“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.
Open accessAbstract
There exists a general consensus that prolonged grief disorder (PGD), or some variant of PGD, represents a distinct mental disorder worthy of diagnosis and treatment. Nevertheless, confusion remains over whether different names and proposed symptom criteria for this disorder identify the same or different diagnostic entities. This study aimed to determine whether PGD, complicated grief (CG), and persistent complex bereavement disorder (PCBD) as described by the DSM‐5 are substantively or merely semantically different diagnostic entities. Data were derived from the Yale Bereavement Study, a longitudinal community‐based study of bereaved individuals funded by the US National Institute of Mental Health, designed explicitly to evaluate diagnostic criteria for disordered grief. The results suggested that the difference between PGD and PCBD is only semantic. The level of agreement between the original PGD test, a new version of the PGD test proposed for ICD‐11 and the PCBD test was high (pairwise kappa coefficients = 0.80‐0.84). Their estimates of rate of disorder in this community sample were similarly low (∼10%). Their levels of diagnostic specificity were comparably high (95.0‐98.3%). Their predictive validity was comparable. In contrast, the test for CG had only moderate agreement with those for PGD and PCBD; its estimate of rate of disorder was three‐fold higher (∼30%); its diagnostic specificity was poorer, and it had no predictive validity. We conclude that PGD, PCBD and proposed ICD‐11, but not CG, symptom‐diagnostic tests identify a single diagnostic entity. Ultimately, brief symptom‐diagnostic tests, such as the one proposed here for ICD‐11, may have the greatest clinical utility.
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There is an ongoing discussion about which criteria best describe the phenomenon of pathological grief.
“There is also an ongoing discussion about which criteria best describe the phenomenon of pathological grief (Boelen et al., 2018;Cozza et al., 2019;Maciejewski et al., 2016;Mauro et al., 2017).”
From The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis (2020) · cites this paper as Maciejewski et al., 2016
The differences between PGD and PCBD may be merely semantic as the two disorders show comparable predictive validity and similar high levels of diagnostic specificity (95.0-98.3%).
“The results of a recently published study found that the differences between PGD and PCBD may be merely semantic as the two disorders show comparable predictive validity and similar high levels of diagnostic specificity (95.0-98.3%) (Maciejewski et al., 2016).”
From Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis (2017) · cites this paper as Maciejewski et al., 2016
PGD is included in the Appendix of DSM-5 and is expected to be included as a mental disorder in ICD-11.
“From a nosological perspective, expansions and alignment of this research seems crucial as PGD is included in the Appendix of DSM-5 and is expected to be included as a mental disorder in ICD-11 (Bryant, 2014; Maciejewski et al., 2016; Maercker et al., 2013; Rosner, 2015).”
From Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis (2017) · cites this paper as Maciejewski et al., 2016
The main differences between PGD and PCBD are semantic rather than substantive.
“The main differences between PGD and PCBD are semantic rather than substantive.”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Maciejewski et al., 2016
The ICD-11 criteria for PGD have been refined to be clinically useful, valid, and reliable.
“the ICD-11 criteria for PGD has been refined to be clinically useful, valid and reliable (Maercker et al., 2013; Maciejewski et al., 2016).”
From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Maciejewski et al., 2016
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- Authors
- Maciejewski, P. K., Maercker, A., Boelen, P. A., & Prigerson, H. G.
- Affiliations
- Weill Cornell Medicine (US)
- Department of Psychology, Division of Psychopathology University of Zurich Switzerland
- Utrecht University (NL)
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2016-09-22
- Volume
- 15
- Issue
- 3
- Pages
- 266-275
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC5032512
- OpenAlex
- W2521854558
- Cited by
- 298
- References
- 39
- Citations by year
- 2026: 8 · 2025: 20 · 2024: 24 · 2023: 22 · 2022: 30 · 2021: 34 · 2020: 46 · 2019: 39 · 2018: 38 · 2017: 36 · 2016: 1
- FWCI
- 50.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Institute of Minority Health and Health Disparities (MD007652)
- National Institute of Mental Health (MH56529)
- National Cancer Institute (CA106370 and CA197730)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- prolonged grief disorder, complicated grief, diagnostic validity, diagnostic specificity, predictive validity, ICD-11, DSM-5, bereavement, diagnostic agreement
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