Assembly Approves New Diagnosis of Prolonged Grief Disorder for DSM-5-TR

The APA Assembly last month approved the addition of prolonged grief disorder to DSM.

With Assembly approval, the new diagnostic category will be included in DSM-5-TR, the update to DSM containing text revisions that is reaching the final stages of production. At the request of the DSM Steering Committee, the Board of Trustees reviewed and then approved the new diagnostic category first in October—with Assembly approval following last month—to expedite its inclusion in DSM-5-TR (see Psychiatric News).

The Assembly also voted to accept the report of the Nominating Committee with a slate of candidates for the spring 2021 Assembly election (see box).

The diagnosis of prolonged grief disorder is based on a large body of research indicating that some people experience persistent difficulties associated with bereavement that are substantially prolonged beyond culturally normative expectations, Kenneth Kendler, M.D., vice chair of the DSM Steering Committee, told the Board in October.

Those data suggest that symptoms of prolonged bereavement are different from those associated with major depression; moreover, specific treatment approaches have been developed and tested for sustained symptoms of bereavement.

“There is substantial evidence that the proposed category would meet criteria for a mental disorder, have strong evidence of validity, and be capable of being applied reliably,” said Kendler. “We believe it will have substantial clinical value, identifying a group of patients not now receiving appropriate clinical attention and facilitate the appropriate use of available treatments.”

The Assembly voted to approve an action paper asking that APA work with other medical organizations and elected officials to eliminate barriers to implementation of telehealth in all public and private health plans. The action paper also asks APA to encourage hospital systems, academic centers, libraries, and other stakeholders to provide a secure venue for patients to complete telehealth visits when they lack the appropriate technological services or feel more comfortable at a location outside their home.

Additionally, the Assembly approved an action paper calling on the APA Board to create a task force to explore changing APA’s name to reflect the specific medical training of psychiatrists—such as, for instance, “The American Psychiatric Physicians Association (APPA)” or “The American Association of Psychiatric Physicians (AAPP).” The Assembly asked that the Board report back to the Assembly on its findings and any associated action plan for consideration at the spring 2021 Assembly meeting.

Assembly members approved 10 new position statements on the following subjects:

• Impact of Cannabis on Children and Adolescents

• Concerns About Use of the Term “Excited Delirium” and Appropriate Medical Management in Out-of-Hospital Contexts

• Suicide Among Black Youth in the United States

• Sexual Abuse of Migrants in ICE Custody

• Growing Fear Over Coronavirus Spread and Mental Health Impact in ICE Detention Centers

• Abortion and Women’s Reproductive Health Care Rights (The Assembly also retired a 2014 statement on the same subject.)

• Screening and Treatment of Mood and Anxiety Disorders During Pregnancy and Postpartum

• Use of the Terms Client and Provider

• Medicaid Coverage for Maternal Postpartum Care

• Reducing the Burden of Treatment Plan Documentation

The Assembly also voted to approve revised statements on medical necessity and ensuring access to psychiatric services for elderly individuals.

The majority of the action papers were referred to the Joint Reference Committee (JRC) for consideration and, if approved, they will then be referred to the appropriate APA component. The Assembly-approved position statements that have already been reviewed and approved by the JRC will be submitted for consideration by the Board at its meeting this month. ■