New Book Addresses Prolonged Grief Disorder Diagnosis and Treatment
WASHINGTON – Hospice Foundation of America (HFA) today announced the publication of Understanding Prolonged Grief Disorder, written and edited by some of the nation’s leading grief experts and healthcare professionals.
Prolonged grief disorder (PGD) is a new diagnosis in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) Inclusion of PGD validates the occurrence of a disorder characterized by the persistence of pervasive, intense grief. With the possible exception of posttraumatic stress disorder (PTSD), this is the first time a loss-related condition has been identified as a diagnosable condition.
Yet the new diagnosis has not been fully embraced and continues to generate controversy as demonstrated by academic debate and public opinion. Opponents believe it pathologizes grief and that its study has been too culturally limited, but researchers who proposed the disorder continue to make a strong, data-supported case that its recognition will help a minority of the bereaved who suffer significant distress and impairment as a result of a death loss.
In this volume of scholarly and personal work, grief experts, researchers, students, and healthcare practitioners, will all find perspectives that both illuminate and challenge the evidence-based research that led to the inclusion of the diagnosis. A prominent theme addressed by book authors and editors is whether some people may experience grief—which professionals agree consists of a wide range of emotional, physical, and spiritual responses to loss—as something more than what is understood to be a “typical” response.
Chapters explore the history of how clinicians and researchers conceptualize grief complications; how PGD can impact children and adolescents; how clinicians can develop a culturally sustaining approach to the diagnosis; strategies and interventions for treating PGD; and why the diagnosis may not serve all grievers. The book’s cover features artwork by a woman treated for PGD, illustrating her experience through the therapeutic process. View the full table of contents here.
Dr. Mary-Frances O’Connor, author of The Grieving Brain, notes in the Foreword that, “Grief is simply the human reaction to the awareness we have lost someone so vitally important to us, whether it is days, months, years, or decades after a loss. But the diagnostic code for PGD acknowledges that, for some people, grief does not change over time; some people become derailed in adapting to the fact that they have grief.”
Available now, the book is part of HFA’s ongoing educational initiative to increase awareness of grief and bereavement and the hospice philosophy of care. Understanding Prolong Grief Disorder is available to order on HFA's website, or by calling 800-854-3402.
Selected excerpts from Understanding Prolonged Grief Disorder (K. J. Doka and A. S. Tucci, Editors):
From Dr. Mary-Frances O’Connor, author of The Grieving Brain:
Reading this book . . . gives us a way to pause, to learn, and to reflect on how the contemporary thinkers of our time are contemplating, researching, and intervening on grieving.
Beyond simply documenting their current thinking, we witness the authors of each chapter wrestle with the grave question of when a person’s response to loss becomes worthy of intervention. This is the reason for you to read this book, to understand the depth and nuance each author has applied to these difficult decisions about how to shape a cultural and therapeutic response to grieving.
Grief is simply the human reaction to the awareness we have lost someone so vitally important to us, whether it is days, months, years, or decades after a loss. But the diagnostic code for PGD acknowledges that, for some people, grief does not change over time; some people become derailed in adapting to the fact that they have grief.
Grieving is the way that grief changes over time, without ever going away. The great myth of our culture is that grief will go away some day, with enough “grief work” or time. The pushback to including PGD in the DSM-5-TR and ICD-11 arises in part from the belief that the diagnosis is simply a calcification of this myth.
From Dr. M. Katherine Shear, founding Director of the Center for Prolonged Grief
Many people experience grief as surprisingly powerful, unfamiliar, and disconcertingly attention-grabbing. Yet there is a tendency in our modern American culture to encourage bereaved individuals to put painful experiences aside and move on. There is little supportive social guidance in the form of clear expectations or rituals to help bereaved people navigate forward, let alone learn and grow, from the experience of grief. This can leave a bereaved person feeling concerned about whether they are grieving too much or too little, too briefly or too long; in other words, whether they are “doing it right.”
From Dr. Joanne Cacciatore and Dr. Kara Thieleman, Arizona State University
Contextualizing traumatic grief will require more work on the part of clinicians, and insurers will need to pay for that time. Autobiographies, even intergenerationally, must be told in a safe place. Hope is not irretrievably lost nor is integration impossible. However, without the appropriate social and community care, it will be much more challenging. There is no bypass for the grieving person, nor for the system that seeks to understand complex problems. Yes, grief is complicated and can endure over time. But it shouldn’t be considered a disorder.
From Dr. Jillian Blueford, University of Denver, and Dr. Nancy Thacker Darrow, University of Vermont
Over two decades of research have provided a solid foundation for understanding the manifestation and experience of PGD. Yet, thanatologists are still in early phases of understanding how cultural phenomena may impact the accuracy of a PGD diagnosis.
Although there is now a formal diagnostic criteria for PGD, the uniqueness of the grieving process requires that clinicians conceptualize the entirety of the client, including their cultural identities, such as religious beliefs, age, and neuroability, along with norms, beliefs, and values that have shaped their identities and interactions with others.
From John Barba, describing his personal experience after treatment for PGD
It comes down, in some way, to the obvious: shall I live in the real world of the now and future, or live forever in the past world of longing and regret? . . . Well, I still grieve over the death of my wife; in some sense all grief is prolonged. But if I can focus on grieving as the form that love takes after death, then it does not interfere so much with other aspects of my life.
Understanding Prolong Grief Disorder is available to order on HFA's website, or by calling 800-854-3402.
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