Improving the understanding and treatment of complex grief: an important issue for psychotraumatology

In the Netherlands, every year 500,000 people are confronted with the death of a close relative. Many of these people experience little emotional distress. In some, bereavement precipitates severe grief, distress, and dysphoria. A small yet significant minority of bereaved individuals develops persistent and debilitating symptoms of persistent complex bereavement disorder (PCBD) (also termed prolonged grief disorder), posttraumatic stress disorder, and depression. Knowledge about early identification of, and preventive care for complex grief has increased. Moreover, in recent years there has been an increase in treatment options for people for whom loss leads to persistent psychological problems. That said, preventive and curative treatments are effective for some, but not all bereaved individuals experiencing distress and dysfunction following loss. This necessitates further research on the development, course, and treatment of various stages of complex grief, including PCBD. “Complex grief” is an informal term referring to debilitating, non-normative grief. It will likely be named Prolonged Grief Disorder in the forthcoming ICD-11. It is named Persistent Complex Bereavement Disorder in DSM-5. Research on the development, course, and treatment of complex grief is needed. This research should address different stages and manifestations of complex grief.

在荷兰，每年约有50万人经历至亲离世的丧亲事件。其中多数人群仅会出现轻微的情绪困扰，部分个体则会因丧亲陷入剧烈的哀伤、痛苦与情绪烦躁。仅有占比微小却不容忽视的丧亲群体，会发展出持续且使人衰弱的症状，包括持续复杂性丧亲障碍（Persistent Complex Bereavement Disorder, PCBD，亦称迁延性哀伤障碍）、创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）及抑郁症。
目前学界对复杂性哀伤（Complex Grief）的早期识别与预防性干预的认知已有所提升；此外，近年来针对丧亲后出现持续性心理问题的人群，可供选择的治疗方案也日渐丰富。尽管如此，预防性与治疗性干预仅对部分丧亲后出现情绪困扰与功能受损的人群有效，并非适用于所有此类群体。因此，针对包括持续复杂性丧亲障碍在内的复杂性哀伤的不同发展阶段、病程转归与治疗方案，仍需开展进一步研究。
“复杂性哀伤”是一个非正式术语，用于描述使人衰弱的非规范性哀伤反应。该病症在即将发布的国际疾病分类第11版（ICD-11）中或将被命名为迁延性哀伤障碍（Prolonged Grief Disorder）；而在《精神障碍诊断与统计手册第5版》（DSM-5）中，其正式名称为持续复杂性丧亲障碍（Persistent Complex Bereavement Disorder, PCBD）。当前仍需针对复杂性哀伤的发生发展、病程转归与治疗方案开展研究，且该研究需覆盖复杂性哀伤的不同阶段与临床表现形式。