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Prolonged Grief Disorder for ICD-11: the Primacy of Clinical Utility and International Applicability

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Prolonged Grief Disorder for ICD-11: the Primacy of Clinical Utility and International Applicability Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2018 Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability Killikelly, Clare ; Maercker, Andreas Abstract: A new mental health disorder, prolonged grief disorder (PGD), will be included in the 11th edition of the International Classification of Diseases (ICD-11). We provide a brief overview ofthe historical conceptualizations of disordered grief and the previous research efforts to assess and define this condition. We describe the new ICD-11 PGD symptom criteria and how they are conceptualized in terms of the World Health Organization’s call for improved clinical utility. Finally, we review the research evidence for the clinical utility of the new ICD-11 PGD symptom structure and usability in the international arena. DOI: https://doi.org/10.1080/20008198.2018.1476441 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-152215 Journal Article Published Version The following work is licensed under a Creative Commons: Attribution 4.0 International (CC BY 4.0) License. Originally published at: Killikelly, Clare; Maercker, Andreas (2018). Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European Journal of Psychotraumatology, 8(Suppl 6):1476441. DOI: https://doi.org/10.1080/20008198.2018.1476441 EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 2018, VOL. 8, 1476441 https://doi.org/10.1080/20008198.2018.1476441 RESEARCH ARTICLE Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability Clare Killikelly and Andreas Maercker Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland ABSTRACT ARTICLE HISTORY A new mental health disorder, prolonged grief disorder (PGD), will be included in the 11th edition Received 15 October 2017 of the International Classification of Diseases (ICD-11). We provide a brief overview of the historical Accepted 2 May 2018 conceptualizations of disordered grief and the previous research efforts to assess and define this KEYWORDS condition. We describe the new ICD-11 PGD symptom criteria and how they are conceptualized in International Classification terms of the World Health Organization’s call for improved clinical utility. Finally, we review the of Diseases; 11th edition; research evidence for the clinical utility of the new ICD-11 PGD symptom structure and usability in prolonged grief disorder; the international arena. clinical utility; international applicability; World Health Trastorno por duelo prolongado en CIE-11: prioridad en utilidad Organization clínica y aplicabilidad internacional PALABRAS CLAVE Clasificación Internacional El nuevo trastorno mental, trastorno por duelo prolongado (TDP), será incluido en la de Enfermedades 11a decimoprimera edición de la Clasificación Internacional de Enfermedades (CIE-11). Se pre- Edición; trastorno por duelo senta una breve revisión general de las conceptualizaciones históricas del duelo patológico prolongado; utilidad clínica; y los esfuerzos previos en materia de investigación para evaluar y definir esta condición. Se aplicabilidad internacional describen los nuevos criterios sintomáticos de CIE-11 para TDP y cómo son conceptualiza- dos en relación al llamado de la Organización Mundial de la Salud (OMS) para favorecer la 关键词 utilidad clínica. Finalmente, se revisa la evidencia de investigaciones sobre la utilidad clínica 国际疾病分类第11版; 延 长哀伤障碍; 临床实用性; de la estructura sintomática del nuevo TDP de la CIE-11 y su aplicabilidad en la esfera 国际适用性 internacional. HIGHLIGHTS ICD-11延长哀伤障碍：临床实用性和国际适用性的首要原因 • We present the new ICD-11 国际疾病分类第 版（ ）将包括一个新的心理健康障碍——延长哀伤障碍（ ）。 diagnostic criteria for 11 ICD-11 PGD prolonged grief disorder. 我们简要概述了哀伤障碍的历史概念，以及前期评估和定义这种情况的研究工作。 我们描 • We discuss the WHO’s 述了新的ICD-11 PGD症状标准，以及如何根据世界卫生组织（WHO）改善临床实用性的呼 prioritization of clinical utility 吁对其进行概念化。 最后，我们回顾了新的ICD-11 PGD症状结构的临床应用，及其在国际 and how this shaped the new 范围内使用性的研究证据。 diagnostic criteria. • We review prior and current research evidence supporting the new diagnostic criteria. • We introduce new directions in cross-cultural applicability of the new PGD criteria. 1. Introduction significant functional impairment that persist beyond half a year after the loss of a significant In the proposal for the 11th edition of the other. Until recently, researchers and clinicians International Classification of Diseases (ICD-11), have used different diagnostic criteria and differ- disorders specifically associated with stress have ent assessment measures for disordered grief, as been a topic of great interest for researchers and the previous diagnostic criteria for PGD had not clinicians, particularly the categories of post-trau- been established and recognized. This article pre- matic stress disorder (PTSD) and complex post- sents the new ICD-11 diagnostic guideline for traumatic stress disorder (complex PTSD). This PGD. The new guidelines are in line with the paper focuses on the category of prolonged grief requirements and recommendations by the World disorder (PGD), which is a newcomer to psycho- Health Organization (WHO) for improved clinical pathology and, for the first time, included in a utility and international applicability. This debate leading classification guideline such as the ICD- piece aims to underline the rationale for the new 11. PGD is characterized by core symptoms such ICD-11 PGD criteria; first, with regard to recom- as longing for and preoccupation with the mendations by the WHO and, secondly, in terms deceased, along with emotional distress and of previous formative research (Prigerson & CONTACT Clare Killikelly [email protected] Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zürich, Binzmühlestr. 14/17, Zürich CH-8050, Switzerland © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 2 C. KILLIKELLY AND A. MAERCKER Maciejewski, 2017; Reynolds, Cozza, & Shear, et al., 1997; Prigerson et al., 2009, 1999; Shear et al., 2017). 2011 ). Each will be described below. In 2009, a broad group of authors developed a consensus on the criteria for a clinical diagnosis of 1.1. PGD diagnosis and its precursors PGD, here termed PGD-2009 criteria (Horowitz Previous reviews have thoroughly documented the his- et al., 1997; Prigerson et al., 2009, 1999). An analysis tory of PGD (Jordan & Litz, 2014; Maercker & Lalor, of a sample of 317 individuals from the Yale 2012; Wagner & Maercker, 2010), and therefore we Bereavement Study (Prigerson et al., 2009) generated provide a brief overview relevant to the current ICD- sensitive and specific items for the PGD-2009 criteria 11 PGD criteria. In 1993, Horowitz and colleagues (Table 1). Around the same time as the refinement of developed the first diagnostic criteria for a bereave- the PGD-2009 criteria, Shear and colleagues built on ment-related disorder, termed ‘pathological’ then ‘com- the earlier conceptualization of disordered grief as plicated’ grief (CG) (Horowitz, Bonanno, & Holen, CG and proposed important mechanisms for the 1993;Horowitzetal.,1997). It was noted that alongside behavioural and biological aetiology (Shear et al., PTSD, which occurs in response to a traumatic event 2007; Zisook & Shear, 2009). Shear and colleagues (or events), patients could experience intrusive preoc- proposed alternative diagnostic criteria for CG devel- cupation, avoidance and intense negative emotions oped from a large clinical sample of treatment-seek- after bereavement. Horowitz and colleagues originally ing individuals and from a consensus with clinical conceptualized disordered grief in line with stress- experts (Reynolds et al., 2017; Shear, 2015; Shear, response syndromes; as a reaction to a stressful life Jackson, Essock, Donahue, & Felton, 2006; Shear event. This ignited research in the field and since this et al., 2011). The PGD-2009 criteria and CG criteria initial introduction and conceptualization, several differ in terms of the populations in which they were research groups have used different terminology assessed, the statistical methods used to assess the (pathological, complicated, traumatic, prolonged, criteria, the number of items required to receive a chronic or morbid grief), theoretical conceptualiza- diagnosis and descriptions of the items (Maciejewski tions, assessment measures and diagnostic criteria for & Prigerson, 2017; Reynolds et al., 2017). It should be a disorder of grief (Wagner & Maercker, 2010). With noted that at the time of the revision of the regard to terminology, in addition to CG, ‘traumatic Diagnostic and Statistical Manual of Mental grief’ was frequently used by Prigerson and colleagues Disorders, 4th Edition (DSM-IV), persistent complex (e.g. Prigerson et al., 1999) as their research uncovered bereavement disorder (PCBD) was introduced as a the importance of including core symptoms of separa- compromise between the two proposed diagnostic tion distress and traumatic distress along with the asso- criteria for PGD and CG and placed in section III ciated negative
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