Inventory of Complicated Grief (ICG)

Grief is a natural response to loss, but for some individuals, the grieving process can become prolonged and interfere with daily functioning. The Inventory of Complicated Grief (ICG) is a widely recognized tool designed to identify and measure symptoms of complicated grief (CG), a condition now referred to as Prolonged Grief Disorder (PGD) in the DSM-5-TR.

What Is the Inventory of Complicated Grief (ICG)?

The ICG is a 19-item self-report questionnaire developed by Dr. Holly Prigerson and her colleagues. It evaluates symptoms of complicated grief by assessing the intensity and persistence of grief-related thoughts, emotions, and behaviors.

Complicated grief goes beyond the normal mourning process and includes prolonged symptoms like:

• Intense yearning or longing for the deceased.
• Persistent emotional pain.
• Difficulty accepting the loss.
• Avoidance of reminders of the deceased.

Purpose and Applications

The ICG is primarily used in:

• Clinical settings to diagnose complicated grief and plan interventions.
• Research studies to measure the prevalence of complicated grief and assess treatment outcomes.
• Therapeutic contexts to monitor client progress during grief counseling.

Structure of the ICG

The ICG consists of 19 questions rated on a 5-point Likert scale:

• 0 = Not at all
• 1 = Slightly
• 2 = Moderately
• 3 = Quite a bit
• 4 = Extremely

Respondents reflect on their experiences in the past month. The total score ranges from 0 to 76, with higher scores indicating more severe symptoms of complicated grief.

Key Domains Assessed

The ICG evaluates several aspects of grief, including:

1. Yearning: Persistent desire or longing for the deceased.
2. Intrusive Thoughts: Difficulty moving on due to constant memories or preoccupations.
3. Difficulty Accepting the Loss: Struggling to acknowledge the finality of the death.
4. Avoidance: Actively avoiding people, places, or activities that remind the individual of the deceased.
5. Impaired Functioning: Grief interfering with daily life, relationships, or responsibilities.
6. Bitterness and Anger: Resentment or anger related to the death.
7. Loneliness: Feeling isolated due to the absence of the deceased.

Scoring and Interpretation

• Scores ≥ 25: Indicative of complicated grief. This threshold suggests the need for clinical attention.
• Scores < 25: Likely consistent with normal grieving. However, individual circumstances must always be considered.

Benefits of the ICG

1. Standardized Assessment: Offers a structured way to evaluate grief-related distress.
2. Quick Administration: Takes 5–10 minutes to complete, making it practical for busy clinical settings.
3. Validated Tool: Extensive research supports its reliability and validity across diverse populations.
4. Treatment Planning: Helps clinicians tailor therapeutic approaches based on specific symptoms.

Limitations of the ICG

1. Subjective Responses: As a self-report tool, it relies on the individual’s perception, which may be influenced by denial or emotional state.
2. Cultural Sensitivity: Grief varies widely across cultures, and the ICG may not fully capture culturally specific expressions of loss.
3. Overlap with Depression and Anxiety: Symptoms of complicated grief may mimic or coexist with other conditions, requiring careful differential diagnosis.

Using the ICG in Practice

Administration

The ICG can be administered in-person, online, or via paper forms. It’s essential to ensure a supportive environment where respondents feel comfortable sharing sensitive feelings.

Clinical Implications

• Positive Screening: If a patient scores 25 or above, clinicians should explore symptoms further using interviews or additional assessments.
• Therapeutic Follow-Up: Interventions such as Complicated Grief Therapy (CGT), cognitive-behavioral therapy (CBT), or support groups can be introduced.

Integration with Other Tools

To gain a comprehensive understanding of the individual’s mental health, the ICG can be used alongside tools like the Patient Health Questionnaire (PHQ-9) for depression or the GAD-7 for anxiety.

Treatment of Complicated Grief

Effective treatments include:

1. Complicated Grief Therapy (CGT): A structured, evidence-based approach focusing on loss processing and restoration of life satisfaction.
2. CBT Techniques: Address distorted thought patterns contributing to prolonged grief.
3. Mindfulness Practices: Support individuals in managing overwhelming emotions.
4. Medication: In cases where complicated grief coexists with depression or anxiety, SSRIs may be prescribed.

The Inventory of Complicated Grief (ICG) is a vital tool for identifying individuals experiencing prolonged or severe grief. Its structured approach allows clinicians and researchers to evaluate the impact of grief on a person’s life, enabling timely and targeted interventions. For individuals struggling with loss, seeking professional support and using tools like the ICG can be the first step toward healing and reclaiming their life.