Time will tell: Pathways to prolonged grief, pathways to acceptance

The presentation will begin with a discussion of recent research on the resolution of grief over time. It will present evidence demonstrating the normal, or normative, pattern of changes in the intensity of grief as time elapses since the loved one's death. These patterns will be related to changes in the acceptance of the loss over time. Findings will reveal that by 6 months post-loss, the stages, or states, of grief have peaked and on average are in decline whereas acceptance gradually increases reflecting a mirror image of grief. A significant minority (+- 10%) of bereaved survivors will remain stuck in a state of chronic grief and many of these individuals will meet criteria for what we call Prolonged Grief Disorder (PGD). We will review evidence from our own and others' research showing the distinctive phenomenology (symptoms and diagnoses) of PGD. describe how Item Response Theory was used to determine the most Informative and robust set of items. We will discuss how combinatorics was applied to determine the algorithm for PGD that provided most the most sensitive and specific criteria set. This diagnostic algorithm was then tested for convergent and divergent validity with competing diagnoses (e.g., Major Depressive Disorder, Posttraumatic Stress Disorder) and then predictive validity was examined. We will review evidence suggesting which bereaved survivors are likely to be at heightened risk for PGD, and note promising new therapies for its treatment. We will conclude that the course, distinctive symptoms, course, outcomes and response to treatment of PGD symptoms highlight the need for its accurate diagnosis and treatment, providing the rationale for its inclusion in DSM-V.