| A. Bereavement (loss of a significant other) |
A. The person has been bereaved, i.e. experienced the death of a loved one, for at least 6 months |
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| B. Separation Distress: The bereaved person experiences yearning (e.g. craving, pining, or longing for the deceased; physical or emotional suffering as a result of the desired but unfulfilled reunion with the deceased) daily or to a disabling degree |
B. Atleast one of the following symptoms of persistent intense acute grief has been present for a period longer than is expected by others in the person’s social or cultural environment |
Separation distress can be manifest in several different ways. A meaningful minority of people who meet criteria for CG by other methods do not endorse yearning. |
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1. Persistent intense yearning or longing for the person who died |
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2. Frequent intense feelings of loneliness or like life is empty or meaningless without the person who died |
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3. Recurrent thoughts that it is unfair, meaningless or unbearable to have to live when a loved one has died, or a recurrent urge to die in order to find or to join the deceased |
Suicidal thinking and behaviors are elevated in CG and are important symptoms |
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4. Frequent preoccupying thoughts about the person who died, e.g. thoughts or images of the person intrude on usual activities or interfere with functioning |
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| C. Cognitive, emotional and behavioral symptoms: The bereaved person must have five or more of the following symptoms experienced daily or to a disabling degree: |
C. At least 2 of the following symptoms are present for at least a month: |
It is important that these symptoms are all related to the death. |
| 1. Confusion about one's role in life or diminished sense of self (i.e. feeling that a part of oneself has died) |
1. Frequent troubling rumination about circumstances or consequences of the death, e.g. concerns about how or why the person died, or about not being able to manage without their loved one, thoughts of having let the deceased person down, etc. |
Rumination is a clinically significant symptom of CG |
| 2. Difficulty accepting the loss |
2. Recurrent feeling of disbelief or inability to accept the death, like the person can’t believe or accept that their loved one is really gone |
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| 3. Avoidance of reminders of the reality of the loss |
3. Persistent feeling of being shocked, stunned, dazed or emotionally numb since the death |
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| 4. Inability to trust others since the loss |
4. Recurrent feelings of anger or bitterness related to the death |
People with CG are mistrustful because they feel that others don't understand them or are critical of them |
| 5. Bitterness or anger related to the loss |
5. Persistent difficulty trusting or caring about other people or feeling intensely envious of others who haven’t experienced a similar loss |
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| 6. Difficulty moving on with life (e.g. making new friends, pursuing new interests) |
6. Frequently experiencing pain or other symptoms that the deceased person had, or hearing the voice or seeing the deceased person |
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| 7. Numbness (absence of emotion) since the loss |
7. Experiencing intense emotional or physiological reactivity to memories of the person who died or to reminders of the loss |
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| 8. Feeling that life is unfulfilling, empty or meaningless since the loss |
8. Change in behavior due to excessive avoidance or the opposite, excessive proximity seeking, e.g. refraining from going places, doing things, or having contact with things that are reminders of the loss, or feeling drawn to reminders of the person, such as wanting to see, touch, hear or smell things to feel close to the person who died. (Note: sometimes people experience both of these seemingly contradictory symptoms.) |
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| 9. Feeling stunned, dazed or shocked by the loss |
9. Disturbing emotional or physiological reactivity to reminders of the loss |
This item is strongly related to CG symptoms in Bonanno studies and is clinically meaningful |
| D. Timing: Diagnosis should not be made until at least six months have elapsed since the death |
D. The duration of symptoms and impairment is at least 1 month |
Need minimum duration of symptoms. CG is not diagnosed until at least 6 months after the loss but some people have transient increases in symptoms after that time and should not be considered to have CG |
| E. Impairment: The disturbance causes clinically significant impairment in social, occupational or other important areas of functioning (e.g. domestic responsibilities) |
E. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning, where impairment is not better explained as a culturally appropriate response |
we added distress, in line with other DSM diagnoses, and the possibility that impairment might be explained as a culturally appropriate response -e.g. when certain activities are not considered appropriate until a year has passed |
| F. Relation to other mental disorders: The disorder is not better accounted for by major depressive disorder , generalized anxiety disorder or posttraumatic stress disorder |
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We favor omission of this criterion in line with thinking of other work groups about the difficulties of hierarchical diagnoses |
