Complicated bereavement: Disease state or state of being?

The point at which the experience of grief in response to bereavement becomes "pathological" has been debated for many years without resolution. This article reviews the current status of this debate. The debate centers around the extent to which "complicated grief" represents a truly unique pathological entity, when contrasted with major depressive disorder, post-traumatic stress disorder, and "uncomplicated grief." Significant research findings suggest it may be possible to distinguish grief from depressed as well as traumatic forms of distress, with acceptable reliability and validity. Yet, "complicated grief" relates to both of these types of distress as well as to a unique aspect - separation distress. It is at the intersection of these types of distress with significant disruption of daily life functioning that we find the proposed diagnosis of "complicated grief." The question is whether this diagnosis should be designated at this time, and, if so, how. This article concludes in favor of a compromise position that the diagnosis should be incorporated into DSM-V but relegated to its Appendix B [disorders proposed for further study] due to the lack of clarity surrounding its diagnostic criteria.