IPGDS: The First Assessment Tool Built for ICD-11 Prolonged Grief Disorder

Prolonged Grief Disorder entered ICD-11 in 2019 and DSM-5-TR in 2022. Two major diagnostic systems now recognize the same condition. But recognition without measurement is incomplete. Most clinicians assessing grief still rely on instruments built for earlier conceptualizations — the PG-13, the ICG, the TGI — none of which were designed to map directly onto the ICD-11 PGD criteria.

The IPGDS was built to close that gap. Not adapted. Built.

What the IPGDS Measures

The core module contains 13 items covering the ICD-11 PGD criteria: persistent longing for the deceased, intense emotional pain (sadness, guilt, anger, denial, blame, difficulty accepting the loss), and functional impairment. Items assess both symptom presence and deviation from cultural norms — a direct operationalization of ICD-11's requirement that symptoms exceed what is expected in the person's cultural context.

This cultural caveat is not decorative. ICD-11 states that PGD can only be diagnosed if grief responses are more intense or persistent than cultural norms would predict. The IPGDS is the only instrument that includes items specifically designed to capture this distinction. The full scale adds 19 culturally specific items identified through expert interviews and focus groups with German-speaking and Chinese participants — items like "feeling stuck in grief" that emerge from cultural context rather than diagnostic criteria alone.

Cross-National Validation

The instrument has been tested across five countries and multiple languages. A 2022 study examined the ICD-11 PGD guidelines using IPGDS data from Switzerland, China, Israel, Portugal, and Ireland — 2,131 bereaved participants in total. Confirmatory factor analysis supported the scale's structure across all five samples. Persian and Arabic versions followed.

The Arabic version matters especially. The refugee addendum (IPGDS-ARD) was developed through focus groups and cognitive interviews with Arabic-speaking bereaved refugees. It adds scales for ambiguous loss — the specific form of grief when a loved one's fate is unknown — and refugee adjustment factors that complicate mourning. No other PGD instrument addresses this population.

Why This Matters for Practice

PGD affects approximately 10% of bereaved adults. It is now a billable diagnosis. It has evidence-based treatments — grief-focused CBT, prolonged exposure adapted for grief, internet-based interventions. But the assessment bottleneck persists. Clinicians need a validated screening instrument that maps onto the criteria they are expected to diagnose.

The IPGDS is free. It is brief enough for routine screening. It is available in at least seven languages. It includes a cultural supplement that operationalizes the most conceptually challenging aspect of the ICD-11 definition. And for clinicians working with refugee populations — where bereavement is frequent and complicated by displacement — the IPGDS-ARD is the only purpose-built option.

If your practice encounters grief and you are diagnosing under ICD-11, this is your assessment tool. Download it. Learn the scoring. Integrate it into your intake protocol for patients presenting with persistent bereavement complaints. PGD is no longer a concept — it is a diagnosis, and it requires diagnostic-grade measurement.