Thoughts about Prolonged Grief Disorder

So, if you are following me, you probably already know that “Prolonged Grief Disorder”, or PGD, has been added to the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the DSM.

Some background — The DSM is produced by the American Psychiatric Association, or the APA. The APA revises the DSM periodically. The last major revision was in 2013, so nearly a decade ago.

The DSM uses common language and standard criteria to allow its users, mostly in the United States, to classify and communicate a patient’s mental diagnosis after an evaluation. The DSM isn’t just used by mental health professionals, either. It is used across the health care system and even by the legal system in the United States.

The reason that adding PGD to the DSM is a such a significant change is that insurance companies, hospitals and clinics may require a DSM diagnosis before beginning, or in the case of insurance companies, paying for treatment.

Needless to say, this revision is not without controversy. There is a good, and in my opinion, balanced article on this in the New York Times.

I think there has been some misunderstanding about Prolonged Grief Disorder. As I’ve written, grief has no timeline, and the intensity of your grief WILL vary. One of the most important criteria of Prolonged Grief Disorder is duration of intense grief— a year for adults. This means intense “distress or impairment”, for most of every day, for at least 30 days in a row after a year.

Most grieving people will, unfortunately, suffer intense impairment for FAR longer than policies like bereavement leave, or even just ordinary sick leave, provide at most organizations. I know my period of intense impairment was about six weeks after Leah died. Of course, I’ve had bad days since then, even a few periods of multiple bad days in a row.

As I write this, I am one day shy of eleven months since Leah died. I can say, that my own experience has been that the frequency and duration of intense impairment has declined over time. I do think that if a grieving person is severely impaired for most of the day, every day, after a year, then yes, additional help should be available to them.

(Part of me thinks the criteria should be every day for 14 days in a row after six months or maybe even 90 days, but that’s my personal opinion.) I’ve written that I was fortunate enough to have resources available to me immediately after Leah died, and that I DID reach out for help immediately. I was told that this action was at least out of the ordinary, if not outright extraordinary, especially for a man in his late 50s. Maybe so, but it should be normal, not unusual to ask for, and get, help as soon as a loved one dies.

Don’t wait a year. Don’t wait a month. Ask for help, and if you are having trouble finding the right resources for YOUR grief, speak up.