3.3 Tegen PGD

Question 1

Waar gaat artikel Eisma over?

Eisma (2023)

Answer 1

Challenges van PGD
- Non-linear history
- Unclear differentiation of PGD from normal grief
- Potential nega societal consequences

Question 2

Factors that play a role in research/including PGD

Eisma (2023)

Answer 2

1. Construct validity: dimensionality of symptoms of PGD
2. Convergent validity: correlations with other disorders
3. Divergent validity: how distinct symptoms are from related disorders.
4. Criterion validity: how predictive symptoms are compared to other relevant constructs.

Question 3

Non-linear history of PGD

Eisma (2023)

Answer 3

• Different proposals that did not build up on another.
• Proposals differ in content, duration necesarry for diagnosing and system count
• Because of differences, uncertain whether research from the past can be generalized to current criteria
• Most research done in Western countries (high heterogenity between cultures is reported)

Question 4

Unclear differentiation of PGD from normal grief

Eisma (2023)

Answer 4

Evidence on differentiation is unconvincing.

Problem is that there is still no definition for normal grief.

Currently differentiated (but no evidence):
1. HIgher intensity
2. Longer time period
3. Leading to functional impairment

Question 5

3 potential nega societal consequences

Eisma (2023)

Answer 5

1. Giving medication to normal grievers
   It could lead to: overdiagnosis, or normal grief being labeled as medical disorder.
2. Pharmacotherapy
   Might lead to developing more medication for grieving people + limited evidence that medication can help grieving.
3. Stigma
   Might develop because of labeling + side effects of this could lead to depression, suicide or less help seeking.

Question 6

Conclusion

Eisma (2023)

Answer 6

Some support for inclusion of PGD in DSM, but there are still some remaining challenges as well.

Question 7

Waar gaat artikel Wakefield over?

Wakefield (2012)

Answer 7

Vindt dat diagnostic criteria moeten kunnen differentieren tussen disorder en extreem normal grieving.

Vindt dat er emperical en conceptual dificiencies zijn voor de argumenten die PGD ondersteunen

Question 8

Suggestions for PGD

Removing the bereavement exclusion of adjustment disorders (AD)

Wakefield (2012)

Answer 8

It currently says that AD can only be diagnosed if the symptoms are not dure to bereavement.
- Huge impact: then AD can be diagnosed very easily just because of normal grieving.

Question 9

Suggestions for PGD

Adding a new category concerning adjustment disorders that relate to bereavement

Wakefield (2012)

Answer 9

This would alow people who do not show depressive symptoms while grieving to get diagnosed.
- The threshold is very low and it only needs one symptom for the diagnosis (like yearning).

Question 10

Evaluation of 4 empirical arguments and 1 conceptual argument

PGD shows discriminant validity because there are distinctive symptoms that differentiate it from normal grieving

Wakefield (2012)

Answer 10

So, this argument says that PGD symptoms differ from normal grieve and therefore it’s a psychopathology.

In reality: not clear distinctions between symptoms of normal grievers and PGD.

Question 11

Evaluation of 4 emperical arguments and 1 conceptual argument

PGD has discriminant validity because it identifies grief symptoms that are more severe than normal grieve symptoms

Wakefield (2012)

Answer 11

This states that severity of symptoms can help distinguish.

It is not clear where cut-off point is of extreme, since even normal grieving can be very intense.

Question 12

Eveluation of 4 empirical arguments and 1 conceptual argument

PGD shows predictive validity because there is a chronic and interminable grieving process

Wakefield (2012)

Answer 12

Interminability argument= if symptoms are still present after 6 or 12 months, they will not disappear and will be there indefinitely.

Unsupported, because almost no studies that measure grieve after 18 months

Alternative hypothesis= lengthy normal grieving (grieving takes longer, but not a disorder)

Question 13

Evaluation of 4 empirical arguments and 1 conceptual argument

PGD shows predictive validity because it is able to predict nega physical and mental health outcomes that are not likely to occur in normal grievers

Wakefield (2012)

Answer 13

Symptoms are overly inclusive.

Conceptual problems with predictive validity argument, because questionable to pathologize an entire group due to small minority experience nega outcomes.

VB: coughing, in theory it’s related to tubercolosis but one would not pathologize it just because someone is caughing

Question 15

Evaluation of 1 conceptual argument

PGD shows conceptual validity because grief can be compared to a wound

Wakefield (2012)

Answer 15

Wound analogy

Difference between physical wound and mental (grief) wound= we have to deal with loss of a loved one and adapt to these changes. Physical wounds happen due to damage, it’s not a part of an adaptive system.

VB: physical wound can get infected, makes the healing process more complicated. This can be seen in grief as more intense symptoms that last for a longer time. However, there is still a lack of evidence to support PGD

Question 16

Discussion

Wakefield (2012)

Answer 16

1. No distinctive symptoms that differentiate between PGD and normal grieving
2. No difference in severity between normal grieving and PGD
3. Time frame does not help to distinguish between maladaptive grieving and those who just improve slowly.
4. Negative effects that are said to result from PGD are not pathogenic