Prospective evaluation of the DSM-5 persistent complex bereavement disorder criteria in adults: dimensional and diagnostic approaches

2020 ◽  
pp. 1-10 ◽  
Author(s):  
Elie G. Aoun ◽  
Giovanna Porta ◽  
Nadine M. Melhem ◽  
David A. Brent
Keyword(s):  
Functional Impairment ◽  
High Sensitivity ◽  
Close Relative ◽  
Related Disorder ◽  
Prolonged Grief ◽  
Dsm 5 ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder ◽  
Grief Reactions ◽  
Over Time

Abstract Background We examine the performance of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) persistent complex bereavement-related disorder (PCBD) criteria in bereaved adults to identify prolonged grief cases determined prospectively. Methods Bereaved adults (n = 138) were assessed at 8, 21, 32, 67, and 90 months after the sudden death of a spouse or close relative. We used latent class growth analysis to identify the longitudinal trajectories of grief assessed using the Inventory for Complicated Grief. To validate the trajectory that corresponded to prolonged grief, we examined the baseline predictors of these trajectories and their relationship with functional impairment. Results We found three distinct trajectories of grief reactions. One of these trajectories (13.8%) showed high and sustained grief reactions that persisted for almost 7.5 years after the death. Participants with prolonged grief showed greater functional impairment [relative risk ratio (RRR) = 0.82, 95% confidence interval (CI): 0.70 to −0.97; p = 0.02] and higher self-reported depression (RRR = 1.21, 95% CI 1.09 to 1.96; p = 0.001) than participants whose grief reactions subsided over time. The original PCBD (requiring 6 criterion C symptoms) criteria correctly identified cases (57.9–94.7%) with perfect specificity (100%) but low to high sensitivity (5.6–81.3%); however, its sensitivity increased when revising criterion C to require ⩾3 (45.5–94.1%). The dimensional approach showed high sensitivity (0.50–1) and specificity (0.787–0.97). Conclusions We recommend revisions to the PCBD criteria, which are overly restrictive and may exclude cases with clinically significant grief-related distress and impairment. In the meantime, clinicians need to monitor grief symptoms over time using available dimensional approaches to reduce the burden of grief.

Persistent Complex Bereavement Disorder

2018 ◽  
Author(s):  
Meredith E. Charney ◽  
Sarah Wieman ◽  
Nicole Leblanc ◽  
Naomi Simon
Keyword(s):  
Differential Diagnosis ◽  
Clinical Features ◽  
Psychological Response ◽  
Prolonged Grief ◽  
Loved One ◽  
Traumatic Grief ◽  
Assessment And Treatment ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder ◽  
Over Time

Grief is an intensely painful, but natural and normal psychological response following the death of a loved one. Although there is no uniform pattern for adapting to loss, for the majority of people, acute grief naturally evolves over time into a more integrated, less painful form of grief in a way that is healthy and adaptive; this enables return to a satisfying life without the deceased. However, a growing literature has shown that complications can arise such that the natural recovery from acute grief stalls and grief becomes persistently intense and debilitating. This chapter describes the etiology, diagnostic and clinical features, differential diagnosis, epidemiology, pathophysiology, assessment, and treatment of this condition, termed “complicated grief,” “traumatic grief,” “prolonged grief,” or “persistent complex bereavement disorder.”

A case series: Efficacy of short term EMDR on patients with persistent complex bereavement disorder (PCBD)

2017 ◽  
Vol 41 (S1) ◽  
pp. S360-S361
Author(s):  
F.D. Usta ◽  
A.B. Yasar ◽  
A.E. Abamor ◽  
M. Caliskan
Keyword(s):  
Sleep Disturbances ◽  
Case Series ◽  
Traumatic Loss ◽  
Degree Relative ◽  
Current Case ◽  
Prolonged Grief ◽  
Persistent Complex Bereavement ◽  
Competing Interest ◽  
Persistent Complex Bereavement Disorder ◽  
Emdr Therapy

Grief is a normal response to loss of someone to whom a bond was formed; however, prolonged grief is considered pathological. Persistent complex bereavement disorder (PCBD) is defined as a persistent longing for the deceased over 12 months. Several treatment ways have been used for traumatic loss including eye movement desensitization and reprocessing (EMDR). In the current case series, effectiveness of EMDR on three PCBD patients will be indicated. Three patients applied to the clinic with similar complaints based on different traumatic backgrounds; commonly, all experienced death of a first-degree relative. Complaints of the patients were over-thinking about the deceased, sleep disturbances, self-blaming, social isolation, avoiding talks about lost relative, and loss of interest in activities. After pre-interviews, they were advised EMDR therapy. One session of EMDR was applied to two of the patients, and two EMDR sessions were conducted on one of them. After the sessions, the patients reported not feeling guilty about the loss anymore, returning their normal routines, feeling better, and showing decreased avoidance. Additionally, the scores of scales (CAPS, BAI, BDI, and IES-R) significantly declined. EMDR therapy can show successful results in a shorter time than other treatment ways used for PCBD treatment [1].Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Diagnosing Posttraumatic Stress Disorder in Refugees

2020 ◽  
Author(s):  
Shafaz Veettil ◽  
Anastasiya Vinokurtseva
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Predictive Power ◽  
Stress Disorder ◽  
High Sensitivity ◽  
Symptom Cluster ◽  
Related Disorder ◽  
Dsm 5 ◽  
Health Distress ◽  
Sensitivity Specificity

Global crises has amounted to the forced international displacement of 25.4 million refugees. Refugees from conflict-affected areas are especially vulnerable to posttraumatic stress disorder (PTSD) compared to the general population due to their past and present hardships and history of trauma. PTSD is characterized by a constellation of symptoms identified by the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM-5 departed from DSM-IV by reclassifying PTSD as a trauma- and stressor-related disorder and introducing a fourth symptom cluster—negative alterations in mood/cognition—to the previous three-symptom cluster model. In severely traumatized refugees, this new cluster exhibited relatively high sensitivity, specificity, positive predictive power, and negative predictive power—in concordance with the range of symptoms exhibited by this population—and allowed for the applicability of the DSM-5 criteria. However, the Western sample basis of the DSM-5 might make it inferior to alternative models as a diagnostic tool for PTSD in refugees and as a springboard for treatment. In addition (and possibly due) to PTSD, refugees are at high risk for mental health distress and suffer from poor health outcomes. Optimizing diagnostic criteria and overcoming barriers to diagnosis and access to care would benefit patients and facilitate treatment.

scholarly journals A cognitive approach to persistent complex bereavement disorder (PCBD)

2017 ◽  
Vol 10 ◽  
Author(s):  
Michael Duffy ◽  
Jennifer Wild
Keyword(s):  
Cognitive Model ◽  
Diagnostic Category ◽  
Post Traumatic Stress ◽  
Cognitive Approach ◽  
Prolonged Grief ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
International Statistical Classification ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder

AbstractPersistent complex bereavement disorder (PCBD) has been included in the appendix of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders as a condition for further study, and a new diagnostic category of prolonged grief disorder (PGD) is likely to be added to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) (Maercker et al., 2013). Whilst there is increasing evidence that prolonged grief has distinct characteristics (Bryant, 2012), there are clinical features that overlap with post-traumatic stress disorder (PTSD), such as intrusive memories, emotional numbing, and avoidance of trauma or loss reminders. Here we describe how the cognitive model for persistent PTSD (Ehlers and Clark, 2000) and trauma-focused cognitive therapy for PTSD (Ehlers et al., 2005) have been helpful in treating persistent complex grief.

scholarly journals Complicated grief: recent developments in diagnostic criteria and treatment

2018 ◽  
Vol 373 (1754) ◽  
pp. 20170273 ◽  
Author(s):  
Satomi Nakajima
Keyword(s):  
Diagnostic Criteria ◽  
Complicated Grief ◽  
Behavioural Therapy ◽  
Pathological State ◽  
Human Beings ◽  
Duration Of Symptoms ◽  
Related Disorder ◽  
Biological Studies ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder

Although grief is a natural response to loss among human beings, some people have a severe and prolonged course of grief. In the 1990s, unusual grief persisting with a high level of acute symptoms became known as ‘complicated grief (CG)’. Many studies have shown that people who suffer from CG are at risk of long-term mental and physical health impairments and suicidal behaviours; it is considered a pathological state, which requires clinical intervention and treatment. DSM-5 (2013 Diagnostic and statistical manual of mental disorders , 5th edn) proposed ‘persistent complex bereavement disorder’ as a psychiatric disorder; it is similar to CG in that it is a trauma- and stress-related disorder. In recent years, there has been considerable research on the treatment of CG. Randomized controlled trials have suggested the efficacy of cognitive behavioural therapy including an exposure component that is targeted for CG. However, experts disagree about the terminology and diagnostic criteria for CG. The ICD-11 ( International classification of diseases , 11th revision) beta draft proposed prolonged grief disorder as a condition that differs from persistent complex bereavement disorder with respect to terminology and the duration of symptoms. This divergence has arisen from insufficient evidence for a set of core symptoms and the biological basis of CG. Future studies including biological studies are needed to reach consensus about the diagnostic criteria for CG. This article is part of the theme issue ‘Evolutionary thanatology: impacts of the dead on the living in humans and other animals’.

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