| A. The person has been bereaved, ie, experienced the dead of a loved one, for at least 6 months |
| B. At least 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 |
| 1. Persistent intense yearning or longing for the person who died |
| 2. Frequent intense feelings of loneliness or like life is empty or meaningless without the person who died |
| 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 |
| 4. Frequent preoccupying thoughts about the person who died, eg, thoughts or images of the person intrude on usual activities or interfere with functioning |
| C. At least two of the following symptoms are present for at least 1 month. |
| 1. Frequent troubling rumination about circumstances or consequences of the death, eg, 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 |
| 2. Recurrent feeling of disbelief or inability to accept the death, as if the person cannot believe or accept that their loved one is really gone |
| 3. Persistent feeling of being shocked, stunned, dazed, or emotionally numb since the death |
| 4. Recurrent feelings of anger or bitterness related to the death |
| 5. Persistent difficulty trusting or caring about other people or feeling intensely envious of others who have not experienced a similar loss |
| 6. Frequently experiencing pain or other symptoms that the deceased person had, or hearing the voice of or seeing the deceased person |
| 7. Experiencing intense emotional or physiological reactivity to memories of the person who died or to reminders of the loss |
| 8. Change in behavior due to excessive avoidance or the opposite, excessive proximity seeking, eg, 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.) |
| D. The duration of symptoms and impairment is at least 1 month |
| 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 |
