The newest DSM official disorder, prolonged grief disorder, comes at just the right time.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
As we rather quietly approach the landmark of one million pandemic deaths in the United States with no clear end in sight, we may be psychiatrically boosted by an official new diagnosis. Last month, the update of the American Psychiatric Association’s DSM included a timely new disorder: prolonged grief disorder.
As implied in the New York Times article, “How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer,” this development was not without controversy.1 Would it pathologize and stigmatize normal grieving? Or would it be a welcome addition for those who still seem preoccupied with loss and do not seem to be getting over it enough by the 1 year mark, which preliminary research puts at 4%? If that percentage does not seem high, consider that it seems that about 10 people are profoundly affected by pandemic losses. In a way, it updates Freud’s discussion of mourning and melancholia, with the melancholia representing the continuing conscious and unconscious preoccupation with—and longing for—the loved one. Moreover, the social isolation of the pandemic has hindered the use of normal community and religious mourning processes.
The other important grieving number is how many grieving individuals are generally left behind from COVID-19 deaths. Research estimates at least 9.2 So, if this preliminary research and my math is right, if 1,000,000 will have died, then on average 9,000,000 loved ones will be at risk for prolonged grief. Using 4%, that projects out to be 360,000 with prolonged grief disorder and coming at a time of limited resources and an epidemic rate of burnout in clinicians.
The good psychiatric news among all the bad news of the pandemic, as well as the Ukraine invasion and all our usually ambivalent losses, is that there are promising new treatments that may help. There is a 16-session program called prolonged grief disorder therapy, which has some similarities to exposure therapy for the trauma underlying PTSD. Another perspective is that prolonged grief is like an addiction, and hence the trials of whether a medication like naltrexone would provide some relief. Interestingly enough, antidepressants do not seem to be beneficial for this condition. The message to us and primary care physicians is: do not prescribe them for prolonged grief.
There is an implied preventive aspect to this disorder. That means trying to reduce unnecessary deaths, such as with the pandemic, and resolving ambivalent relationships with loved ones before they die. When that cannot be done, transforming the suffering into psychological strengthening, or is sometimes called posttraumatic growth, becomes the goal.
Responding to these challenges will be quite a test of psychiatry in terms of being an appropriate resource to society. Time will help tell us whether this new diagnosis, coming at a time of great societal psychological need, will have enough beneficial consequences to justify its inclusion in our diagnostic manual. I am predicting that it will.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
1. Barry E. How long should it take to grieve? Psychiatry has come up with an answer. The New York Times. March 18, 2022. Accessed April 12, 2022. https://www.nytimes.com/2022/03/18/health/prolonged-grief-disorder.html
2. Verdery AM, Smith-Greenaway E, Margolis R, Daw J. Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States. Proc Natl Acad Sci U S A. 2020;117(30):17695-17701.