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Am J Psychiatry 1997; 154:904-910
Copyright © 1997 by American Psychiatric Association
Diagnostic criteria for complicated grief disorder
MJ Horowitz, B Siegel, A Holen, GA Bonanno, C Milbrath and CH Stinson
Langley Porter Psychiatric Institute, University of California, San Francisco 94143-0984, USA.
OBJECTIVE: Some prolonged and turbulent grief reactions include symptoms
that differ from the DSM-IV criteria for major depressive disorder. The
authors investigated a new diagnosis that would include these symptoms.
METHOD: They developed observer-based definitions of 30 symptoms noted
clinically in previous longitudinal interviews of bereaved persons and then
designed a plan to investigate whether any combination of these would serve
as criteria for a possible new diagnosis of complicated grief disorder.
Using a structured diagnostic interview, they assessed 70 subjects whose
spouses had died. Latent class model analyses and signal detection
procedures were used to calibrate the data against global clinical ratings
and self-report measures of grief-specific distress. RESULTS: Complicated
grief disorder was found to be characterized by a smaller set of the
assessed symptoms. Subjects elected by an algorithm for these symptoms
patterns did not significantly overlap with subjects who received a
diagnosis of major depressive disorder. CONCLUSIONS: A new diagnosis of
complicated grief disorder may be indicated. Its criteria would include the
current experience (more than a year after a loss) of intense intrusive
thoughts, pangs of severe emotion, distressing yearnings, feeling
excessively alone and empty, excessively avoiding tasks reminiscent of the
deceased, unusual sleep disturbances, and maladaptive levels of loss of
interest in personal activities.
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Complicated Grief Disorder: The Evolution of a New Diagnosis?
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