Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients

Psychol Med. 2017 Mar;47(4):608-615. doi: 10.1017/S0033291716002749. Epub 2016 Nov 8.


Background: Persistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research.

Method: Two groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria.

Results: PCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2-75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4-65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8-100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group.

Conclusions: Both proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.

Keywords: Complicated grief; DSM-5 criteria; functional impairment; persistent complex bereavement disorder; stress.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Bereavement*
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care
  • Practice Guidelines as Topic / standards*
  • Psychiatric Status Rating Scales*
  • Psychological Trauma / diagnosis*
  • Syndrome