Following years of controversy, the American Psychological Association (APA) in March added "prolonged grief" as a new disorder in the Diagnostic and Statistical Manual of Mental Disorders(DSM).

Prolonged grief disorder is experienced by about 4% of bereaved people overall, and up to 49% after an unnatural loss (such as the death of a child or deaths by accident, disaster, homicide, or suicide). It is defined as grief-intense longing for or preoccupation with the deceased-that continues beyond 12 months in adults and six months in children or a grief reaction that is greater than that expected by social and cultural norms.

Clinicians and experts opposed to the diagnosis say it pathologizes grieving, a universally experienced and normal process. They argue that because grieving is highly individualized, it is not appropriate to place a one-size-fits-all end date on the process. Moreover, it is generally recognized that certain losses-violent deaths, for example, or loss of a child-bring on more intense grief of longer duration. Yet, the new classification doesn't distinguish between more intensive normal grief and a mental health disorder, say the critics who worry this will lead to false-positive diagnoses. And, as noted in a March 18 New York Times article, there is also concern that categorizing prolonged grief as a psychiatric disorder will lead to marketing by drug companies to "persuade the public that they need medical treatment to emerge from mourning."

Those in favor of including prolonged grief disorder in the DSM say it will increase access to treatment for people who are unable to move beyond grief on their own. Arguing for inclusion of the diagnosis in a chapter in the 2008 APA Handbook of Bereavement Research and Practice, three prominent researchers in the field, Holly G. Prigerson, Lauren C. Vanderwerker, and Paul K. Maciejewsky, cite studies supporting prolonged grief as a distinct mental disorder and conclude that "standardized criteria would enable clinicians to detect, treat, and receive reimbursement" for providing care. Other proponents note that the diagnosis will open up funding opportunities for research to develop effective interventions and medications.-Karen Roush, PhD, RN, FNP-BC, news director