With traumatic bereavement: Bereavement due to homicide or suicide with persis- tent distressing preoccupations regarding the traumatic nature of the death (often in re- sponse to loss reminders), including the deceased’s last moments, degree of suffering and mutilating injury, or the malicious or intentional nature of the death.
Persistent complex bereavement disorder is diagnosed only if at least 12 months (6 months in children) have elapsed since the death of someone with whom the bereaved had a close relationship (Criterion A). This time frame discriminates normal grief from persistent grief. The condition typically involves a persistent yearning/longing for the deceased (Criterion Bl), which may be associated with intense sorrow and frequent crying (Crite- rion 82) or preoccupation with the deceased (Criterion B3). The individual may also be preoccupied with the manner in which the person died (Criterion B4).
Six additional symptoms are required, including marked difficulty accepting that the in- dividual has died (Criterion C1) (e.g. preparing meals for them), disbelief that the individual is dead (Criterion C2), distressing memories of the deceased (Criterion C3), anger over the loss (Criterion C4), maladaptive appraisals about oneself in relation to the deceased or the death (Criterion C5), and excessive avoidance of reminders of the loss (Criterion C6). Individuals may also report a desire to die because they wish to be with the deceased (Criterion C7); be dis- trustful of others (Criterion C8); feel isolated (Criterion C9); believe that life has no meaning or purpose without the deceased (Criterion C10); experience a diminished sense of identity in which they feel a part of themselves has died or been lost (Criterion C11); or have difficulty en- gaging in activities, pursuing relationships, or planning for the future (Criterion C12).
pairment in psychosocial functioning (Criterion D). The nature and severity of grief must be beyond expected norms for the relevant cultural setting, religious group, or develop- mental stage (Criterion E). Although there are variations in how grief can manifest, the symptoms of persistent complex bereavement disorder occur in both genders and in di- verse social and cultural groups.
Some individuals with persistent complex bereavement disorder experience hallucina- tions of the deceased (auditory or visual) in which they temporarily perceive the deceased’s presence (e.g., seeing the deceased sitting in his or her favorite chair). They may also ex- perience diverse somatic complaints (e.g., digestive complaints, pain, fatigue), including symptoms experienced by the deceased.
The prevalence of persistent complex bereavement disorder is approximately 2.4%—4.8%.
The disorder is more prevalent in females than in males.
Persistent complex bereavement disorder can occur at any age, beginning after the age of 1 year. Symptoms usually begin within the initial months after the death, although there may be a delay of months, or even years, before the full syndrome appears. Although grief responses commonly appear immediately following bereavement, these reactions are not diagnosed as persistent complex bereavement disorder unless the symptoms persist be- yond 12 months (6 months for children).
Young children may experience the loss of a primary caregiver as traumatic, given the disorganizing effects the caregiver’s absence can have on a child’s coping response. In Chil- dren, the distress may be expressed in play and behavior, developmental regressions, and anxious or protest behavior at times of separation and reunion. Separation distress may be predominant in younger children, and social/identity distress and risk for comorbid de— pression can increasingly manifest in older children and adolescents.
Environmental. Risk for persistent complex bereavement disorder is heightened by in- creased dependency on the deceased person prior to the death and by the death of a child.
Disturbances in caregiver support increase the risk for bereaved children.
Genetic and physiological. Risk for the disorder is heightened by the bereaved individ- ual being female.