Grief and the new DSM-5 clinical category: A narrative review of the literature

Aim: Grief is a common reaction to loss and it is considered a physiological and instinctive response. The "normal" grief evolves into an "integrated" phase within one year from death, and it is a non-pathological condition, that does not require specific therapeutic interventions. When this “integrated phase” does not occur, the subject could reach pathological manifestations related to the grief. The Persistent Complex Bereavement Disorder (PCBD) was proposed as a new category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. PCBD is a new clinical category characterized by symptoms related to the detachment and to the post-traumatic distress and it differs from normal and uncomplicated grief, for the disability caused by these reactions and their persistence and pervasiveness. Method: We examined reviews and studies of different researches done in the last twenty years, concerning the issues of loss, "normal" and "complicated" mourning that led to the diagnostic category of PCBD. For this review we based our consideration starting from those pathological conditions that preceded PCBD, as “pathological”, “complicated” and “traumatic” grief. Results: PCBD results a new important clinical category showing specific symptoms, diagnostic criteria and treatment. It presents many differences with other pathologies, that goes into differencial diagnosis with PCBD, and it and can be treated with targeted therapeutic approaches. Conclusions: Diagnostic criteria for PCBD could allow an early diagnosis and a correct treatment avoiding underdiagnosis and misdiagnosis. Further researches could focus on the evaluation of more neurobiological aspects, new psychometric tools, for assessing susceptibility to this pathology, and on the cultural aspects that may influence mourning reactions, in an ethno-psychiatric perspective.