PG-13-R Grief Assessment: How Clinicians Use It in Practice

What the PG-13-R Measures

The Prolonged Grief Disorder-13-Revised (PG-13-R) is a 13-item self-report scale designed to align directly with the DSM-5-TR diagnostic criteria for Prolonged Grief Disorder. It is one of a small number of instruments that maps precisely onto the diagnostic entity rather than measuring grief severity in general terms.

The first two items establish temporal parameters — whether the loss occurred at least 12 months ago (6 months for minors) and whether the individual has experienced persistent yearning or preoccupation with the deceased nearly every day during that period. Items 3 through 12 evaluate the frequency of ten core PGD symptoms over the past month, rated on a 5-point Likert scale: emotional numbness, difficulty accepting the death, feeling life is meaningless, identity confusion, difficulty moving forward, avoidance of reminders, intense emotional pain, feeling stunned or shocked, bitterness, and difficulty trusting others. Item 13 assesses functional impairment.

Scoring and Clinical Thresholds

The PG-13-R produces a total symptom score calculated from items 3 through 12. A score of 30 or greater, combined with confirmed temporal duration and functional impairment (items 1, 2, and 13), indicates probable Prolonged Grief Disorder at the syndromal level.

This scoring structure matters clinically because it distinguishes between two things that often get conflated: intense grief symptoms (which can score high on items 3–12 without meeting the temporal threshold) and diagnosable PGD (which requires both symptom severity and duration). A client at month three post-loss who scores 35 on the symptom items is experiencing intense acute grief — not PGD. That same score at 14 months post-loss, with confirmed functional impairment, changes the clinical picture entirely.

When to Administer the PG-13-R

Three natural administration points in a clinical grief treatment protocol:

Intake (after the temporal threshold). Administer the PG-13-R once the loss meets the 12-month temporal criterion. Before that point, the Brief Grief Questionnaire (BGQ) is a better screening tool — its 5-item format identifies clients at risk for complicated grief without requiring the diagnostic time threshold. A BGQ score of 4 or above flags the need for comprehensive assessment once the temporal window opens.

Midcourse (around session 10). In a 16-session CGT protocol, session 10 is the structured midcourse review point. Readministering the PG-13-R here helps track symptoms during exposure and cognitive interventions. Record the score alongside functional change and clinical response; no specific score decrease guarantees continued treatment authorization, which depends on the payer's criteria. Score stability or increase warrants treatment plan review — not abandonment of the protocol, since oscillation is expected, but potentially a shift in therapeutic emphasis.

Termination. A final PG-13-R administration documents the treatment outcome. The pre/post score comparison is one measure to include in the termination summary, alongside functional change and the course of care.

PG-13-R vs. Other Grief Instruments

The PG-13-R occupies a specific niche in the assessment landscape:

Inventory of Complicated Grief (ICG): Broader, 19 items, measures intensity of grief-related thoughts and behaviors. A cutoff of 25 or above suggests clinically significant complicated grief. The ICG captures a wider range of grief reactions but is not mapped to DSM-5-TR PGD criteria specifically. Best used as a complementary measure alongside the PG-13-R.

Brief Grief Questionnaire (BGQ): 5-item screening tool. Fast, low-burden, suitable for early identification. Not diagnostic — it flags risk rather than confirming a disorder. A BGQ score of 4 or above triggers comprehensive assessment with the PG-13-R or ICG.

Adult Attitude to Grief Scale (AAG): 9-item tool measuring coping style rather than symptom severity. Maps onto three dimensions — overwhelmed, controlled, resilient — and produces an Index of Vulnerability score. Useful for treatment planning (which coping mode is dominant?) rather than diagnosis.

In practice, a robust assessment battery starts with the BGQ for screening, adds the PG-13-R and ICG once the temporal threshold is met, and supplements with the AAG for treatment planning. The combination provides diagnostic precision, symptom tracking, and coping profile data that supports both clinical decision-making and insurance documentation.

Documentation Implications

Payers may require objective, measurable evidence of medical necessity and treatment progress. The PG-13-R provides one validated symptom measure; interpret it alongside the temporal criterion, functional impairment, and the full clinical picture.

Document the score in every progress note where it is administered. When scores increase temporarily (common during exposure-intensive phases of treatment), note this in clinical assessment language: "PG-13-R symptom score of 33 represents a 2-point increase from prior administration, clinically consistent with intensified grief processing during active imaginal revisiting phase of CGT protocol."

The Therapist's Grief Counseling Framework & Tools includes scoring sheets for the PG-13-R, ICG, BGQ, and AAG — integrated into the session-by-session treatment protocol so assessment, intervention, and documentation work as a single clinical system.