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Recently, prolonged grief disorder (PGD), a diagnosis characterized by severe, persistent and disabling grief, was formally included in the 11th revision of the International Classification of Diseases [ICD-11; (1): Table 1]. To meet PGDICD-11 criteria one needs to experience persistent and pervasive longing for the deceased and/or persistent and pervasive cognitive preoccupation with the deceased, combined with any of 10 additional grief reactions assumed indicative of intense emotional pain for at least six months after bereavement. Contrary to the 5th revision of the Diagnostical and Statistical Manual of Mental Disorders [DSM-5; (11)] and the 10th revision of the International Classification of Diseases [ICD-10; (12)], the ICD-11 only uses a typological approach, implying that diagnosis descriptions are simple and there is no strict requirement for the number of symptoms one needs to experience to meet the diagnostic threshold. Some researchers have argued that PGDICD-11’s typological approach is helpful, as it will lead to greater sensitivity in case identification in clinical practice and increased cross-cultural applicability (13). Others have highlighted that the typological approach allows for flexible diagnostic algorithms in research, so that PGDICD-11 criteria can be adapted to resemble the characteristics of both stricter and more lenient precursor criteria (14). In the current contribution, we take a different, complementary position. We highlight a series of challenges in using the PGD criteria for research purposes and discuss the application of a method that employs flexibility of PGDICD-11 diagnostic approach to address these challenges, which may help in working toward the unbiased, structured, and transparent identification of optimal criteria for disturbed grief.

ICD-11 Prolonged Grief Disorder Criteria: Turning Challenges Into Opportunities With Multiverse Analyses