Is pathological grief lasting more than 12 months grief or depression?

DSM-5 and ICD-11 have proposed new psychiatric diagnoses to describe persistent and severe grief reactions. These initiatives have sparked much controversy because of concerns that diagnosing grief responses may overpathologize normative distress following bereavement. This review outlines the evidence for diagnosing grief.

Multiple studies indicate that, more than 6 months after bereavement, 10-15% of bereaved people experience marked impairment secondary to severe grief responses. This response is characterized by intense yearning for the deceased together with related symptoms, is noted across cultures and age groups, is distinct from depression and anxiety, and contributes to psychiatric morbidity, poor health behaviors, physical illnesses, and occupational and social dysfunction. Psychotherapeutic interventions targeted at the core symptoms of prolonged grief show promising results, in contrast to poor response to psychotherapy and pharmacological interventions targeted at depression.

There is convergent evidence that introducing psychiatric diagnoses to identify bereaved people suffering prolonged severe grief responses addresses a major public health issue, is supported by convergent evidence, and has the potential to minimize inappropriate treatment as a result of misdiagnosis.