A Call for Sound Empirical Testing and Evaluation of Criteria for Complicated Grief Proposed for DSM-V

Abstract

The empirical testing of diagnostic criteria for Complicated Grief (CG) by autonomous investigators is a welcome development. Cross-validation studies are essential to an impartial evaluation of diagnostic criteria for CG proposed for inclusion in the DSM-V. Nevertheless, the review of evidence to confirm or disconfirm the diagnostic validity of the proposed CG criteria requires a fair, unbiased, and relevant examination of the data. It is our view that Hogan, Worden, and Schmidt's (2003–2004) “An Empirical Study of the Complicated Grief Disorder Criteria” (see Table 1) fails to meet these standards. Hogan et al. test for the independence between: a) separation distress and traumatic distress symptoms, b) CG and depressive symptoms, c) CG symptoms and presumably “normal” symptoms of grief. Testing for the independence of these constructs is a red herring. Issues central to the validity and reliability of a CG diagnosis should focus on the ability of the symptoms to identify the small number of bereaved persons with enduring and acutely distressing grief that is associated with significant dysfunction. Despite asking the wrong questions, the basic results remain consistent with claims that we have made all along (e.g., that CG symptoms are unidimensional; that more than half the variance in CG symptoms cannot be explained by depressive symptoms; that CG symptoms distinguish themselves from normal grief symptoms with respect to their intensity and chronicity and the prediction of morbidity). There is little doubt of the need for more empirical work to evaluate the reliability, validity, sensitivity, specificity, and diagnostic efficiency of criteria proposed for CG. It is our hope that the call will be heard by investigators who will test issues relevant to the creation of a sound CG diagnosis.