ARQ National Psychotrauma Centre

TO THE EDITOR: We read with interest the article by Cozza et al. on the accuracy of DSM-5 persistent complex bereavement disorder criteria (1).The study suggests that complicated grief criteria are more sensitive in detecting cases with griefrelated symptoms than persistent complex bereavement disorder or prolonged grief disorder criteria, without compromising specificity.However,we feel that the article’s findings fail to prove superiority of the complicated grief criteria set.

There exists a general consensus that prolonged grief disorder (PGD), or some variant of PGD, represents a distinct mental disorder worthy of diagnosis and treatment. Nevertheless, confusion remains over whether different names and proposed symptom criteria for this disorder identify the same or different diagnostic entities.

Summary

It is clinically well known that olfactory intrusions in PTSD can be a disabling phenomena due to the involuntary recall of odor memories. Odorants can trigger involuntary recall of emotional memories as well have the potential to help diminishing emotional arousal as grounding stimuli. Despite major advances in our understanding of the function of olfactory system, the study of the relation of olfaction and emotional memory is still relatively scarce.

Dr Halvorsen quite rightly draws attention to the various definitions of clinically significant change, which all have their advantages and disadvantages. We especially agree with the comment that the threshold for clinically significant change should at least coincide with the threshold for reliable change (18.66 in our sample).

Objectives: Post Traumatic Stress Disorder (PTSD) is a significant health problem with as key symptoms aversive memory intrusions and overgeneralization of the traumatic event, as well as sleep disturbances. Interestingly, sleep has an important role in memory consolidation. In particular, sleep spindles in different cortical areas reflect reprocessing and consolidation of specific memory traces. Given their strong relationship with memory reprocessing during sleep and reported memory and sleep alterations in PTSD, sleep spindles may play a role in the aetiology of PTSD.

Background:

In the Netherlands, every year 500,000 people are confronted with the death of a close relative. Many of these people experience little emotional distress. In some, bereavement precipitates severe grief, distress, and dysphoria.

A small yet significant minority of bereaved individuals develops persistent and debilitating symptoms of persistent complex bereavement disorder (PCBD) (also termed prolonged grief disorder), posttraumatic stress disorder, and depression.

Knowledge about early identification of, and preventive care for complex grief has increased.

ABSTRACT Since the inception of posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), there has been an ongoing polemic debate about the veracity, assessment, neurobiology, and longitudinal course of the disorder. As a consequence, its clinical utility has been the subject of a significant amount of conflicting opinion due to the competing interests involving clinicians, insurance companies, victim’s groups, and governments.