Grief ICD-10 Codes: How The World Health Organization Views Grief And Mental Health

Many view grief as an inescapable part of life, so they may be surprised to learn that, in some cases, a grief response can progress into a diagnosable and treatable mental health condition. In fact, federal and international health organizations include unhealthy grief responses in medical categorization manuals like the International Statistical Classification of Diseases and Related Health Problems, Tenth Edition (ICD-10). Grief-related ICD-10 codes may include prolonged grief disorder (code F43.81) and adjustment disorders (code F43.2). If you’re experiencing challenges with grief, consider seeking support by attending therapy in person or online.

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What is the ICD-10, and how does it classify unhealthy grief?

ICD-10 is short for the International Statistical Classification of Diseases and Related Health Problems, a publication by the World Health Organization (WHO). It is a classification list that categorizes a wide variety of medical concerns, including the following:

• Physical diseases
• Mental health disorders
• Symptoms, abnormal findings, and medical complaints
• Social circumstances and external causes related to disease and injury

The ICD-10 was updated to its 11th version in 2022, but it can take a long time to transition to the newest edition, so many international health organizations continue to use diagnostic codes from the tenth version.

The United States uses a modification known as the ICD-10 Clinical Modification (ICD-10-CM), developed by the U.S. Department of Health and Human Services. The U.S. government requires Medicare and Medicaid claims to use ICD-10-CM classification codes, meaning that most of the medical industry in the country uses this system. 

The ICD-10 can be thought of as the equivalent to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), but for all medical conditions, including those involving grief.

Grief conditions in the ICD-10

Unhealthy grief responses are classified in the ICD-10 under the “Mental, Behavioral, and Neurodevelopmental disorders” category within Diagnostic Related Group 882, which is generally for mental health conditions that do not involve depression, psychosis, developmental disorders, or personality disorders. 

Grief disorders belong to the subcategory “Reaction to severe stress, and adjustment disorders,” which includes conditions like post-traumatic stress disorder, a mental illness that can commonly co-occur with grief responses. The ICD-10 conditions related to grief in this section include prolonged grief disorder and adjustment disorders. 

Prolonged grief disorder

Prolonged grief disorder is listed under the ICD-10 subheading “Other reactions to severe stress,” separating it from post-traumatic stress disorder and adjustment disorders. This condition can also be referred to as persistent complex bereavement disorder, complicated grief disorder, or pathological grief. Its ICD-10 code is F43.81. (Suggestion- “This link is for the APA and not the ICD-10 subheading. Link needs to be more accessible an concise”)

Prolonged grief disorder can be defined as a persistent and pervasive grief response following the death of someone close to the person. It tends to be persistent in that it lasts for more than six months following the loss (and typically for much longer). 

It can be pervasive in that the grief usually leads to intense emotional pain and an ongoing preoccupation with or longing for the deceased person that impacts the bereaved person’s ability to work, go to school, socialize, take care of themselves or their family, or fulfill their personal responsibilities.

Other symptoms of prolonged grief disorder may include those listed below:

• Sadness and hopelessness
• Assigning blame for the death, typically to oneself, friends or family members, doctors, or a higher power
• A sense of being stunned or dazed
• Believing one has lost a part of oneself with the person who has died, also known as identity diminishment
• Bitterness and anger
• Denial and difficulty accepting the death 
• Anhedonia, or the inability to experience pleasure or a positive mood
• Withdrawal from meaningful social connections and relationships
• Guilt and shame
• Loss of interest in previously enjoyed activities or hobbies
• Emotional numbness
• Being unable to remember positive memories of the deceased person, or becoming very upset when reflecting on such memories
• Suicidal ideation
• Difficulty trusting other people
• Believing that life is meaningless and empty
• Engaging in self-harm
• Problems regulating emotions, particularly if the deceased person was a key component of one’s emotional support system
• Fear that other close relationships will end in death, which can result in increased anxiety related to loved ones’ safety and well-being

Certain populations may have a higher risk of developing prolonged grief disorder, and the condition may be more likely to manifest under particular circumstances. 

Parents who lose a child and a partner who loses their spouse (especially at a younger age or after a prolonged illness) can be at higher risk of developing the disorder. Prolonged grief disorder can also be more common if a person is prevented from engaging in customary grieving rituals, such as during the COVID-19 pandemic, when funeral gatherings were canceled, or if the death was associated with a stigmatized cause, such as suicide or substance overdose. 

Adjustment disorder

Per the ICD-10, the adjustment disorder diagnosis can be split into the following categories, each of which has a specific code:

• Adjustment disorder unspecified (F43.20)
• Adjustment disorder with depressed mood (F43.21)
• Adjustment disorder with anxiety (F43.22)
• Adjustment disorder with mixed anxiety and depressed mood (F43.23)
• Adjustment disorder with disturbance of conduct (F43.24)
• Adjustment disorder with mixed disturbance of emotions and conduct (F43.25)
• Adjustment disorder with other symptoms (F43.29)

These categories can reflect the wide range of reactions and behaviors a person experiencing adjustment disorder may display, many of which can also overlap with symptoms of prolonged grief disorder. Several symptoms associated with adjustment disorder include the following:

• A preoccupation with the loss and its consequences
• Excessive worry about the loss
• Intrusive stressful thoughts about the loss
• Ruminating about one’s future now that the loss has occurred
• Engaging in “what-if” thinking patterns about ways the loss could have been prevented
• Avoiding thoughts, emotions, conversations, people, places, and situations associated with the loss
• Depressive or anxious responses
• Worsened impulse control
• Increased substance use (often alcohol or tobacco) as a maladaptive coping mechanism
• Irritability
• Difficulty concentrating
• Demoralization (loss of hope, confidence, and enthusiasm)
• Sleep disturbances and having a hard time falling or staying asleep (insomnia)
• Somatic concerns, like stomach pain or headaches

Finding help for processing grief

Whether or not your grief symptoms have progressed to the point of prolonged grief disorder or adjustment disorder, the grieving process can still seem overwhelming. It can be beneficial to connect with a mental health professional to talk through your emotions and learn healthy coping skills, and you do not need a formal diagnosis to do so.

After a significant loss, life often seems turbulent and unpredictable. Adding an in-person therapy appointment to your calendar during such a time may cause added stress. In this situation, online therapy can be a beneficial alternative. 

Researchers have found that attending therapy online can have similar outcomes to attending therapy in person, including when addressing symptoms of grief and loss. One group of psychology researchers conducted a meta-analysis of studies examining the use of online therapy for grief counseling and found that it seemed to be comparable to in-person therapy.