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Cited by 648Grief, Bereavement, and Mental HealthDeath, Funerary Practices, and MourningPosttraumatic Stress Disorder Research

Diagnostic criteria for complicated grief disorder

Mardi J. Horowitz, Bryna Siegel, Are Holen, George A. Bonanno, Constance Milbrath, Charles H. Stinson·1997·American Journal of Psychiatry
DOI 10.1176/ajp.154.7.904
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Abstract

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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  • In Global North samples, dreaming of the deceased was originally one of the 30 symptoms proposed as a key intrusive symptom of complicated grief but is not used in the more recent Inventory of Complicated Grief.

    “In Global North samples, dreaming of the deceased was originally one of the 30 symptoms proposed as a key intrusive symptom of complicated grief (Horowitz et al., 1997), but is not used in the more recent Inventory of Complicated Grief (Prigerson et al., 1995).”

    From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Horowitz et al., 1997

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Authors
Horowitz, M. J., Siegel, B., Holen, A., Bonanno, G. A., Milbrath, C., & Stinson, C. H.
Affiliations
University of California, San Francisco (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
1997-07-01
Volume
154
Issue
7
Pages
904-910
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/ajp.154.7.904
OpenAlex
W2179616438
Cited by
648
References
44
Citations by year
2026: 8 · 2025: 10 · 2024: 12 · 2023: 13 · 2022: 19 · 2021: 15 · 2020: 17 · 2019: 22 · 2018: 15 · 2017: 25 · 2016: 28 · 2015: 36 · 2014: 37 · 2013: 37 · 2012: 38
FWCI
12.62
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
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
diagnostic criteria, prolonged grief disorder, bereavement, death of a spouse, intrusive thoughts, longing, sleep disorders, avoidance, loss of interest, major depressive disorder, latent class analysis, signal detection
MeSH terms
Adjustment Disorders, Adult, Algorithms, Mental Disorders, Bereavement, Depressive Disorder, Diagnosis, Differential, Family Characteristics, Female, Follow-Up Studies, Grief, Humans, Male, Middle Aged, Terminology as Topic, Personality Inventory, Psychiatric Status Rating Scales, Psychometrics, Sensitivity and Specificity, Severity of Illness Index, Stress Disorders, Post-Traumatic, Reproducibility of Results, Models, Statistical, Likelihood Functions, Widowhood

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