If you’ve never heard of prolonged grief disorder, that might be because it’s brand new.

The diagnosis didn’t exist a few years ago. But if you have heard of prolonged grief disorder, that might be because it’s inspiring a lot of debate in the community of people who research, diagnose, and define new psychological disorders.

See, that community generally relies on one of two main reference materials: either the International Classification of Diseases, also known as the ICD, or the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM. But the ICD and DSM don’t entirely agree on what prolonged grief disorder is. I mean, they agree that it exists… as of very recently.

But the process to define a new disorder can be complicated. So here’s what psychologists are arguing about, and what resolving this could mean for the people who live with the condition. [♪ INTRO] So, there’s a controversy over the exact symptoms of prolonged grief disorder. The main problem is that we have more than one guiding handbook for diagnosing disorders, and they don’t perfectly align with one another.

Now, we don’t really need multiple diagnostic manuals. We just kind of ended up with this system over time. In the late 19th century, researchers first compiled the ICD.

It was created to be the international handbook for diagnosis of all medical conditions. And it’s been going strong for more than 100 years, now under the steady watch of the World Health Organization. They try to keep it low cost, and it has been translated into many languages so it can really be an international resource.

With that in mind, the manual generally focuses on clinical symptoms that a medical practitioner in all kinds of settings could use to diagnose a patient. But in 1952, a new manual emerged: the DSM. This guide was more specific to mental and behavioral conditions, rather than the health of your entire body.

And since there already was a handbook that included all that stuff and a whole lot more, the DSM didn’t really catch on until its third edition almost three decades later. That edition of the DSM shifted focus to prioritize research-based diagnostic criteria over your healthcare provider’s discretion. And that’s when the DSM took off and drove a wedge between itself and the ICD.

See, the ICD is intended for broad use and provides a resource for clinicians to use their best judgment on a case by case basis. The DSM, on the other hand, standardized things, providing more of a sense of reproducibility. Today, the DSM is overseen by the American Psychological Association and it’s the primary reference material used by U.

S. psychiatrists. The ICD is used in the U. S. as well, but also in many other parts of the world.

So the ICD and DSM each bring their own special something to the table. And both handbooks are referenced by scientists and researchers. But neither are perfect.

That’s why they need to be regularly updated. New research is literally published every day, so they need to keep their medical recommendations and categorizations current. On top of that, society changes over time.

So the language used in these handbooks has to be updated to ensure that they’re addressing topics like race, gender, and ability with respect. As of the filming of this video, we’re up to the eleventh ICD and the “text revision” of DSM version 5. Both of which contain the same new condition: prolonged grief disorder.

But each handbook defines it a little differently. A person mourning the loss of a loved one often experiences depression and loneliness. But when you have prolonged grief disorder, that doesn’t go away with time.

A diagnosis requires grief to still be present months after the loss. According to the DSM-5-TR, you might have prolonged grief disorder if you avoid reminders of the loss, feel alone, and feel that life is meaningless. But according to the ICD, you might have difficulty accepting the death, guilt, denial, blame, and an inability to experience a positive mood.

The two manuals agree on prolonged grief disorder’s other symptoms, so for the most part, we know what it is. That’s because it’s not really a “brand new disorder.” It would be alarming if people suddenly started experiencing this new condition. But that’s not what’s happening.

Your doctor has probably seen these signs before. The new part is the acknowledgement that it’s an independent diagnosis from something like PTSD. And there’s just enough disagreement between the prolonged grief symptoms listed in the ICD and DSM for controversy.

Ultimately, they both draw more from the previous versions of their own document than from each other. So it’s reasonable that they’d come up with slightly different definitions. But this all means that we don’t really know how, or if we should standardize this new diagnosis in the two reference materials.

Some researchers argue that we should, because otherwise there isn’t really a unified place to slot in new information about it. Anyone looking into this diagnosis may miss the foundational research or end up diagnosed differently by different practitioners. Essentially, they feel it makes the diagnosis unreliable.

But others think that the DSM and ICD seem to agree about enough points in the diagnosis, so it’s fine to have their own spins on it. These researchers argue that this is more of a commentary on how psychology works than anything else, because we don’t have the same physical tests and biomarkers that we can use in other parts of the body. And they see this as an advantage rather than a shortcoming.

Having multiple definitions allows for more flexible diagnosis, so practitioners can use the more relevant option for the patients they’re seeing. If it were too strict of a definition, we might end up pathologizing the normal variability across people. So both sides have a point.

But as the controversy wages on, the National Institutes of Health is working in the background to propose a third option. Their new system is called the Research Domain Criteria, or RDoC. Among other things, it would use the neuroscience tools we have to diagnose people better.

Essentially addressing some of the reliability and biometric concerns. The RDoC allows for the use of laboratory techniques like electrophysiology and functional neuroimaging to understand which neural circuits might be involved in producing symptoms. Only time will tell whether that’s a new can of worms that makes this a three way debate or a solution to the current dichotomy.

Until then, if researchers agree that prolonged grief disorder is worth recognition, then it probably is. Giving something a name and identifying its symptoms can produce more knowledgeable clinicians, greater access to services, public awareness, and greater clarity in research. We’ve seen this time and time again with things like improved autism awareness and an increase in ADHD diagnoses.

But how we recognize it needs to go through a system of checks and balances that’s peer-reviewed by people who have studied these things for years. So it’s good that researchers are scrutinizing the new diagnosis. Let’s allow the scientists and heads of international organizations to work this out and be the ones getting grief over these changes.

That way, people who suffer from prolonged grief disorder can get the help they need. This episode of SciShow was brought to you by our patrons. For every 10,000 people who enjoy our videos, only one supports us on Patreon.

If that one person is you, thank you. We could not do it without you. [♪ OUTRO]