Grief can be described as the acute pain that accompanies loss. It is a natural response to distressing or traumatic events, characterized by a range of emotions such as profound sadness, anger, loneliness, guilt, and helplessness. People who are grieving might also experience a lack of energy, have trouble concentrating, question their thoughts and beliefs about the world, and socially isolate themselves. While an individual who has experienced significant loss might continue to think about and miss the deceased, typical grief responses tend to improve within six months.
For approximately 10% of bereaved adults, intense feelings of grief continue or worsen with time, often causing disruptions in their daily lives. Prolonged Grief Disorder (PGD), also known as complicated grief and traumatic grief, is characterized by incapacitating and continued grief that causes problems in the daily life of the affected individual. It is particularly common among individuals who have lost a child or romantic partner. It is also typically experienced after a violent or abrupt death such as a suicide, homicide, or an accident.
In order to be diagnosed with PGD, the bereavement of the individual must have occurred at least a year prior (or six months for children and adolescents). In addition to this, there must be clinically significant evidence of one or both of the following nearly every day for a month:
Intense longing for the deceased individual
Preoccupation with thoughts or memories of the deceased individual
Further, at least three of the following symptoms must occur nearly every day for a month:
Identity disruption (e.g., feeling as though part of oneself has died) since the death
Marked sense of disbelief about the death
Avoidance of reminders that the person is dead
Intense emotional pain related to the death
Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with friends, pursuing interests, or planning for the future)
Emotional numbness (absence or marked reduction of emotional experience) as a result of the death
Feeling that life is meaningless as a result of the death
Intense loneliness as a result of the death
The presentation of these symptoms must be clinically significant and not better captured by cultural, occupational, social norms or another mental disorder. It is important to note that while PGD can happen to anyone, symptoms can look different based on the individual’s age, gender, culture, socioeconomic status, and other factors (DSM-5-TR, 2022).
Why is this a separate diagnosis?
The classification of a certain kind of grief as normal and the rest as disordered sparked a lot of controversy within the mental health community. While some argue that this classification would help individuals understand their condition and get access to the help they need, critics claim that this pathologizes fundamental human emotions, risking overmedicalization and stigmatization. It was only in March 2022 that Prolonged grief disorder was added to the DSM-V-TR under Trauma and Stressor-Related Disorders.
In part, this was motivated by research which suggested that grief is distinct from depression and is more closely associated with stress-related disorders. While depression typically manifests as a general loss of interest and detached sadness or numbness, prolonged grief involves consistent symptoms that are specifically related to the deceased, such as intense longing for them and preoccupation with them.
PGD is also distinct from Post-Traumatic Stress Disorder (PTSD) in the primary emotions associated with both. While PGD is typically characterized by longing, emptiness, and sadness, individuals with PTSD tend to experience hyperarousal, heightened reactivity, and emotions such as fear, anger, guilt, and shame. While there are some areas of overlap between PGD, major depression, and PTSD, there are clear distinctions between them. Hence, specific kinds of interventions tend to work best for each of these disorders. In fact, therapeutic interventions that were typically used for depression and interpersonal concerns were proving to be ineffective in dealing with PGD when compared to methods specifically tailored to target grief.
When do you check in with a therapist?
If you meet the criteria mentioned above or if your grief is significantly impacting your daily functioning, it might be helpful to check in with a therapist. Treatment can take different forms, including individual psychotherapy, art therapy, and support groups. In particular, exercises that alternate between focusing on your loss and focusing on restoration in the present are proven to be beneficial in tandem with relational interventions and cognitive restructuring. If it feels like the right decision for you, reach out to a professional to help manage your grief.
By: Nethra Palepu
Mental Health Counseling Intern
Jordan, A. H., & Litz, B. T. (2014). Prolonged grief disorder: diagnostic, assessment, and treatment considerations. Professional Psychology: Research and Practice, 45(3), 180.
Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged grief disorder: Course, diagnosis, assessment, and treatment. Focus, 19(2), 161-172.
Diagnostic and statistical manual of mental disorders : DSM-5-TR. American Psychiatric Association (Fifth edition, text revision ed.). Washington, DC. 2022.
Geralyn Dexter, L. M. H. C. (2022, April 6). Complicated or prolonged grief. Verywell Health. Retrieved July 24, 2022, from https://www.verywellhealth.com/prolonged-grief-disorder-5218745