Prolonged Grief Disorder — DSM-5-TR Criteria 🕊️

Important Diagnostic Note

Prolonged Grief Disorder (PGD) is a DSM-5-TR diagnosis within the Trauma- and Stressor-Related Disorders chapter. The diagnosis is intended to distinguish persistent, clinically significant grief following the death of someone close from expected bereavement. Clinicians should consider the patient’s developmental, cultural, social, and religious context when evaluating whether the grief response exceeds expected norms.

ICD-10-CM Diagnosis Code

The specific ICD-10-CM diagnosis code for prolonged grief disorder is F43.81. It falls under the category of reactions to severe stress and adjustment disorders.

A. Bereavement and Timing

• The death of a person who was close to the bereaved occurred at least 12 months ago for adults.
• For children and adolescents, the death occurred at least 6 months ago.

B. Separation Distress

Since the death, the patient has experienced one or both of the following symptoms, present most days to a clinically significant degree and occurring nearly every day for at least the last month:

• Intense yearning or longing for the deceased person.
• Preoccupation with thoughts or memories of the deceased person. In children and adolescents, preoccupation may focus on circumstances surrounding the death.

C. Cognitive, Emotional, and Behavioral Symptoms

Since the death, at least 3 of the following symptoms have been present most days to a clinically significant degree and occurred nearly every day for at least the last month:

• Identity disruption, such as feeling that a part of oneself has died.
• Marked sense of disbelief about the death.
• Avoidance of reminders that the person is dead.
• Intense emotional pain related to the death, such as anger, bitterness, or sorrow.
• Difficulty reintegrating into relationships and activities after the death.
• Emotional numbness or marked reduction in emotional experience related to the death.
• Feeling that life is meaningless as a result of the death.
• Intense loneliness as a result of the death.

D. Clinically Significant Distress or Impairment

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. Cultural Context

The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual’s context.

F. Differential Diagnosis / Exclusion Considerations

The symptoms are not better explained by another mental disorder, including Major Depressive Disorder or Posttraumatic Stress Disorder, and are not attributable to the physiological effects of a substance or another medical condition.

Clinical Documentation Considerations

Clinicians should document the timing and circumstances of the loss, the patient’s relationship with the deceased, separation-distress symptoms, associated cognitive/emotional/behavioral symptoms, functional impact, cultural context, and relevant differential diagnoses. PGD should not be diagnosed solely because grief is intense or lasts longer than expected; the full diagnostic criteria and clinical context should be considered.