The symptoms of persistent complex bereavement disorder are observed across cultural settings, but grief responses may manifest in culturally specific ways. Diagnosis of the dis- order requires that the persistent and severe responses go beyond cultural norms of grief responses and not be better explained by culturally specific mourning rituals.
Individuals with persistent complex bereavement disorder frequently report suicidal ideation.
Persistent complex bereavement disorder is associated with deficits in work and social func- tioning and with harmful health behaviors, such as increased tobacco and alcohol use. It is also associated with marked increases in risks for serious medical conditions, including cardiac dis- ease, hypertension, cancer, immunological deficiency, and reduced quality of life.
Normal grief. Persistent complex bereavement disorder is distinguished from normal grief by the presence of severe grief reactions that persist at least 12 months (or 6 months in children) after the death of the bereaved. It is only when severe levels of grief response per- sist at least 12 months following the death and interfere with the individual’s capacity to function that persistent complex bereavement disorder is diagnosed.
Depressive disorders. Persistent complex bereavement disorder, major depressive dis- order, and persistent depressive disorder (dysthymia) share sadness, crying, and suicidal thinking. Whereas major depressive disorder and persistent depressive disorder can share depressed mood with persistent complex bereavement disorder, the latter is characterized by a focus on the loss.
Posttraumatic stress disorder. Individuals who experience bereavement as a result of trau- bereavement disorder. Both conditions can involve intrusive thoughts and avoidance.
Whereas intrusions in PTSD revolve around the traumatic event, intrusive memories in per- sistent complex bereavement disorder focus on thoughts about many aspects of the relation- ship with the deceased, including positive aspects of the relationship and distress over the separation. In individuals with the traumatic bereavement specifier of persistent complex be- reavement disorder, the distressing thoughts or feelings may be more overtly related to the manner of death, with distressing fantasies of what happened. Both persistent complex be- reavement disorder and PTSD can involve avoidance of reminders of distressing events.
Whereas avoidance in PTSD is characterized by consistent avoidance of internal and external reminders of the traumatic experience, in persistent complex bereavement disorder, there is also a preoccupation with the loss and yeaming for the deceased, which is absent in PTSD.
Separation anxiety disorder. Separation anxiety disorder is characterized by anxiety about separation from current attachment figures, whereas persistent complex bereavement disorder involves distress about separation from a deceased individual.
The most common comorbid disorders with persistent complex bereavement disorder are major depressive disorder, PTSD, and substance use disorders. PTSD is more frequently comorbid with persistent complex bereavement disorder when the death occurred in trau- matic or violent circumstances.
A problematic pattern of caffeine use leading to clinically significant impairment or distress, as manifested by at least the first three of the following criteria occurring within a 12-month period: 1. A persistent desire or unsuccessful efforts to cut down or control caffeine use.
2. Continued caffeine use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by caffeine.
3. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome ior caffeine.
b. Caffeine (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
4. Caffeine is often taken in larger amounts or over a longer period than was intended.
5. Recurrent caffeine use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated tardiness or absences from work or school related to caffeine use or withdrawal).