category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. PCBD is a new clinical category characterized by symptoms related to the detachment and to the post-traumatic distress and it differs from normal and uncomplicated grief, for the disability caused by these reactions and their persistence and pervasiveness.


Method: We examined reviews and studies of different researches done in the last twenty years, concerning the issues of loss, "normal" and "complicated" mourning that led to the diagnostic category of PCBD. For this review we based our consideration starting from those pathological conditions that preceded PCBD, as “pathological”, “complicated” and “traumatic” grief.


Results: PCBD results a new important clinical category showing specific symptoms, diagnostic criteria and treatment. It presents many differences with other pathologies, that goes into differencial diagnosis with PCBD, and it and can be treated with targeted therapeutic approaches.


Conclusions: Diagnostic criteria for PCBD could allow an early diagnosis and a correct treatment avoiding underdiagnosis and misdiagnosis. Further researches could focus on the evaluation of more neurobiological aspects, new psychometric tools, for assessing susceptibility to this pathology, and on the cultural aspects that may influence mourning reactions, in an ethno-psychiatric perspective.


Keywords


Grief; Pathological grief; Mourning; Bereavement; Complicated grief; Traumatic grief; prolonged grief disorder; Persistent and complex bereavement disorder; Loss; Death.

Full Text:

PDF

References


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Publishing, 2013.

Areia, N. P., Fonseca, G., Major, S., & Relvas, A. P. (2018). Psychological morbidity in family caregivers of people living with terminal cancer: Prevalence and predictors. Palliative & supportive care, 1-8.

Boelen, P. (2010). Intolerance of uncertainty and emotional distress following the death of a loved one. Anxiety, Stress, & Coping, 23(4), 471-478.

Boelen, P. A., Keijsers, L., & van den Hout, M. A. (2012). The role of self-concept clarity in prolonged grief disorder. The Journal of nervous and mental disease, 200(1), 56-62.

Boelen, P. A., Van Den Hout, M. A., & Van Den Bout, J. (2006). A cognitive‐behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice, 13(2), 109-128.

Bowlby, J. (1969-1982). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.

Silva, A.C., de Oliveira Ribeiro, N.P., de Mello Schier, A.R., Arias-Carrión, O., Paes, F., Nardi, A.E., Machado, S., Pessoa, T.M. (2014). Neurological aspects of grief. CNS & Neurological Disorders-Drug Targets, 13(6), 930-936.

Carmassi, C., Conversano, C., Pinori, M., Bertelloni, C. A., Dalle Luche, R., Gesi, C., & Dell’Osso, L. (2016). Il lutto complicato nell’era del DSM-5. Rivista di Psichiatria, 51(6), 231-237.

Carmassi, C., Gesi, C., Corsi, M., Pergentini, I., Cremone, I. M., Conversano, C…& Dell'Osso, L. (2015). Adult separation anxiety differentiates patients with complicated grief and/or major depression and is related to lifetime mood spectrum symptoms. Comprehensive psychiatry, 58, 45-49.

Chiu, Y. W., Huang, C. T., Yin, S. M., Huang, Y. C., Chien, C. H., & Chuang, H. Y. (2010). Determinants of complicated grief in caregivers who cared for terminal cancer patients. Supportive Care in Cancer, 18(10), 1321-1327.

Chiu, Y. W., Yin, S. M., Hsieh, H. Y., Wu, W. C., Chuang, H. Y., & Huang, C. T. (2011). Bereaved females are more likely to suffer from mood problems even if they do not meet the criteria for prolonged grief. Psycho‐Oncology, 20(10), 1061-1068.

Dell'Osso, L., Carmassi, C., Musetti, L., Socci, C., Shear, M. K., Conversano, C., ... & Perugi, G. (2012). Lifetime mood symptoms and adult separation anxiety in patients with complicated grief and/or post-traumatic stress disorder: a preliminary report. Psychiatry research, 198(3), 436-440.

Eisenberger, N. I. (2012). The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nature Reviews Neuroscience, 13(6), 421.

Eisma, M. C., Rinck, M., Stroebe, M. S., Schut, H. A., Boelen, P. A., Stroebe, W., & van den Bout, J. (2015). Rumination and implicit avoidance following bereavement: an approach avoidance task investigation. Journal of behavior therapy and experimental psychiatry, 47, 84-91.

Freud S. Trauer und Melancholie. Tr. it. “Lutto e Melanconia”, 1917. In: Opere. Vol. 8. Torino: Bollati Boringhieri, 1989.

Gesi, C., Carmassi, C., Shear, K. M., Schwartz, T., Ghesquiere, A., Khaler, J., & Dell'Osso, L. (2017). Adult separation anxiety disorder in complicated grief: an exploratory study on frequency and correlates. Comprehensive psychiatry, 72, 6-12.

Gündel, H., O’Connor, M. F., Littrell, L., Fort, C., & Lane, R. D. (2003). Functional neuroanatomy of grief: an FMRI study. American Journal of Psychiatry, 160(11), 1946-1953.

Hardison, H. G., Neimeyer, R. A., & Lichstein, K. L. (2005). Insomnia and complicated grief symptoms in bereaved college students. Behavioral sleep medicine, 3(2), 99-111.

Hensley, P. L., Slonimski, C. K., Uhlenhuth, E. H., & Clayton, P. J. (2009). Escitalopram: an open-label study of bereavement-related depression and grief. Journal of Affective Disorders, 113(1-2), 142-149.

Horowitz, M. J. (1993). Stress-response syndromes. In International handbook of traumatic stress syndromes (pp. 49-60). Springer, Boston, MA.

Horowitz, M., Stinson, C., Fridhandler, B., Milbrath, C., Redington, D., & Ewert, M. (1993). Pathological grief: An intensive case study. Psychiatry, 56(4), 356-374.

Horowitz, M.J., Siegel, B., Holen, A., Bonanno, G.A., Milbrath, C., Stinson, C.H. (1997). Diagnostic criteria for complicated grief disorder. Am J Psychiatry; 154: 904-10.

Ito, M., Nakajima, S., Fujisawa, D., Miyashita, M., Kim, Y., Shear, M. K., ... & Wall, M. M. (2012). Brief measure for screening complicated grief: reliability and discriminant validity. PloS one, 7(2), e31209.

Jacobs, Carolyn Mazure, Holly Prigerson, S. (2000). Diagnostic criteria for traumatic grief. Death studies, 24(3), 185-199.

Jordan, J. R. (2008). Bereavement after suicide. Psychiatric Annals, 38(10), 679.

Jordan, J. R., & Neimeyer, R. A. (2003). Does grief counseling work? Death studies, 27(9), 765-786.

Kersting, A., Brähler, E., Glaesmer, H., & Wagner, B. (2011). Prevalence of complicated grief in a representative population-based sample. Journal of affective disorders, 131(1), 339-343.

Kim, J., Tol, W. A., Shrestha, A., Kafle, H. M., Rayamajhi, R., Luitel, N. P., ... & Surkan, P. J. (2017). Persistent complex bereavement disorder and culture: Early and prolonged grief in Nepali widows. Psychiatry, 80(1), 1-16.

Latham, A. E., & Prigerson, H. G. (2004). Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality. Suicide and Life-Threatening Behavior, 34(4), 350-362.

Lee, S. A. (2015). The Persistent Complex Bereavement Inventory: a measure based on the DSM-5. Death studies, 39(7), 399-410.

Lee, S. A. (2018). Factorial structure of the persistent complex bereavement inventory: Testing a hierarchical factor model. Death studies, 42(6), 356-361.

Lombardo, L., Lai, C., Luciani, M., Morelli, E., Buttinelli, E., Aceto, P., ... & Penco, I. (2014). Eventi di perdita e lutto complicato: verso una definizione di disturbo da sofferenza prolungata per il DSM-5. Rivista di Psichiatria, 49(3), 106-114.

Lombardo, L., Morelli, E., Luciani, M., Bellizzi, F., Aceto, P., Penco, I., & Lai, C. (2012). Pre-loss demographic and psychological predictors of complicated grief among relatives of terminally ill cancer patients. Psychotherapy and psychosomatics, 81(4), 256-258.

Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O’Connor, M. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of affective disorders, 212, 138-149.

Maciejewski, P. K., Maercker, A., Boelen, P. A., & Prigerson, H. G. (2016). “Prolonged grief disorder” and “persistent complex bereavement disorder”, but not “complicated grief”, are one and the same diagnostic entity: an analysis of data from the Yale Bereavement Study. World Psychiatry, 15(3), 266-275.

Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Ommeren, M., Jones, L. M., ... & Somasundaram, D. J. (2013). Diagnosis and classification of disorders specifically associated with stress: proposals for ICD‐11. World Psychiatry, 12(3), 198-206.

Marques, L., Bui, E., LeBlanc, N., Porter, E., Robinaugh, D., Dryman, M. T., ... & Simon, N. (2013). Complicated grief symptoms in anxiety disorders: prevalence and associated impairment. Depression and anxiety, 30(12), 1211-1216.

McConnell, M. H. (2017). Wanting What is Already Gone: Functional Imaging Differentiating Reward Components in Bereavement.

McDermott, O. D., Prigerson, H. G., Reynolds, C. F., Houck, P. R., Dew, M. A., Hall, M., ... & Kupfer, D. J. (1997). Sleep in the wake of complicated grief symptoms: an exploratory study. Biological Psychiatry, 41(6), 710-716.

Merlo, E. M., Frisone, F., Settineri, S., & Mento, C. (2018). Depression signs, Teasing and Low Self-esteem in Female Obese Adolescents: a clinical evaluation. Mediterranean Journal of Clinical Psychology, 6(1).

Monk, T. H., Houck, P. R., & Katherine Shear, M. (2006). The daily life of complicated grief patients—What gets missed, what gets added? Death Studies, 30(1), 77-85.

Morgan, J. D. (Ed.) (2005). Death and bereavement around the world: Death and bereavement in Asia, Australia, and New Zealand. New York, NY: Baywood.

Morgan, J. D., & Laugani, P. (Eds.) (2002). Death and bereavement around the world: Major religious traditions. New York, NY: Baywood.

Neimeyer, R. A., Baldwin, S. A., & Gillies, J. (2006). Continuing bonds and reconstructing meaning: Mitigating complications in bereavement. Death studies, 30(8), 715-738.

Newson, R. S., Boelen, P. A., Hek, K., Hofman, A., & Tiemeier, H. (2011). The prevalence and characteristics of complicated grief in older adults. Journal of affective disorders, 132(1), 231-238.

O'Connor, M. F. (2012). Immunological and neuroimaging biomarkers of complicated grief. Dialogues in clinical neuroscience, 14(2), 141.

O'Connor, M. F., Wellisch, D. K., Stanton, A. L., Eisenberger, N. I., Irwin, M. R., & Lieberman, M. D. (2008). Craving love? Enduring grief activates brain's reward center. Neuroimage, 42(2), 969-972.

Prigerson, H. G., & Jacobs, S. C. (2001). Diagnostic criteria for traumatic grief. Handbook of bereavement research, 614-646.

Prigerson, H. G., Bridge, J., Maciejewski, P. K., Beery, L. C., Rosenheck, R. A., Jacobs, S. C., ... & Brent, D. A. (1999). Influence of traumatic grief on suicidal ideation among young adults. American Journal of Psychiatry, 156(12), 1994-1995.

Prigerson, H. G., Frank, E., Kasl, S. V., & Reynolds III, C. F. (1995). Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses. The American journal of psychiatry, 152(1), 22.

Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., ... & Bonanno, G. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS medicine, 6(8), e1000121.

Schulz, R., Boerner, K., Shear, K., Zhang, S., & Gitlin, L. N. (2006). Predictors of complicated grief among dementia caregivers: a prospective study of bereavement. The American journal of geriatric psychiatry, 14(8), 650-658.

Settineri, S., Gitto, L., Conte, F., Fanara, G., Mallamace, D., Mento, C., ... & Grugno, R. (2012). Mood and sleep problems in adolescents and young adults: an econometric analysis. The journal of mental health policy and economics, 15(1), 33-41.

Shear, K., & Shair, H. (2005). Attachment, loss, and complicated grief. Developmental psychobiology, 47(3), 253-267.

Shear, M. K. (2012). Getting straight about grief. Depression and anxiety, 29(6), 461-464.

Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., ... & Gorscak, B. (2011). Complicated grief and related bereavement issues for DSM‐5. Depression and anxiety, 28(2), 103-117.

Shulla, R. M., & Toomey, R. B. (2018). Sex differences in behavioral and psychological expression of grief during adolescence: A meta-analysis. Journal of adolescence, 65, 219-227.

Silver RC, Wortman CB. The Stage Theory of Grief. JAMA. 2007;297(24):2692–2694.

Silverman GK, Jacobs SC, Kasl SV, Shear MK, Maciejewski PK, Noaghiul FS, Prigerson HG: Quality of life impairments associated with diagnostic criteria for traumatic grief. Psychol Med 2000;30:857–862.

Simon, N. M., Shear, K. M., Thompson, E. H., Zalta, A. K., Perlman, C., Reynolds, C. F., ... & Silowash, R. (2007). The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Comprehensive psychiatry, 48(5), 395-399.

Smid, G. E., Kleber, R. J., de la Rie, S. M., Bos, J. B., Gersons, B. P., & Boelen, P. A. (2015). Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss. European Journal of Psychotraumatology, 6(1), 27324.

Spuij, M., Dekovic, M., & Boelen, P. A. (2015). An open trial of ‘Grief‐Help’: A cognitive–behavioural treatment for prolonged grief in children and adolescents. Clinical psychology & psychotherapy, 22(2), 185-192.

Stroebe, M., Schut, H., & Boerner, K. (2010). Continuing bonds in adaptation to bereavement: Toward theoretical integration. Clinical psychology review, 30(2), 259-268.

Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), 1960-1973.

Stroebe, M., van Son, M., Stroebe, W., Kleber, R., Schut, H., & van den Bout, J. (2000). On the classification and diagnosis of pathological grief. Clinical psychology review, 20(1), 57-75.

World Health Organization. (‎2004)‎. ICD-10: international statistical classification of diseases and related health problems : tenth revision, 2nd ed. World Health Organization.

Zhang, B., El-Jawahri, A., & Prigerson, H. G. (2006). Update on bereavement research: Evidence-based guidelines for the diagnosis and treatment of complicated bereavement. Journal of palliative medicine, 9(5), 1188-1203.




DOI: https://doi.org/10.6092/2282-1619/2019.7.2244

Refbacks

  • There are currently no refbacks.