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Prolonged Grief Disorder Questionnaire

The document outlines a questionnaire for assessing Prolonged Grief Disorder (PG-13-Revised), focusing on emotional responses and functional impairments following the death of a significant person. It includes a series of questions regarding feelings of longing, confusion about identity, emotional pain, and social engagement. The final question assesses the impact of these symptoms on daily functioning.

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92 views1 page

Prolonged Grief Disorder Questionnaire

The document outlines a questionnaire for assessing Prolonged Grief Disorder (PG-13-Revised), focusing on emotional responses and functional impairments following the death of a significant person. It includes a series of questions regarding feelings of longing, confusion about identity, emotional pain, and social engagement. The final question assesses the impact of these symptoms on daily functioning.

Uploaded by

miss khan
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Prolonged Grief Disorder (PG-13-Revised)

Holly G. Prigerson, Ph.D., Jiehui Xu, M.S., Paul K. Maciejewski, Ph.D.

Q1. have you lost someone significant to you? Yes / No


Q2. how many months has it been since your significant other died? Months.
For each item below, please indicate how you currently feel?

Since the death, or as a result of the death... Not at all Slightly Somewhat Quite a bit Overwhelmingly

Q3. do you feel yourself longing or


yearning for the person who died?

Q4. do you have trouble doing the


things you normally do because you
are thinking so much about the
person who died?
Q5. do you feel confused about your
role in life or feel like you don't know
who you are any more (i.e., feeling
like that a part of you has died) ?

Q6. do you have trouble believing


that the person who died is really
gone?

Q7. do you avoid reminders that the


person who died is really gone?

Q8. do you feel emotional pain


(e.g., anger, bitterness, sorrow)
related to the death??

Q9. do you feel that you have trouble


re-engaging in life (e.g., problems
engaging with friends, pursuing
interests, planning for the future)?

Q10. do you feel emotionally numb


or detached from others?

Q11. do you feel that life is


meaningless without the person who
died?

Q12. do you feel alone or lonely


without the deceased?

Q13. have the symptoms above caused significant impairment


Yes / No
in social, occupational, or other important areas of functioning?

Your summed score is 10 . Interpret

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