# 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 nurse explains the time rule for prolonged grief disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) to a student. In each example below, the person has intense yearning for the deceased nearly every day with clear impairment in daily functioning. Which example meets the DSM-5-TR time requirement?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630195  
> language: ko  
> 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 nurse explains the time rule for prolonged grief disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) to a student. In each example below, the person has intense yearning for the deceased nearly every day with clear impairment in daily functioning. Which example meets the DSM-5-TR time requirement?

## 보기

1. A 13-year-old, 7 months after the death of a parent **✔ 정답**
2. An adult, 11 months after the death of a spouse
3. A 16-year-old, 5 months after the death of a sibling
4. An adult, 9 months after the death of a parent

**정답: 1**

## 해설

Prolonged grief disorder, added in DSM-5-TR, requires at least 12 months since the death in adults but at least 6 months in children and adolescents. Only the 13-year-old at 7 months meets the time rule; both adults fall short of 12 months and the 16-year-old falls short of 6 months.

## 심화 해설

Core concept

Prolonged grief disorder (PGD) in DSM-5-TR uses a different minimum duration for adults than for children and adolescents. For adults, the diagnosis requires at least 12 months since the death. For children and adolescents, the threshold is shorter: at least 6 months. In addition to meeting the time rule, the person must show intense yearning or longing for the deceased nearly every day and clinically significant impairment in daily functioning.

Why the age-based time rule matters

The rationale is developmental. Children and adolescents process loss within a rapidly changing cognitive and social framework, and their grief can become entrenched more quickly when support is inadequate. The DSM-5-TR therefore allows a shorter observation window before considering grief pathological in younger individuals. The same symptom picture in an adult is not classified as PGD until a full year has passed, because intense grief during the first year is still considered part of the normal bereavement trajectory.

A 13-year-old at 7 months after the death of a parent meets the DSM-5-TR time requirement because the child/adolescent threshold is 6 months.

An adult at 11 months after losing a spouse does not meet the rule, because the adult threshold is 12 months. A 16-year-old at 5 months after losing a sibling also falls short, because 5 months is less than the 6-month minimum for children and adolescents. An adult at 9 months after losing a parent likewise does not yet qualify.

| Example | Age group | Time since death | Required minimum | Meets time rule? |
| --- | --- | --- | --- | --- |
| 13-year-old, parent | Child/adolescent | 7 months | 6 months | Yes |
| Adult, spouse | Adult | 11 months | 12 months | No |
| 16-year-old, sibling | Child/adolescent | 5 months | 6 months | No |
| Adult, parent | Adult | 9 months | 12 months | No |

Key point! The cutoff is not one universal number. Always identify the person’s age group first, then apply the correct minimum duration: 12 months for adults and 6 months for children and adolescents.

Clinical application to the vignette

The 70-year-old man in the scenario lost his wife 14 months ago. Because he is an adult, the relevant threshold is 12 months. His daily longing for his wife, social withdrawal, and functional decline now occur beyond that window, which is why the nurse is teaching the student about the time rule for PGD. The normal physical examination and laboratory results help rule out medical or substance-related causes of his presentation.

The time criterion is necessary but not sufficient: the diagnosis also requires intense yearning nearly every day plus clinically significant distress or impairment. A person who meets the time rule but does not have daily yearning or functional impairment would not receive a PGD diagnosis.

Why early elevated grief is still clinically important

Even when the time criterion has not yet been met, elevated grief symptoms in the first year after bereavement can predict more persistent grief later. This does not change the diagnostic threshold, but it supports careful monitoring and early supportive intervention. A nurse should document the intensity and duration of grief symptoms, assess functional status, and schedule follow-up rather than dismissing early intense grief as automatically benign.

Watch out! Do not diagnose PGD in an adult at 9 or 11 months, even if the symptoms look identical to the vignette. The time rule is a hard diagnostic requirement in DSM-5-TR, not a clinical judgment call.

## 임상 시나리오

DSM-5-TR Prolonged Grief Disorder: Time CriteriaAge-based minimum duration since death
For adults, PGD requires at least 12 months since the death. For children and adolescents, the threshold is 6 months.

The shorter window in youth reflects developmental differences in grief processing. Intense grief before these thresholds is still considered part of normal bereavement.

CautionDo not diagnose PGD based on symptoms alone. Confirm the time criterion first, then assess for yearning nearly every day and functional impairment.

## 핵심 개념

- **Prolonged Grief Disorder** — DSM-5-TR disorder characterized by intense yearning and functional impairment persisting beyond culturally normative bereavement periods.
- **DSM-5-TR** — Text Revision of the Diagnostic and Statistical Manual, Fifth Edition; added Prolonged Grief Disorder as a formal diagnosis.
- **Time Criterion** — Minimum duration since death required for diagnosis; 12 months for adults, 6 months for children/adolescents.
- **Yearning** — Intense longing or preoccupation with the deceased, a core symptom of Prolonged Grief Disorder.
- **Functional Impairment** — Clinically significant distress or disability in social, occupational, or other important areas of functioning.

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