Table 1.

Proposed DSM-5 Criteria for Persistent Complex Bereavement-Related Disorder

Persistent Complex Bereavement-Related Disorder	Assessment
Criterion A. The person experienced the death of a close family member or close friend at least 12 months ago. In the case of bereaved children, the death may have occurred at least 6 months ago.	Parental death
Criterion B. Since the death at least one of the following symptoms is experienced on more days than not and to a clinically significant degree:
1. Persistent yearning/longing for the deceased. In young children, yearning may be expressed in play and behavior including separation–reunion behavior with caregivers	Item 5a: I very much miss ….
2. Intense sorrow and emotional pain in response to the death	Item 1: The death feels upsetting, overwhelming or devastating
3. Preoccupation with the deceased	Item 2: I think about …. so much that it can be hard for me to do the things I normally do
4. Preoccupation with the circumstances of the death. In children, this preoccupation with the deceased may be expressed through the themes of play and behavior and may extend to preoccupation with possible death of others close to them	Circumstances of Exposure to Death: Do you think there may have been something that you could have done to help prevent the death?
Criterion C. Since the death at least 6 of the following symptoms are experienced on more days than not and to a clinically significant degree:
Reactive distress to the death:
1. Marked difficulty accepting the death. (Note: in children, this is dependent on the child’s capacity to comprehend the meaning and permanence of death)	Item 4: I feel that I cannot accept the death Item 7: I feel that I cannot believe my ….’s death
2. Feeling shocked, stunned, or emotionally numb over the loss	Item 8: I feel shocked over the death Item 16: I feel like I have become numb since the death
3. Difficulty in positive reminiscing about the deceased	Item 3. Memories of …. upset me
4. Bitterness or anger related to the loss	Item 6: I feel angry about the death Item 18: I am bitter over the death
5. Maladaptive appraisals about oneself in relation to the deceased or the death (e.g., self-blame)	Circumstances of Exposure to Death: How accountable do you feel for the death?
6. Excessive avoidance of reminders of the loss (e.g., avoiding of individuals, places, or situations associated with the deceased). (Note: in children this may include avoidance of thoughts and feelings regarding the deceased)	Item 11. I avoid reminders of …. Item 12. I avoid reminders that he/she is dead
Social/identity disruption
7. A desire to die in order to be with the deceased	Grief Interview: Do you wish you were dead to be with your parent?
8. Difficulty trusting other individuals since the death	Item 9. Ever since the death, it is hard for me to trust people
9. Feeling alone or detached from other individuals since the death	Item 10. Ever since the death, I feel like I don’t care about other people as much and I don’t feel as close to people I care about as I used to
10. Feeling that life is meaningless or empty without the deceased, or the belief that one cannot function without the deceased	Item 14. I feel that life is empty or has no meaning without …. Item 20. I feel like the future has no meaning or purpose without …. Item 22. It is difficult for me to imagine life being satisfying without ….
11. Confusion about one’s role in life or a diminished sense of one’s identity (e.g., feeling that a part of oneself died with the deceased)	Item 23. I feel that a part of myself died with ….
12. Difficulty or reluctance to pursue interests since the loss or to plan for the future (e.g., friendships, activities)	Item 13. Sometimes people who lose a loved one feel that they cannot go back to normal life and be able to make new friends and do new activities. Do you feel that making new friends or doing new activities would be difficult for you?
Criterion D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning	CGAS ≤ 70
Criterion E. The bereavement reaction must be out of proportion or inconsistent with cultural, religious, or age-appropriate norms	Not assessed

Note:

^aInventory for Complicated Grief–Revised for Children (ICG-RC) item.