790 Conditions for Further Study
Reactive distress to the death
1. Marked difficulty accepting the death. In children, this is dependent on the child’s
capacity to comprehend the meaning and permanence of death.
2. Experiencing disbelief or emotional numbness over the loss.
3. Difficulty with positive reminiscing about the deceased.
4. Bitterness or anger related to the loss.
5. Maladaptive appraisals about oneself in relation to the deceased or the death (e.g.,
self-blame).
6. Excessive avoidance of reminders of the loss (e.g., avoidance of individuals,
places, or situations associated with the deceased; in children, this may include
avoidance of thoughts and feelings regarding the deceased).
Social/identity disruption
7. A desire to die in order to be with the deceased.
8. Difficulty trusting other individuals since the death.
9. Feeling alone or detached from other individuals since the death.
10. Feeling that life is meaningless or empty without the deceased, or the belief that
one cannot function without the deceased.
11. Confusion about one’s role in life, or a diminished sense of one’s identity (e.g., feel-
ing that a part of oneself died with the deceased).
12. Difficulty or reluctance to pursue interests since the loss or to plan for the future
(e.g., friendships, activities).
D. The disturbance causes clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning.
E. The bereavement reaction is out of proportion to  or inconsistent with cultural, religious,
or age-appropriate norms.
Specify if: 
With traumatic bereavement:  Bereavement due to homicide or suicide with persis-
tent distressing preoccupations regarding the traumatic nature of the death (often in re-