Symptom heterogeneity of DSM-5-TR prolonged grief disorder

Prolonged grief disorder (PGD) is defined in DSM-5-TR by the presence of one of two separation distress symptoms (yearning or preoccupation) and three of eight accessory symptoms (e.g., loneliness). This definition yields 657 possible clinical presentations of PGD. Such symptom heterogeneity may hamper the identification of risk and protective factors and effective treatments for PGD. Despite concerns associated with heterogeneity, no studies have yet determined actual patterns of PGD symptoms among people with probable PGD.

Data were drawn from two datasets comprising 2679 bereaved adults with probable PGD who completed the Traumatic Grief Inventory-Self Report Plus (TGI-SR+) online.

We identified 396 of 657 possible PGD symptom profiles. The most common profile was the presence of all PGD criteria (n = 407, 15%). The five most frequently observed PGD symptom profiles were experienced by 37% of participants (n = 980). Other PGD symptom profiles were reported by fewer than 2% of the sample (n = 1699, 63%).

No clinical interview was applied to assess diagnostic status.

While there is substantial heterogeneity in profiles of PGD, a relatively small set of profiles can be considered diagnostic prototypes. Future research may help clarify whether risk and protective factors and treatment responses vary dependent on PGD profiles.