Conditions for Further Study 791
Persistent complex bereavement disorder requires clinically significant distress or im-
pairment in psychosocial functioning (Criteri on D). The nature and severity of grief must
be beyond expected norms for the relevant cu ltural setting, religio us group, or develop-
mental stage (Criterion E). Although there are variations in  how grief can manifest, the
symptoms of persistent complex bereavement disorder occur in both genders and in di-
verse social and cultural groups.
Associated Features Supporting Diagnosis 
Some individuals with persistent complex bereavement disorder experience hallucina-
tions of the deceased (auditory or visual) in which they temporarily perceive the deceased’s
presence (e.g., seeing the deceased sitting in his or her favorite chai r). They may also ex-
perience diverse somatic complaints (e.g., digestive complaints, pain, fatigue), including
symptoms experienced by the deceased. 
Prevalence
The prevalence of persistent complex bere avement disorder is approximately 2.4%–4.8%.
The disorder is more prevalent in females than in males.
Development and Course 
Persistent complex bereavement disorder can o ccur at any age, beginning after the age of
1 year. Symptoms usually begin within the initial months af ter the death, although there
may be a delay of months, or even years, before the full syndrome a ppears. Although grief
responses commonly appear immediately following bereavemen t, these reactions are not
diagnosed as persistent comp lex bereavement disorder unless the symptoms persist be-
yond 12 months (6 months for children). 
Young children may experience the loss of a primary caregiver as traumatic, given the
disorganizing effects the caregiver’s absence ca n have on a child’s coping response. In chil-