Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Is pathological grief lasting more than 12 months grief or depression? Richard A. Bryant Purpose of review DSM-5 and ICD-11 have proposed new psychiatric diagnoses to describe persistent and severe grief reactions. These initiatives have sparked much controversy because of concerns that diagnosing grief responses may overpathologize normative distress following bereavement. This review outlines the evidence for diagnosing grief. Recent findings Multiple studies indicate that, more than 6 months after bereavement, 10–15% of bereaved people experience marked impairment secondary to severe grief responses. This response is characterized by intense yearning for the deceased together with related symptoms, is noted across cultures and age groups, is distinct from depression and anxiety, and contributes to psychiatric morbidity, poor health behaviors, physical illnesses, and occupational and social dysfunction. Psychotherapeutic interventions targeted at the core symptoms of prolonged grief show promising results, in contrast to poor response to psychotherapy and pharmacological interventions targeted at depression. Summary There is convergent evidence that introducing psychiatric diagnoses to identify bereaved people suffering prolonged severe grief responses addresses a major public health issue, is supported by convergent evidence, and has the potential to minimize inappropriate treatment as a result of misdiagnosis. Keywords diagnosis, DSM-5, grief, ICD-11, prolonged grief INTRODUCTION There is no doubt that bereavement is one of the most stressful experiences people can endure. There is much debate, however, regarding the nature of postbereavement psychological disturbance and the appropriate manner in which it should be con- ceptualized [1 && ,2 && ]. This debate has intensified in recent years with the imminent introductions of DSM-5 and ICD-11, both of which have proposed significant changes in how severe grief reactions are described. This review outlines the current evidence pertaining to grief reactions, with parti- cular emphasis on the evidence for and against the inclusion of the new diagnostic categories. The extent to which grief is distinct from anxiety and depression following bereavement is discussed particularly in light of current controversy about postbereavement depression. Finally, these devel- opments are discussed in the context of current evidence for treating these postbereavement con- ditions. DEFINING PROLONGED GRIEF In recent years, there has been an explosion of research documenting the specific nature of grief reactions. Consistent across all studies is the con- clusion that sadness, missing the deceased, and a range of other reactions are normative in the initial months after the death. The issue that has been the focus of most attention has been those reactions that persist beyond this period, and represent chronic disturbances in mood, cognition, and behaviour. Exemplifying these earlier studies, a clus- ter of grief specific symptoms that were associated with poorer long-term outcome was found in a School of Psychology, University of New South Wales, New South Wales, Australia Correspondence to Richard Bryant, School of Psychology, University of New South Wales, NSW, 2052, Australia. Tel: +61 2 9385 3640; fax: +61 2 9385 3641; e-mail: r.bryant@unsw.edu.au Curr Opin Psychiatry 2013, 26:41–46 DOI:10.1097/YCO.0b013e32835b2ca2 0951-7367 ß 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins www.co-psychiatry.com REVIEW