Traumatic grief refers to the psychological distress which may occur in a bereaved individual following the loss of a loved one. Common mental health disorders in this population are, among others, posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and persistent complex bereavement disorder (PCBD).
Recently, PCBD was included in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (1). The core underlying characteristic of PCBD is ‘prolonged yearning’, whereas ‘anxiousness’ and ‘depressed mood’ are described to be central to PTSD or MDD (2, 3). Other core symptoms of PCBD include ‘avoidance of reminders of the death’, ‘difficulties accepting the loss’, and ‘significant impairment of daily functioning’ (4, 5). Similar concepts with slightly different criteria are called prolonged grief disorder (PGD), which has been included in the International Classification of Diseases, 11th revision (ICD-11) (6-8), and/or complicated grief (3).
There is an ongoing discussion about which criteria best describe the phenomenon of pathological grief (9-12). This ongoing discussion about the criteria makes it difficult for researchers to compare research findings and further develop theories and interventions for those affected by psychological problems following bereavement. For example, recently, two meta-analyses computing the prevalence rate of PCBD showed that the different criteria sets account for significant differences even in a multivariate analysis with other risk factors (13, 14). Furthermore, recent research showed that symptoms of PGD, PTSD, and MDD tend to co-occur together in bereaved individuals presenting with serious distress, especially following the loss of close kin or a traumatic loss (15-17). This can make it difficult for clinicians to adequately diagnose and choose the best therapy for the patient. Should the PGD symptoms, the PTSD symptoms, or the MDD symptoms be treated first? Is prolonged exposure the best treatment approach for this group of patients, or does treatment need to focus more on meaning-making? These are all relevant clinical questions, and no definite answer has yet to be formulated.
Therefore, action is needed to reach consensus about both the clinical relevance of traumatic grief in diagnoses and treatment and disturbed grief criteria. In order to achieve these goals, we think that greater collaboration between clinicians and researchers internationally is needed to derive a shared conceptualization of natural and pathological grief. The ESTSS supports the idea of creating a platform in which clinicians and researchers from all over Europe (and also other parts of the world) get to know each other, exchange ideas, collaborate, and share knowledge about traumatic grief. The first activity of the ESTSS Special Interest Group (SIG) Traumatic Grief will be a network meeting and workshop at the ESTSS conference of 2021 in Belfast.
If you are interested, you can subscribe to the e-mail list of the ESTSS SIG Traumatic Grief by filling out this form: https://forms.gle/fQWPs6vxC6iHDdi17
More information about traumatic grief can be found on various websites (please let me know if you think a website is missing: a.a.a.m.j.djelantik@uu.nl):
https://www.culturalclinicalpsych-yrn.com
https://www.robertneimeyerphd.com/research.html
https://www.apa.org/helpcenter/grief
https://rouw.arq.org/ (Dutch)
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013 May 18, 2013.
2. Maercker A, Znoj H. The younger sibling of PTSD: similarities and differences between complicated grief and posttraumatic stress disorder. European Journal of Psychotraumatology. 2010;1.
3. Shear MK. Clinical Practice. Complicated grief. The New England Journal of Medicine. 2015;372(2):153-60.
4. Boelen PA, Prigerson HG. The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults. European Archives of Psychiatry and Clinical Neuroscience. 2007;257(8):444-52.
5. Silverman GK, Jacobs SC, Kasl SV, Shear MK, Maciejewski PK, Noaghiul FS, et al. Quality of life impairments associated with diagnostic criteria for traumatic grief. Psychological Medicine. 2000;30(4):857-62.
6. Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine. 2009;6(8):e1000121.
7. Killikelly C, Maercker A. Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European journal of psychotraumatology. 2017;8(sup6):1476441.
8. World Health Organization. International Classification of Diseases, 11th Revision. Geneva: World Health Organization 2018.
9. Mauro C, Shear MK, Reynolds CF, Simon NM, Zisook S, Skritskaya N, et al. Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients. Psychological medicine. 2017;47(4):608-15.
10. Maciejewski PK, Maercker A, Boelen PA, Prigerson HG. “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. 2016;15(3):266-75.
11. Boelen PA, Lenferink LIM, Nickerson A, Smid GE. Evaluation of the factor structure, prevalence, and validity of disturbed grief in DSM-5 and ICD-11. Journal of Affective Disorders. 2018;240:79-87.
12. Cozza SJ, Shear MK, Reynolds CF, Fisher JE, Zhou J, Maercker A, et al. Optimizing the clinical utility of four proposed criteria for a persistent and impairing grief disorder by emphasizing core, rather than associated symptoms. Psychological Medicine. 2019:1-8.
13. Lundorff M, Holmgren H, Zachariae R, Farver-Vestergaard I, O'Connor MF. Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders. 2017;212:138-49.
14. Djelantik AAAMJ, Smid GE, Mroz A, Kleber RJ, Boelen PA. The prevalence of Prolonged Grief Disorder in bereaved individuals following unnatural losses: Systematic review and meta-regression analysis. Submitted. 2019.
15. Djelantik AAAMJ, Robinaugh DJ, Kleber RJ, Smid GE, Boelen PA. Symptomatology following loss and trauma: Latent class and network analyses of prolonged grief disorder, posttraumatic stress disorder, and depression in a treatment‐seeking trauma‐exposed sample. Depression and Anxiety. 2019.
16. Maccallum F, Bryant RA. Symptoms of prolonged grief and posttraumatic stress following loss: A latent class analysis. Australian & New Zealand Journal of Psychiatry. 2019;53(1):59-67.
17. Nickerson A, Liddell BJ, Maccallum F, Steel Z, Silove D, Bryant RA. Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss. BMC Psychiatry. 2014;14:106-244X-14-106.
