University of New South Wales, Sydney, New South Wales, Australia.
Curr Opin Psychiatry. 2014 Jan;27(1):21-6. doi: 10.1097/YCO.0000000000000031.
Although there is much evidence for the construct of prolonged grief, there was much controversy over the proposal to introduce a prolonged grief diagnosis into Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and it was finally rejected as a diagnosis in DSM-5. This review outlines the evidence for and against the diagnosis, and highlights the implications of the DSM-5 decision.
Convergent evidence indicates that prolonged grief characterized by persistently severe yearning for the deceased is a distinct construct from bereavement-related depression and anxiety, is associated with marked functional impairment, is responsive to targeted treatments for prolonged grief, and has been validated across different cultures, age groups, and types of bereavement. Although DSM-5 has rejected the construct as a formal diagnosis, evidence continues to emerge on related mechanisms, including maladaptive appraisals, memory and attentional processes, immunological and arousal responses, and neural circuitry.
It is most likely that the International Classification of Diseases (ICD-11) will introduce a diagnosis to recognize prolonged grief, even though DSM-5 has decided against this option. It is probable that the DSM-5 decision may result in more prolonged grief patients being incorrectly diagnosed with depression after bereavement and possibly incorrectly treated. The DSM-5 decision is unlikely to impact on future research agendas.
尽管有大量证据支持延长哀伤障碍的概念，但将其纳入《精神障碍诊断与统计手册》第五版（DSM-5）的提议仍存在诸多争议，最终该障碍未被DSM-5 纳入诊断。本文概述了支持和反对该诊断的证据，并强调了 DSM-5 决策的影响。
大量证据表明，持续性严重的对逝者的思念是延长哀伤障碍的特征，它与丧亲相关的抑郁和焦虑不同，与明显的功能障碍相关，对针对延长哀伤障碍的治疗有反应，并在不同文化、年龄组和丧亲类型中得到验证。尽管 DSM-5 拒绝将该障碍作为正式诊断，但与相关机制的证据仍在不断涌现，包括适应不良的评价、记忆和注意力过程、免疫和唤醒反应以及神经回路。
国际疾病分类（ICD-11）很可能会引入一个诊断来识别延长哀伤障碍，尽管 DSM-5 已否决了这一选择。在丧亲后，很可能会有更多的延长哀伤障碍患者被错误地诊断为抑郁症，并可能被错误地治疗。DSM-5 的决定不太可能影响未来的研究议程。
