Psychiatrists Can't Agree About This New Disorder
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- čas přidán 24. 01. 2024
- Prolonged grief disorder recently debuted in both of the two manuals that clinicians use to diagnose psychological conditions. But the DSM and the ICD don't completely agree on what it is.
Hosted by: Stefan Chin (he/him)
Correction:
2:26 The DSM-5-TR is produced by the American Psychiatric Association, not the American Psychological Association.
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pubmed.ncbi.nlm.nih.gov/34912...
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Eight months seems awfully radical. Especially when the loss is of someone very dear, like a child, partner, or close friend. Don't most people grieve such losses for longer than that? Surely we're not all going to just bounce right back after burying our most loved ones? This sounds like something the corporate world demands, rather than how real human beings are.
Yes, but that grieving process may not rise to the level of a disorder. I doubt that the large majority people who have long-term grief would meet the criteria for this diagnosis
Long term grief is not the same as PLGD. Long term grief is normal, PLGD is a pathology that effects daily functioning.
The issue here is pathology: in psychiatry, one of the most important unspoken criteria for diagnosing an illness is "Is this pathological?"
In other words, is it preventing the patient from being able to function in their day to day life or relationships.
An easy example: Two people might have the exact same symptoms for Condition 10B, which we have made up for the example. Person 1 finds that this Condition 10B has a significantly negative impact on their job performance, ability to maintain a happy and healthy personal life, and their interpersonal relationships, so it causes them distress. Person 2 finds that Condition 10B has absolutely no impact on their job performance, ability to maintain a happy and healthy personal life, or their interpersonal relationships at all.
Person 1 has the medical condition known as Condition 10B.
Person 2 does NOT have the medical condition known as Condition 10B.
But BOTH have the same symptoms.
Why?
Because only one of them is unable to function in a healthy way due to the symptoms.
So that 8 months isn't JUST looking at time! It is looking at impact.
Some people may grieve for years but be otherwise able to function normally and healthily in their job, private life, and interpersonal life. Great! They are doing fine. And this is MOST people. Most people can attend a funeral for a departed loved one and return to work the following week despite the depth of their grief.
Other people may grieve for a few months but be totally unable to function at work, or in their private time, or in their interpersonal relationships. They may be unable to function at basic tasks, like routine work responsibilities, driving, or having normal conversations. That person needs medical help.
Same symptoms. Different impact.
8 months is just the length of time that psychiatrists are identifying as a medically significant period they can point to and say "Most people would be past the pathological stage at this point, but this person is not, so we need to help them."
That's all.
As others have stated, the severity may differ from normal for those with this disorder. Also, just because something is common doesn’t mean the behavior isn’t disordered. Prevalence is not the sole factor in deciding what constitutes disordered behavior.
Depression is classified as lasting more than 2 weeks and it’s pretty normal to get sad from a divorce for longer than 2 weeks. It’s just a general number.
"Two standards? Someone should really make one that works!"
There are now three standards.
I was looking for exactly this comment
xkcd/927
You see, when a mommy standard meets a different daddy standard (...) and then a new standard is born!
yeah i was like "did these people learn nothing from xkcd"
Three standards? Pathetic. I could make a better one...
Four standards....
I've heard a good description of grief over time as follows: there's a sealed box with a button on one of the inside walls. The box also contains a ball bouncing around. Whenever the ball hits the button, you feel the same intensity of grief. But the ball changes in size. When grief is fresh, the ball is large, filling the box and constantly pressing the button. Over time the ball shrinks and the button is hit less frequently, but when it is, it still triggers a moment of intense grief. Perhaps, for some, that ball just never shrinks...
I loved your comment so much that I screenshot it and sent it to my mum, who's still dealing with such raw grief from losing her own mum 3 years ago. Thank you for putting it into much better words than I ever could have
I think with my grief the ball doesn't shrink as much as the box grows.
Thank you, I lost my Mom 11 years ago both Dad and I have been treading water ever since, some days are great now but others hit home like it was just yesterday.
My therapist has talked about the grief box a few times and it's really helpful to be reminded of. It's a great analogy for different things, including trauma.
I've used the analogy of a huge boulder falling onto a little stream, blocking its flow completely. Over time the stream starts to trickle around the boulder, the flow struggling to keep going. Over time, the stream adapts and learns to flow around the boulder. But the boulder doesn't ever go away, it's just part of the stream now.
I experienced prolonged grief disorder after my husband of 50 years passed. It took 9 years to reach a point where his passing no longer affected much of my behavior. I think much of the grieving process was impacted by multiple losses that occurred close to the time of my husband's passing.
I'm so sorry for your loss. I hope you've been able to find some peace. ❤
My condolences for the loss of your husband.
Wish you love and comfort 💕
I know this.
@@richross4781 what?
@@beesRsuperior
What I said was that people love to complain. All so a hundred people will reply to tell them how great they are.
Permanent victims. It gets boring after a while.
My personal experience with grief is: It never goes away. Sure, the pain happens less often and is less intense over time, but it's still there. I still grieve over someone I lost 40 years ago.
It is when the intensity doesn't change, is the problem. However, everyone experiences loss differently as I have seen people over it quite quickly and some people many years later experiencing the loss as if it were yesterday.
In psychology the definition of a disorder is that it impacts the person's life in ways the person doesn't like and/or can't live with. It changes their behavior, makes it hard to get through life. So, as others have said, when the severe grief just keeps going.
So, everyone talking about the long tail of grief are talking about something psychology has already addressed
@@steggopotamus It may be related, or it may not be, but my life went to hell right about that time and with few exceptions has gone downhill ever since.
I'm pretty sure the disorder requires it to be sort of all consuming rather than the very normal brief reminders and sorrow that happen regularly after a loss.
@@darcieclements4880 It seems all disorders these days come as a "spectrum," from "barely noticeable" to "debilitating/incapacitating."
I have CPTSD and I think my whole life could be described as prolonged grief disorder
Good grief!!
Ummmm… maybe _part_ of CPTSD but CPTSD as whole is *far more* stuff than the prolonged grief disorder psychopathologies (either criteria)
Playing the victim still? 11 years in and still going strong. I bet people love coming round to your house.
@@richross4781yikes dude, way to be an ass
I have CPTSD too. I’m sorry the other comments are royal assholes.
It sucks.
I think the only thing i find weird about this as a diagnosis is the idea of putting a "timer" on normal grief. There are so many factors that might prolong someone's grief, why are we gonna other people by breaking it off into a whole new disorder?
It apart feels like it might overlap a bit with C-PTSD or PTSD.
i totally agree with you. every person's grief is so different, too, depending on the relation to their person/how they died/etc etc etc. i don't think it serves anyone to pathologize grief.
Very true!
To be honest the vast majority of diagnoses are framed around a constructed conceptualization of "normal" -- one which often holds implicit cultural and political bias towards smooth functioning within the economic and social status quo hegemonies.
Which isn't to say we should go straight up anti-psychiatry or that all these categories are arbitrary nonsense or whatever. At the very least they describe trends within our contemporary sociological (and personal) contexts.
But the pervasive paradigm of pathologization within the field could certainly use a critical reassessment.
@@Kadaspala This. And to the OPs comment, when I lost my mom, my work gave me 2 days of family leave. Everyone offered condolences, but after about 2 weeks, the "you should move past it" crowed starting coming. Putting a timer on how long you "should" grieve I feel is going to do a lot of harm, intentional or not. I resigned shortly after. 4 years later my dad passed and a couple months after that my girlfriends son's dad passed and a few months after that, my beloved cat of 14 years, then after that, (couple more months), one of my gfs friends also passed. I was broken. Still am, but healing slowly. My advice. Any one that tells you how long you *should* grieve for, can piss right off.
I think maybe it's helpful for practitioners to have a sub-diagnosis of grief in order to tailor treatment for those who are experiencing it in various ways. I agree that pathologizing can come from a lack of empathy and/or be centered around getting a patient to act productive, but having a separate treatment plan for grief that interferes with someone's life at a length of time when loved ones and acquaintances may not be treating them with as much kindness and patience seems reasonable.
They both seem to have forgotten the grief of a life changing event. Fell down steps in 2017 and I haven't been able to move forward. I grieve every day for the life I lost. I miss performing in community theater. I miss dancing. I miss working. I was an ER nurse. I had a life and dreams and everything is gone. I live in pain every day. I can't find joy or a desire for anything. I exist. Thing is, I injured my back in 2007 a week after I had gotten rid of all my stuff in preparation for Opera company auditions and a temporary move to MN to study dance. I ended up losing my music and performing life, but found a new creative outlet in writing and, while sad, was able to move on. I ended up having surgery in 2013 which gave me my life back again. And while it was too late to go back to a performing career, I was able to do theater. I remember the first day of rehearsal. It was like I suddenly could breathe again.
So I've survived this before. I don't know why I'm not able to move on this time. I have a history of depression, but this isn't like any depression I've ever known.
As a Clinical Psychologist, I find having to use both the DSM and the ICD to be very annoying and difficult.
As a lay person, the three bullet points shown in the video as to how the guidelines differ don't seem to contrast all that much. Obviously language is weird and individual practitioners are going to interpret those bullet points their own way, but to me it seems like a diagnosis would occur based off either one.
@@kimberlyreeder6052 as someone with a master's degree in the specialty of forensic mental health, once you're having to code the diagnosis and deal with health insurance companies, it can certainly get complicated in a tedious way.
I wish mental health professionals would look at the brain before diagnosing, medicating or writing papers about mental illnesses. the chaos in the books is cause by chaos in research
@@HomeFromFarAwaythat is what they do 😐
@@kimberlyreeder6052-- Part of the problem is that you need to have a billable diagnosis for the insurance company, not only to reimburse you for any office visits with the patient, but sometimes to justify coverage of specific treatments including medications.
For example, a specific patient might have features that overlap more than one ICD-10 diagnosis, but in a lot of EMR systems as soon as you put in a differential diagnosis, it generates a "unspecified" code in that category.
And because pharmacy benefit managers are not working for the patient, but are bean counters trying to keep the insurance company from having to pay any money for patient care, they will use any excuse they can to deny coverage for a medication or some other treatment modality. And sometimes certain treatments will work for a variety of conditions, even if they've only been FDA approved for a very specific condition. But the PBM will point to the fact that the patient's exact diagnosis isn't that specific condition, and deny coverage.
I'm in a surgical subspecialty, not psychiatry, but this comes up all the time. And because psychiatry can be even more nuanced than other specialties when it comes to making a diagnosis, I would imagine it would come up even more frequently for them.
When my dad died, my mom just gave up on everything. Totally depressed and put no effort or care into relationships the home family or anything. She passed away a few months ago in a state of emotional blank if that makes sense. The only time she would light up is if she was talking about my dad. Wow was she in love for 60 years
This happened to my Grandpa when his wife (my Nanna) died. And they had been together for at least 50 years too. It must feel like losing a most beloved piece of themselves, heartbreaking 😢
I am so sorry for your loss.
I'm 38 yrs old. I lost my father in 1993. My mother gave up on everything. I mean EVERYTHING. She only went to work and did what was expected of her. She severely physically abused and neglected me emotionally. She pretended to go to therapy. And what I mean by "pretended" is that she went to a church group that told her what she was going through was normal and that she was a "great" mom. Her sisters were toxic asf too and did the same. She did not protect me and she thinks she did a great job by doing the BARE MINIMUM in keeping me alive. She didn't. She is a HORRIBLE person and I am currently no contact with her and her sisters. My children and I are SO MUCH happier for it. I am NOTHING like she was as a parent. We NEED to get these people help. It is affecting others and their ability to live.
My grandmother lost a child to murder. She lived 35 more years, speaking of him multipe times a day an in her death bed.
😢😢😢 The weight of that grief must been immense 😢
Prolonged grief disorder might be the culmination of a much earlier and deeper loss of ourselves through our lifetime's mental health decline,
Many depressive disorders are the result of prolonged pain with "no way outs" of it.
It's almost like our current work, education, and overall culture SUUUUCK for mental health.
I agree. Sadly, I noticed a lot of issues in psychology when it comes to treatment and acknowledging external pressures such as poverty. Tho it's possible that's mostly a symptom of my country not covering psychological treatments (aka they don't know how to deal with a poor person because they only get to treat people who can afford them).
@@Dekubud it's true, however even people who can afford it might not be able to heal their ❤️ after a meaningful loss, there's individuals that can totally change someone's life for the better, being with them is an incredible journey and losing such side of reality is gonna hurt, no matter what, things wouldn't be so harsh and sad if our society had more people that honestly cared and loved each other, there would be more familiar faces, more strength, more stuff to do to forget the pain more often, and even then there's always that echo of what's no more..
One day we shall learn what's deep down in our mind, body and feelings, to reconnect our memories without pain.
Grief is so cruel, because even when I started slowly healing from it, I then had to deal with immense guilt that I was "getting over" my girlfriend like she meant nothing. Like, I felt guilty when I'd feel even a little happy. Grief is a special different kind of hell to live in.
@@marcussantiagoIt's much easier to get over someone dying than them choosing not to associate with you anymore. I don't think modern relationships are healthy at all. We aren't meant to bond and then break up.
So interesting! 💖
I was misdiagnosed MANY times before we figured out I’m Audhd with PTSD. Learning about the process of diagnosis being so subjective was quite eye opening!
There is a slight error. The DSM is a publication of the American Psychiatric Association (little apa), not the American Psychologic Association. It is used by both psychiatrists and psychologists though.
Thank you! I was looking for this comment 😋
And I really don't think a lot of psychologists -- or psychiatrists -- would think this is a "slight" error. The two APAs certainly have not always agreed with each other, and many members of one of the two professions are irked to be identified as part of the other.
Came here to say this. These are 2 very different organizations.
Since it was founded 50 years before the APsychoA, the APsychiA would not appreciate being called the "little apa." It has fewer members but arguably is the more influential, especially since it publishes the DSM. Both claim all capitals in their abbreviation.
some neuroscientists believe that grief, depression and anxiety are expected, predictable reactions to the world, so calling them disorders can be seen as a misnomer in a lot of cases, though that doesn't rule-out medication.
if they are not disorders, what would you call them?
@@ceterisparibus8966 human
I think it's more of a disorder when it affects quality of life or when it's very prolonged.
Sorta like how anxiety before a big speech is normal, but anxiety where there is no apparent cause is a problem.
@@ceterisparibus8966 responses. Maybe conditions? Think of it this way: if someone cuts you and you bleed, do we call that a bleeding disorder? I don't generally think so, but we still send such people to a doctor for bandages, without calling them abnormal.
@@SaraWolffs Whoa, that’s such a great analogy! Bleeding disorders! I’m definitely going to borrow that in the future - thanks!
Crying every day for 11 years after the shocking sudden death of my fiance was tacked on to my already known CPTSD as one more trauma. But the grief felt different, separate from the fear based CPTSD (that did include depression and anxiety, and other symptoms). Now I know why my grandmother said Don't cry, you'll ruin your face. It quickly aged my looks. But her loss is always just beside me. And don't go to that stages of grief thing, that came from a crappy self help book, not a peer reviewed study.
The stages of grief are more like a roller coaster of grief, lots of turns and twists. The idea that grief is a neat, linear progression has harmed so many.
that "crappy self help book" has helped so many people but ok 🙄
@@shiny_x3placebo helps many people, but that doesn't make it a real medication
My deepest and most sincere condolences on the loss of your fiance. I know that words don't really help. I lost my wife, a while back to a massive heart attack, called Sudden Cardiac Death Syndrome. I have the same Diagnosis. I hope I have let you know you're not alone. Have a wonderful evening and take care of yourself, be gentle on yourself. Anyway write me back if you need to talk
@@shiny_x3 and harmed so many
I always saw the ICD as more of a coding resource rather than a diagnostic one because the copies Ive seen dont really explain criteria like the DSM does.
After 2 years of therapy over the death of my mom I got told to "just move past it and realize she's gone" and refused more appointments. This is probably something I had.
I was depressed after my son died. I saw a therapist for that. After about eight sessions she told me she just dealt with the depression, but that she didn’t treat people for grief.
Whoa, being refused more appointments???? That sounds like a problem w/that clinician/provider or the system, not you as an individual patient!
@@kellydalstok8900, that’s something that the therapist should have made clear to you during your first appointment. How horrible that you spent time building up trust in this person, only to be told this!
@@kellydalstok8900a lot of bs therapists out there
'Realise she's gone' sounds like they thought you were hallucinating. You deserve a second opinion.
I feel like both manuals need to add more things to grieve other than a person. Bc you can grieve so many other things; the loss of a job, a house or other property, loss of a pet, loss of your own identity, or the falling out of a friend (plus other I can’t remember right off the top of my head) Yes, the death of a loved one is the most common thing we think of grief but grief isn’t just one thing, so I think this could be part of the problem that these researchers could be dealing with.
being trans and grief over not having the right childhood 😔❤️🌈
I think the ICD definition is better. The DSM 'trying to avoid reminders of the loss' isn't in everyone who griefs badly. My mom was near suicidal and depressed for two whole years, my brother and I were not far behind the first year. My mom kept hurting herself more mentally at many points by reminding herself of the death, of my dad, of what she lost, etc. But at others she'd try to avoid reminders as well. They called it depression and it is, but this would just attribute a cause.
Prolonged Grief Disorder sounds like what my mother went through after the death of her 2nd husband. Took her over a year to start to move on from his death. And I had to force her to eat, shower, go to work, pay bills, etc. Ya know, daily and necessary activities of life.
Being 14 at the time it was a huge burden on me
Oh jeez, you had to parent your parent. That can cause a whole host of problems. I hope you were able to get the support you needed.
@@GrumpyOldFart2 You have no idea. And no, not really. But such is life
No,that is a normal grieving process.
That’s awful. Do you really view her as having this disorder? Or could she instead have a different personality disorder? Reading a lot of these comments about grieving parents who neglected their children, I get the sense it may sometimes just be grief + narcissistic personality disorder
@@pheart2381there is nothing normal about relying on your 14 year old just to survive for a year. A couple months of shock? Understandable. But to not seek help and just let it ride for a year, while your child mourns her step father? Absolutely unconscionable.
but as of now, Prolonged Grief Disorder is only confined to Bereavement (i.e. death of a family member, friend, or loved one). PGD doesn't extend to divorce, break-ups, etc.
I’m glad this is being looked at. The DSM has been moving towards the idea that grieving is a process that the individual must resolve. But what happens when there is no resolution, no closure? This is often the case: your loved ones’ killer is never found or cannot be prosecuted, or your parents or partner abandon you, and you never learn why. Or you think you were drugged and raped, but you have no memory, and so you’re never certain what happened. These are the kinds of situations that could trap someone in unresolved grief (that manifests like major depression). If you have that, it’s good to get therapy, because a skilled therapist can help you process that which you were never permitted to finish processing yourself.
Sounds like PTSD defined using different terms...
I suffer daily from events that happened decades in the past...'prolonged' fits the bill pretty well.
I agree, and I almost wonder if just classifying it as PTSD would help more people. I lost my dad when I was 13. It took until my mid-30s to realize that that could count as trauma, just because it wasn't like a go-to-war level event.
Grief being specifically from a personal loss. Traumatic stress could be caused by a variety of things.
@@_D_P_ grief is trauma, trauma isn't always grief
I think splitting it out could be helpful, because some professionals have a very narrow definition of PTSD and don't even acknowledge C-PTSD, and grief itself already is counted separately from depression in many cases. My provider literally told me that they can only diagnose PTSD if there was fear of death of myself or others at the time of the traumatic event, and they don't diagnose C-PTSD, but he fully admitted that if not for their office guidelines, I'd probably have a C-PTSD disgnosis. They just don't have the training or resources for handling a proper diagnosis of all but the most obvious form of PTSD, because their goal is to help as many people with the better understood mental health conditions as possible for a low cost, so there just have to be things they don't address as a result.
This prolonged grief disorder being separate can enable them to be like "You know, we don't diagnose your form of PTSD, but be can get you treatment for your prolonged grief," and that is _something._
The DSM-V is a huge mess. So many disorders are inaccurate and patients are rarely consulted on what their condition actually entails.
The DSM-V is a plague. Such a step backwards and we're still stuck with it for the rest of the decade probably.
I don’t think we need nearly as many diagnoses as we have. Making sure people don’t have to live with abusers to be housed would solve an awful lot of problems… 😬
@@misspatvandriverlady7555agreed, but of course this truth is hardly useful if it can't be put into motion. without using something like big brother, how can we prevent abuse with maximal efficiency? where does this abuse begin? how can it be identified without poking in people's personal privacy?
Seriously!
@@omnitoneWe can start by creating a society and culture that actually takes abuse *seriously* and raises children to be actively anti-abuse. We don't need a slow, top-down beurocratic mechanism to fight abuse. We can fight the problem from the bottom-up and create a society that does not tolerate the living of abusers within it
Something you forgot to mention is the cultural variability of grief. The DSM is a US focused guide that defines grief by American social standards. Where as the ICD seems to be more currently diverse. It's a good thing the books and definitions are different.
Was about to comment this. DSM can't be used to accurately diagnose people from other cultures that are not closely related to the American way of life.
I agree. A lot of mental health disorders are bounded by culture.
These things should be critiqued by people experiencing it too.
For example, I'm in several huge social media communities with my fellow autistic people.
I've gotta say, the diagnosis criteria in the manuals only describe how autistic people are judgementally & dismissively perceived by Non-Autistic people.
Nothing about what *we* say it's like to *be* us.
There are massive autistic communities on facebook, instagram, youtube, etc. We're actually autistic adults that can communicate our experiences.
Just read what we've written and if the answer isn't already there, please ask.
#NothingAboutUsWithoutUs
Good point.
My son is 13 and autistic. I am so grateful for all of the community FB groups, and especially CZcams videos from autistic adults and teens. It really helps him understand his own uniqueness, and not feel so alone. It makes it easier to have meaningful conversations around the topic. It also helps me get some insight into things he may struggle with, and has not yet developed the tools to communicate to me.
I have CPTSD & recently was dxd with Prolonged Grief disorder too. Thanks for this video.
I've been dealing with this since my mother passed away in 1982 It's 42 years And they're finally figure out this is a condition Ohh my dear lord how many other conditions are they like missing out on because it's not recognizing what they are? How many more decades is gonna take before someone can Diagnosis let alone gives the help we need.
The DSM definition fits exactly what I've been feeling and dealing with for over 40 years.
Super easy answer. When big pharma makes the magical pill to pay big for. Then it's a real condition
"Grief that doesn't go away after a few months" Umm, so it was my understanding that you never stop grieving you just grow around it like a tree grows around a barbed wire fence. Is that not true?
Great way of putting it!
More than 19 years after the death of my husband, I am still in deep grief about his death and the circumstances in which it occurred. This is a very real experience but it seems very natural (rather than disordered) to feel this way. There are some things we can't just quietly accept if we want a better society. Grief can cause self destructive behavior or even violence through acts of vengeance but it can also be a strong motivator to work toward a gentler, safer world. There is a reason we have evolved to feel such deep and prolonged grief. I have heard that it can ease a bit with time if grieving people can feel they have helped to prevent future tragedies.
These are excellent points!
I study chronic pain and we have had our eyes on cptsd for a long time.
I suffer from the Prelonged Grief Disorder. I lost my wife years ago. I according to my Therapist, I got stuck in the grief stages, with her help i have made progress, i still have really rough days but things are slowly getting better.
I am sorry for your loss and I wish you the best in regaining your health and happiness.
At 2:25 the American Psychological Association is named should be American Psychiatric Association as the overseer of the DSM
The language used in the DSM feels really iffy to me. The ICD is far more reasonable. Naming this condition 'prolonged grief disorder' feels awful and insensitive to me too. Grief should be treated if it's negatively affecting a person's ability to live their life, causing suicidal thoughts, etc., but we really shouldn't be turning it into a 'disorder' that needs to be cured. No one should have to have "took too long to get over the loss of a loved one" on their medical record.
But it is a disorder. How about we learn to treat medical and mental health history differently? Your concern points to a sociological issue in response to information on a medical history.
"Disorder" is unfortunately a word with negative connotations. The problem is the connotation, not the word "disorder". The word "disorder" is likely necessary for health insurance coverage. After all, "prolonged grief" or "grief issues" or "grief differences" isn't going to be covered by health insurance. In addition, there needs to be a time component in order to determine when something has gone from socially expected to disabling. For example, being unable to function immediately after the death of a loved one is socially expected in the US. American culture says that there is an accepted grieving period during which people get off from work, friends and family drop off food and help with errands, there are funerary and burial customs, etc. At a certain point though, American culture also dictates that the grieving person should be able to go back to work and take care of their daily needs. This diagnosis draws a line in that time period. I'd see this as a good thing, since it would allow health insurance coverage to kick in. In the end, in the US, it's all about finding a way to afford mental health treatment. Now that pre-existing conditions can no longer be used to deny health insurance coverage, I personally don't care what it says on my medical record. Just get me the treatment I need to function.
Would like to see this also happen with certain aspects of diagnosing and treating things like bipolar disorder. We know far more about it than we used to and that's great, but there are still some things where - well, frankly I don't know if it's the science that's lacking or the things in place in government/bureaucracy/policy...but SOMETHING is rotten, because I've watched in growing horror as my nephew suffers from not only bipolar (which has presented at a SHOCKING early age, he's not even ten years old), but from myriad mishandling by just about every social worker, teacher, and cop that's gotten involved. There are fewer than a dozen therapists who're even trying to really help the poor boy, and their hands are very much tied by state regs and so on. It's an absolute MESS, and I can't help but wonder - if the science were more clear about how to deal with this disorder, in such young patients, MAYBE the state regs wouldn't be so head-up-the-wazoo? One could hope, anyway.
With the “seeing which neurons cause which symptoms” thing, it has me worried if theyre going to include the rewiring of how neurodivergent peoples brains function, because as an autistic person, the neurons on my brain are completely different from neurons of a neurotypical brain. So im curious if this will account for different neurotypes or if that will be an afterthought.
Thank GOD they are trying to figure this out. I lost my twin 11 years ago through an accident. I can say that all of the examples listed from both diagnostic manuals are part of my prolonged grief disorder. That wasn't difficult.
Itll be up to the insurance companies ultimately.
You touched on a key point, on symptoms negatively impacting quality of life. It's when symptoms are preventing you from functioning in your day to day life for a prolonged period of time that something becomes a problem. If a loss was significant enough in your life, I think you'll always have moments of missing the one you lost and that is normal. We're not machines that process the loss and entirely "get over it".
My sister died 15 years ago and it still feels as fresh as the day she passed. This is wild.
The backwards DSM-V graphic is killing me
One thing they don’t touch on - the ICD is what’s used to bill insurance companies. Doctors get reimbursed based on which ICD “code” they assign a patient. This might he why ICD definitions need to be broader, to allow doctors to make the diagnosis they feel best applies without fear of claims of insurance fraud.
I have all those symptoms from my dogs death in 2018. He was the last best thing in my life. It took over two years before I stopped having panic attacks. I'm too afraid to get into a relationship or have a pet because I can't take anymore loss. I'd rather be alone
I'm so sorry for your loss.
I never understood pet people until I rescued my cat when she was abandoned by her mum as a kitten.
I get scared that she will pass away one day
But strangely I'm more concerned about something happening to me and who will care for her , if she will find a good home and I don't want her to miss me 😭
I’m so sorry man I know how that feels, I lost my best friend around this time last year, she died in my lap on the way to the vet, I still have nightmares can’t look at certain things… I couldn’t and still can’t get a new pet I honestly think it would end me. So I got plants it’s helping a lot actually. I still miss her every second of every day. I hope you are in a better place fr the loss of a pet is just as bad if not worse than the loss of a human if you cared for that pet as though they were human as they are just as much family as the people.
Ever since I got my dog, I think about this nearly every day. She's such a critical part of my life that I don't think I'm going to be able to handle it when the inevitable happens
@@user-hs2jk7tf8d just wanted you to know i read what you wrote here and can relate to it. i constantly think about how i am going to react when the inevitable happens, i found it interesting that you said you cant get a new pet...every time I imagine how i would theoretically move forward, I always always always come to the same conclusion: I won't be going a single day of my life without a pet ever again. I honestly believe that the grief would kill me, otherwise. I can't imagine feeling that level of pain without having my dog to lean on.
I think you should reconsider your position on this. Part of my logic involves, what do I imagine my dog would want for me after she's gone? I can imagine this by flipping it around: if I died first, what would I want to happen to my dog? The answer is immediately obvious, I just want her to be happy. The idea that she would get sadder and sadder over time until she herself died is completely soulcrushing to me. If I allowed that to happen, I can't imagine a greater personal failure. I wouldn't feel betrayed if she found love somewhere else, in fact, her being able to find love somewhere else is literally the only thing that I would want.
I read a story someone posted once about how their pet died and they couldn't imagine moving on, and one person's comment really stuck with me. It said, "Live for her." She wouldn't want me to be sad. I don't think your best friend would want you to be sad either. That love that you have is still inside you. Your best friend needed that love, just as you needed their love. Somewhere out there is an animal that is currently alone that needs that love too. If you ever want to talk about it, I would be willing to listen. Please think about it.
@@monzorella1I completely understand. When you love a person or pet, it's so hard to think of what will inevitability happen. If you're lucky to have others that will be there for you, that will help so much. If you have someone in your life that the cat likes that might be worth discussing with them, like a god parent. I wish you all the best
Dr's discover that sometimes people are sad for a long time and they're arguing about how to monetize it...
PGD is never a stand alone dysfunction , rather, it’s a comorbid condition, or prolonged thanks to one or more other dysfunctions such as depression, etc.
That's what it seems like to me as well. A person can't process grief because they're already emotionally damaged (Depression, PTSD, CPTSD) and/or have emotional disregulation (ASD, ADHD, bipolar).
I know someone who probably meets/met the criteria for PGD. However, that person almost certainly has undiagnosed ADHD, plus something else from growing up in an emotionally unhealthy household (probably CPTSD).
I am diagnosed with this. I wish they would ask the people they suspect of whom have it and work from there. I've been completely disabled by this for over two years...
There literally is no help for us.
"If it were too strict of a definition, we might end up pathologizing the normal variability across people."
Oh no. What an awful hypothetical situation.
Isn't this the case already? I know people that have been diagnosed with 4 different "disorders" by different doctors. I mean, if they cant even agree on what's wrong, what the hell is the point?
@@dewetsteynberg3140That’s OP’s point. It’s already happened.
Or, we might end up realizing that something that is common and normalized or swept under the rug is actually really unhealthy, and that something is wrong not on an individual level but a cultural one.
Oh no.
And we can be someone who helps their grief, or their autism, or ADHD. We do need diagnosis and physicians, but we can also just be aware, proactive, and kind people .
Grief and autism/adhd are completely different, grief is a feeling (that has conditions associated with it, the same way sadness is a feeling but depression is a disorder with the symptoms being an extreme, unending sadness) autism and adhd are neurological conditions, not feelings
@@homemovelha4173 You didn't read. They said we could be someone who helps. Be kind.
@@FuzzyWCTX Thank you, that was going to be my response.
@@FuzzyWCTXnothing they said was unkind
This reminds me of xKCD comic. there are 15 cable standards, which is too many. Let’s make a new cable standard to replace them all. now they’re 16 cable standards.
I saw this on my feed and couldn't find it searching afterwards. I'm so glad it popped back up
The DSM is not overseen by the American psychological association. Psychologists are PhD’s or have a masters in psychology. The DSM is overseen by the American Psychiatric Association, which is comprised of psychiatrists, which are medical doctors. The training is very different. The medical doctor side is focused on figuring out what the diagnosis is for the behavior and then prescribing the medications based on the biochemistry. The psychologist side of things is focused on behavioral therapies that have been shown to work best on that diagnosis.
Well it's been 2 years and I'm still struggling with it so I guess I have a name for this now besides "Can't get over losing everyone I care about in the space of a year"
Grief effects all differently.
watching this video and realizing i very well might have this is kinda heartbreaking. still mourning my mom almost seven years since she died. it's like the whole world has been a little sadder and duller ever since. you just kinda muddle through everyday life, sometimes you can get used to it and be perfectly fine for a bit, but then the pendulum swings the other way every once in a while and you're just hit by how much life sucks now to not be able to share the good and the bad things in life with your best friend.
I know someone with grief disorder. She struggles daily, having lost someone tragically.
The DSM 5 has been out for a while and I have known it since it dropped. Through my young life the DSM 4 I think was around but it may have come out in my late young life and didn't have as much an impact on me.
I do appreciate these books, but even the way they are now some professionals get locked into a diagnosis in the books rather than trying to understand their patient. It's not good when that happens, and we need professionals to be flexible in their understanding and attempts at treatment.
XKCD 927 - here's hoping that doesn't apply here...
Excellent presentation.
Well thats encouraging, the DSM just described me since losing my sister 6 years ago.
I know others among the 236 comments must have already pointed this out that I don't have time to look for right now --but the DSM is NOT a product of the American Psychological Association. It is published by the American Psychiatric Association, which is a completely different organization, and there are many psychologists who think it is too oriented toward the views of psychiatrists, who are M.D.'s. PLEASE make another video which corrects this really huge error!
In the venn diagram, the ICD seemed to describe a person perpetually cycling through the stages of grief over the loss itself; while the DSM seemed to address the inability to cope with or compensate for the absence after loss. Are they two different conditions?
I’ve had two major losses in my life. One took me years to recover from, talking messy home, functioning, etc. The other I just wouldn’t shut up about.
Never heard of it until this video but it explains EVERYTHING going on with me since my dad unexpectedly died 6 years ago. Thank you.
i think its fine that the definitions differ somewhat! i think the purpose of diagnoses for mental disorders is less about, you have this condition and heres how we cure it, and more like a set of guidelines: when people have these kinds of psychological symptoms that are caused by these kinds of experiences, here is a set of treatments you can try to resolve them that have shown to be effective in other people. in my experience, clinicians don't really diagnose you with a mental illness anymore - they say, we're going to try treating you for such-and-such.
I mean, I have these things, but I also have major depressive disorder, cptsd, anxiety, etc. that has been going on for 40 year and then the grief thing is on top of that for going on the last 3 years.
@AeDeeLady. So sorry for what u went thru. I've lost both folks w/o being direct caregivers. It Hurts Bad!! Glad she survived.
I read a reddit post where (this is all from memory) a womans mother died and it destroyed her. The SO was considering divorce because it got to the point she couldn't do anything, including being a mother to her children, and refused to try therapy again.. Someone in the comments linked to a page about prolonged grief disorder, and it perfectly described the poor woman. I hope she has gotten some help and that her SO grew a brain. I had never heard of this before, and it just sounds so unfair. Glad to see a video on it.
"her So grew a brain"?
I think that SO is completely justified to leave if she is harming the kids emotionally, and refuses to cooperate to get better. That doesn't mean she doesn't need help or is to be blamed. The same thing is true for a myriad of things, like addiction. Is it the addicts fault? I don't think so. Do you have to sometimes pick up and leave anyway? Absolutely.
Victoria wore black every day since her beloved Albert died. Was that excessive grief? And, if so: how might that have affected the British Empire at its apogee?
I feel like I get over death real quick. I mean I’ve witnesses death first hand. I saw a stranger die before. I went to all my grandparents funerals. I’ve seen my dog die from old age. The worst deaths are those whom which you haven’t sorted something out. Never apologized for that own thing. Never fixed your relationship. Never got closure for past wrongs. Death is a part of life. Happens to everyone and the limited time we have in life gives life meaning.
I used to think I was the same until my dad's death 7 years ago. It was quite sudden and he was still quite young (in his 50s). I think with my grandparents there had been a kind of tacit knowledge that their time left would be comparatively short, but when my dad was suddenly taken it was as if the ground had been pulled out from under me. Someone who I'd thought would be there for decades to come just suddenly... wasn't. I didn't experience the condition this video is about, but it was definitely a very different grieving experience from other times in the past.
@@WingedAsarath my dad has had multiple near death experiences so I’ve basically already grieved.
Love that stock footage at 2:46 of an important science person drawing circles with one hand and banging on the keyboard with the other. I can't decide if using the 'A' key as a modifier or hitting space twice in a row with two different sets of fingers is funnier. And drawing circles at the same time, no less. Are they inputting data or trying to summon a demon?
But jokes aside, I learned a lot from this and I'll pass this on to my Father, who is a therapist. I've never once heard of the ICD before today despite having grown up with copies of the DSM on the living room coffee table.
It exists. I’ve seen it with many patients, family members, and even strangers.
S/o to that one person on patreon lol you’re real one
Its amazing how many comment without watching the video... it went up minutes ago is minutes long n yet there are minute ago comments o_0 what is with this fastest finger first when the winner is quack.
Tictok disorder
Probably got uploaded to their patreon first and that's where those comments are from?
It’s all point of view. From here, eight minutes after you, I have to ask: did you pre-load your comment so you could paste it in real quick? 😇
@@richardtheweaver4891 no I typed while I was watching. 3 minutes in when it said it was uploaded 3 minutes ago. Which is why I noticed the Quack which luckily didn't make the cut for relevant comments when there were only 3. (I noticed it said 3 comments but showed only 2)
I have been in extreme grief for over three years, lost my mom and a year later my daughter died suddenly. It’s terrible
I spent years with nightmares, flashbacks, compulsions, and intense depression after my dog's death and it never felt like I was taken seriously. I can barely remember him now because I had to refuse to think of him at all just to function. I used to stay up at night checking my dogs' pulses because if I couldn't feel it I was terrified they would be dead; and even if I tried to go to sleep I was overwhelmed by anxiety and insomnia. Grief is natural, but it can be disordered and really ravage your ability to function at all.
...grief is supposed to go away?
Not necessarily, but I don't think it should still hurt like it just happened years after it happened. It's natural to experience grief, but it's also natural to process that grief and continue moving forward. It can look different for different people, and it takes longer for some people of course. A very deep cut won't just disappear, it should become a scar, it shouldn't keep bleeding forever.
Doesn't always. Complicated grief doesn’t seem to. Also, CPT can be used for insurance billing too. Med. Rec. student here
DSM started out as a way to standardise criteria for research, in an attempt to improve the appalling standard of psych research. It's been hijacked by US health insurance organisations and DRGs used to fund hospitalisation. It's not actually about patients. Prolonged grief has cultural/social dimensions too. You may live in a community that considers you 'disloyal' if you move on from your grief
I suspect "prolonged grief disorder" is anything but new. I'd be willing to bet that people have been victims of this for thousands of years.
I had a co worker with this. Her husband was killed in a car accident 30ish years. She refused to drive cars after that, but had no problem being in the passenger seat. She celebrates his birthday with a cake every year even though she just finally remarried.
As a retired minister and board-certified hospital chaplain, I have concerns about both definitions. Both expand an already problematic tendency to medical-ize normal human experiences that are simply uncomfortable. I have certainly worked with folks whose grief left them dysfunctional after a long period. Working with psychologists I was comfortable that existing descriptions and approaches to symptoms were adequate, without pathologizing grief itself.
I really appreciate your thoughts here. I tend to think the DSM in general is full of variations of human experience that may cause one to participate less than ideally in the social and economic order that benefits already powerful people. I know that's probably a lot of grad school jargon, but what I'm getting at is agreement with your big point: when some people act in ways that make other people who are comfortable with existing social norms feel uncomfortable, we often try to demonstrate there's something wrong with a person rather than that our rules about how it's OK to be a human might be need some broadening.
Very good perspective.
I think its the duration that makes it clinically relevant. Just like with trauma, where we see that at some point in the trauma response there is something changing in the brain, which then prolongs the trauma response. The response itself is not the illness. The prolonging factors are at the core.
@@Rithmy this is a good point, but at the same time the idea that "normal" grief lasts only months sounds to me like something corporations and health insurance companies would come up with in order to not have to help people who are grieving.
It could have some sort of physiological component. Obviously the loss of a loved one or something similar to that is a very deep emotional experience. Elevated to another level above other negative experiences. Maybe some people's brains are physically incapable, or have a much harder time with, processing that grief specifically and moving past it. Though figuring that out would require a deeper look into people diagnosed with this since we can't just look at the brain and see how it's all being handled. I haven't actually read TOO much on prolonged grief disorder and I'm not a psychologist so I'm not super familiar with the studies or reasoning behind separating it out from other conditions but that was how I was thinking about it when I first was watching this. It could be mainly a result of over medicalizing normal human experiences though, that's definitely worth considering. You're obviously more qualified than I am, I'm just thinking about it out loud mainly lol.
It takes time to process trauma, and the more relative trauma one accumulates, the longer it will take. But the time to process is also affected by many things, such knowledge of methods of processing, whether they have an environment they feel comfortable in, whether they are depressed, whether they have support from others, and so on.
My mum died suddenly when I was 22, nearly 23 years ago. I read subsequently that sudden death is more traumatic in the short term but over the long-term, both sudden and expected deaths are similarly traumatic. I still miss my mum but I've moved forward with life. That's the key difference, I think. Not being able to move forward. Perhaps a bereavement on top of other trauma and/or existing mental health issues is what causes prolonged grief disorder. I suppose it's similar to the idea of two people experiencing the same traumatic event and one of them having PTSD and the other not?
that's it!
I feel like the ICD is too generalized and skims important things from research for the efficiency of diagnosis rather than a fully "correct" diagnosis.
I feel like for the international document, they need to split physiological health from psychological health. Then, it can be used well beside the DSM. Call it the ICPD (International Classification of Psychiatric/Psychological Disorders). Have that be a companion diagnostic document.
the problem is that today's day we call everything a disorder.
Thank you.
I’m love new videos from SCI Show🎉
Im still grieving the loss of my best friend 5 years after their death. Its a struggle to wake up and be in a world without her.
There many different types of Grief. The loss of a young vibrante love one by murder is different from the emotions loved one dies from a painful terminal illness. On October 1st 2022 my niece whom I was close to, and her husband were shot to death by an insane gunman. My 1st emotion was Horror quickly followed by a feeling of Violation and then Fear. Perhaps the only stage of grief I went through was Anger. My grief counselor said I was dealing with complex Grief. But my emotions don't fit any of the stages of grief. Every time I see a shooting in the news, I go Zombi that is I can't function for several days. I have become agoraphobic I can't be in crowds. I have frequent nightmares and panic attacks. None of these reactions have anything to do with the stages of Grief
You have experienced a significant trauma. There is the death of your niece (and her husband), the people who are grieved AND there is the trauma and the fears borne from the traumatic event "shot to death by an insane gunman". This is complex and I hope you get help from a trauma informed therapist to work through these responses to the traumatic event.
I grieved 5 years, crying every night, after my divorce. I was a live-in primary caregiver to my mom for 3 years. It's been 7 years. I think I greived longer than 5 years; combined with depression, failing health, the pandemic and the nightmare Trump phenomenon. Already suffer cptsd from childhood abuse. I do not bounce back. I do not recover.
What saves me is my daily practice of devotional faith.
I wonder how this would be diagnosed in someone who already has mental illnesses, like cptsd or clinical depression.
I have prolonged grief losing my father. I still feel the pain of grief. I talk to him everyday. I don’t think I will ever get over my dad. ,
Well then
We need a dsm 6th edition book now
It will happen, but probably not for about a decade, based on past experience. FWIW, we only just got the text revision of the DSM-5 last year. This stuff takes a lot of time.
Great Example: Queen Victoria, over Alberta death...YEARS,until her own death in 1901
I wanted to say, at 3:47 with both sets of symptoms, I experienced prolonged grief of my grandmothers passing, I don’t think I was able to fully move past it to a more stable sense until almost 2 years later. After 9 months of constant depression and grieving, dropping out of high school, I ended up doing EMDR which actually ended up helping tremendously with processing the death and my other traumas, but I still grieved over her death and had struggles accepting it for near 2 years. I hate that grief is supposed to be “quick” I don’t think anyone is just able to accept death especially when it’s a shock.
Welp. This might be what I have, instead of just having gone completely emotionally numb. Great.
Soooo depression if it’s NOT from something specific… and the other is when something sad happens and you never recover? Feels like it’s just depression but with more steps 😂
Months? What??? There's a reason Victorians were in mourning for two years. People don't just slough off their grief after six months and walk away happily. I don't know if grief ever truly disappears, the troughs between the waves widen and the waves lessen but they don't disappear. I think this diagnosis is going to pathologize perfectly normal grief.
I thought the same!
I thought the same too, it's the same issue I have with some of the diagnostic criteria for long covid. Depending on the source it says the average time span is still being sick after 3 weeks to 6 months, babygirl I've had this jackass disease for almost 4 years it's not going away anytime soon
I personally struggle with mental health disorders and their nomenclature because a lot of these mental health challenges stem from very reasonable responses to very unreasonable situations. Why pathologize someone who is reacting properly to objectively challenging situations either in their past or present or staring down the barrel of a precarious future. That way, we might be able to address Mental Health better. Somebody else in the comments said that we have way too many different names for way too many different symptoms that overlap way too much. And I couldn't agree more. I think we just need to look at the whole person holistically rather than slapping a title on them and then proceeding to treat them for something that may not even be relevant or may not fit neatly into a proper diagnosis.
Someone else in chat also made a good comment about not even Consulting the person who is receiving the diagnosis.
I personally have run into this and to this day I've commented multiple times about how I didn't feel like my diagnosis was correct and yet I still have it. And I'm still being so-called "treated" for it. People are not entries in the DSM or ICD.
I feel like we're getting further and further from rigorous mental health, if anything. Diagnoses are great, and treating conditions as unique, distinct entities is okay, but holistic treatment taking the entire person into consideration is best.
Also reminder there is no such thing as "mental health" that is completely distinct from other "physical health". Our brains and nerves are another physical organ system after all.
As someone who has a degree in psychology, has long-term mental health issue AND is part of the LGBT community, I agree that it's a good thing for the two books to exist. The way I see it, we ICD can be a great tool in the hands of physicians who aren't specialized in psychiatry/psychology to refer people to a specialist of treat them if referrals aren't possible. But if there is access to a psychiatrist or psychologist, then the DSM can be used to allow to go in more detail with the treatment.