title: Complicated grief as a stress response disorder: evaluating diagnostic criteria in a German sample.
abstract: BACKGROUND
  Complicated grief has been described as a diagnosis candidate for DSM-V. On the basis of the stress response theory, Horowitz et al. [Am J Psychiatry 154 (1997) 904-10] characterized complicated grief as a combination of sustained intrusion, avoidance, and maladaptation symptoms following the loss of a close person. This study aimed at evaluating diagnostic criteria based on the stress response model of complicated grief.
  
  
  METHODS
  We administered a symptom list derived from Horowitz et al.'s operationalization to a sample of bereaved persons and evaluated the psychometric properties of the symptom criteria and symptom category subscales. Using this symptom list and other self-report measures of psychopathology and normal grief reactions, we examined a German sample consisting of 75 participants who had lost either siblings, children, parents, or spouses, on average, 5.4 years prior to the study.
  
  
  RESULTS
  Analyses confirmed the classification of symptoms into intrusion, avoidance, and failure-to-adapt categories with only minimal reordering (two symptom criteria). The symptom category subscales showed favourable psychometric characteristics, receiver operating characteristic (ROC) analyses indicated high diagnostic accuracy of the symptom criteria, and predictive validation revealed a meaningful correlational pattern to standard measures of divergent psychopathology and normal grief reactions.
  
  
  CONCLUSIONS
  The application of a stress response operationalization of complicated grief is supported.
authors.affiliation: Department of Psychology, Dresden University of Technology, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Langner
authors.forename: Andreas
authors.initials: A
authors.lastname: Maercker
mesh_terms: D000223:Adaptation, Psychological; D000275:Adjustment Disorders / Q000175:diagnosis* / Q000523:psychology; D000328:Adult; D000465:Algorithms; D003674:Defense Mechanisms; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005190:Family / Q000523:psychology; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*