As WHO member states begin the transition from using the ICD-10 to the ICD-11 in health care and data reporting systems, it is important for clinicians to gain an understanding of how new diagnostic categories in the ICD-11 Clinical Descriptions and Diagnostic Requirements for Mental, Behavioural, or Neurodevelopmental Disorders have the potential to improve both individual care and public health globally.
In an article published recently in World Psychiatry, an international team of experts and collaborators share insight on the following four new diagnoses in the ICD-11: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. As part of a series of GCP.Network Perspectives articles, key information on prolonged grief disorder is highlighted here.
What is prolonged grief disorder? In the ICD-11, prolonged grief disorder is described as:
- History of bereavement following the death of a partner, parent, child, or other person close to the bereaved.
- A persistent and pervasive grief response: longing or yearning for the deceased and intense emotional pain, difficulty accepting death, feeling to have lost part of oneself, emotional numbing, inability to experience positive mood, and difficulty engaging in social and other activities.
- Grief response persists longer than the social, cultural, or religious norms of one’s culture and context.
- Severely impacts personal, social, occupational, or daily functioning.
- To view the full version of the diagnostic requirements, the ICD-11 CDDR is available here.
Why was prolonged grief disorder added as a new diagnostic category? Although the symptoms of prolonged grief disorder are similar to symptoms experienced during typical bereavement and grieving processes, prolonged grief disorder is distinct in that these reactions do not abate over time and cause severe distress and impairment to daily functioning. Prolonged grief disorder has been associated with marked occupational and social impairment, medical conditions (e.g., increased rates of cancer and cardiovascular problems, impaired sleep), increased substance use behaviors, and elevated rates of other mental disorders such as depression and PTSD. Identifying and recognizing prolonged grief disorder can help to improve access to appropriate and specialized treatment. It is also important to note that this diagnosis is not meant to pathologize universal grief responses; studies show that only 7-10% of bereaved people may suffer from prolonged grief disorder.
How does this new diagnosis improve care provision and advance public health? The inclusion of prolonged grief disorder in the ICD-11 has established a more standardized approach to diagnosing this condition globally, and it has stimulated additional research on evidence-based treatments, such as grief-focused psychotherapy. The introduction of this diagnosis into the ICD-11 has also influenced a similar diagnosis of “persistent complex bereavement disorder” to be formally added to the DSM-5 Text Revision. The convergence of prolonged grief disorder now in both of these major classification systems will further improve standardization in diagnostic processes worldwide, lead to better estimation of global prevalence rates through public health data, and ultimately inform decisions around treatment and resource dissemination.
To read more about the history, research evidence, and controversies around the inclusion of prolonged grief disorder in the ICD-11, the full article is available online here. GCP.Network members can log in and download a PDF of the article on the Scholarly Output page.
Citation: Reed, G.M., First, M.B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C.R., King, D.L., Kraus, S.W. and Bryant, R.A. (2022). Emerging experience with selected new categories in the ICD-11: Complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry, 21: 189-213. https://doi.org/10.1002/wps.20960