# Situation: A 70-year-old man whose wife died 14 months ago is admitted to the psychiatric ward. He lives alone. He says he longs for his wife every day, and his children report that he has stopped seeing his friends. His physical examination and laboratory tests are normal. The psychiatrist diagnoses prolonged grief disorder. Under which chapter of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is this disorder classified?

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> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 70-year-old man whose wife died 14 months ago is admitted to the psychiatric ward. He lives alone. He says he longs for his wife every day, and his children report that he has stopped seeing his friends. His physical examination and laboratory tests are normal.

The psychiatrist diagnoses prolonged grief disorder. Under which chapter of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is this disorder classified?

## 보기

1. Somatic symptom and related disorders
2. Depressive disorders
3. Trauma- and stressor-related disorders **✔ 정답**
4. Obsessive-compulsive and related disorders

**정답: 3**

## 해설

Prolonged grief disorder was added in DSM-5-TR (2022) and placed in the trauma- and stressor-related disorders chapter, alongside disorders that follow an identifiable stressful event. It is not classified among the depressive disorders, although grief and depression can look alike.

## 심화 해설

DSM-5-TR classification of prolonged grief disorder

Prolonged grief disorder (PGD) is a new diagnostic entity introduced in the DSM-5-TR (2022). It is classified under trauma- and stressor-related disorders, not under depressive disorders, somatic symptom disorders, or obsessive-compulsive and related disorders .

The placement in the trauma- and stressor-related disorders chapter reflects the core conceptual model of PGD: the disorder develops following an identifiable, severe stressor—specifically, the death of a loved one. This chapter already includes conditions such as posttraumatic stress disorder (PTSD), adjustment disorders, and reactive attachment disorder, all of which share the feature that a clear external stressor is required for the diagnosis .

| Diagnostic category | Core feature | Requires identifiable stressor? |
| --- | --- | --- |
| Prolonged grief disorder | Yearning, identity disruption, loss of meaning after bereavement | Yes — death of a close person |
| Major depressive disorder | Depressed mood, anhedonia, neurovegetative symptoms | No — may occur without a clear stressor |
| Adjustment disorder | Emotional or behavioral symptoms in response to a stressor | Yes — any identifiable stressor |
| Posttraumatic stress disorder | Intrusion, avoidance, hyperarousal after trauma | Yes — exposure to actual or threatened death, serious injury, or sexual violence |

The distinction from depressive disorders is clinically important. Although grief and depression can present with overlapping features such as sadness, social withdrawal, and sleep disturbance, PGD is defined by attachment-related symptoms—intense yearning or longing for the deceased, preoccupation with the deceased, and a sense that a part of oneself has died—rather than by the pervasive low mood and loss of pleasure that characterize major depression . In the scenario, the patient’s daily longing for his wife and withdrawal from friends are consistent with this attachment disturbance pattern.

Key point! The DSM-5-TR added PGD as a new diagnostic category; it was not present in DSM-5 (2013). The addition was based on evidence that distinctive PGD symptoms can persist, cause significant distress and impairment, and require targeted treatment .

Watch out! The ICD-11 also includes PGD, but the diagnostic criteria differ from DSM-5-TR in content and diagnostic algorithm. For example, the ICD-11 requires a symptom duration of at least 6 months after bereavement, whereas the DSM-5-TR generally requires 12 months for adults. Prevalence estimates and diagnostic agreement between the two systems vary . For licensure examinations, focus on the DSM-5-TR placement: trauma- and stressor-related disorders.

The rationale for placing PGD in the trauma- and stressor-related disorders chapter is that the disorder is conceptually anchored to a specific bereavement stressor, and the clinical picture centers on maladaptive responses to that loss rather than on a primary mood disturbance .

## 임상 시나리오

DSM-5-TR Prolonged Grief Disorder ClassificationWhere PGD sits and why it matters clinically
Prolonged grief disorder is classified under trauma- and stressor-related disorders in DSM-5-TR because diagnosis requires an identifiable stressor: the death of a close person.

In adults, PGD is considered when intense yearning and functional impairment persist beyond 12 months after bereavement.

CautionDo not misclassify PGD as a depressive disorder. Grief and depression can look alike, but PGD is tied to a specific loss and requires a stressor-based diagnostic approach.

## 핵심 개념

- **Prolonged grief disorder** — A DSM-5-TR disorder characterized by intense yearning and functional impairment lasting beyond 12 months after bereavement in adults.
- **Trauma- and stressor-related disorders** — A DSM-5-TR chapter for disorders that require exposure to an identifiable stressful or traumatic event.
- **DSM-5-TR** — The 2022 text revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
- **Bereavement** — The state of having lost a loved one through death, serving as the required stressor for prolonged grief disorder.
- **Major depressive disorder** — A depressive disorder with depressed mood or anhedonia that does not require an identifiable external stressor.

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