What Is Prolonged Grief Disorder?

Prolonged grief disorder is defined by profound and debilitating feelings of loss. The condition has also been referred to as complicated, traumatic, chronic, or pathological grief. The hallmarks of prolonged grief include significant emotional distress and changes to a person's level of functioning. 

While grief is a natural and normal response to painful or traumatic events or losses, prolonged grief makes it challenging for a person to accept the reality of a loss and begin to move forward.

This article discusses prolonged grief disorder, as well as its symptoms, diagnosis, and treatment.

Prolonged Grief Disorder

As a society, our experiences with grief are becoming more prevalent—so much so that the mental health community is adding prolonged grief disorder to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association's handbook for mental health disorders. As of March 2022, the condition will be listed in the text revision of the latest version. 

Prolonged grief can be incapacitating. A person may:

• Have intrusive thoughts
• Feel preoccupied with the person or loss
• Avoid reminders of the reality of the loss

Grief becomes complicated when we lose someone and continue to experience extreme longing or yearning for them, and it causes significant impairment in important areas of functioning. When a person's experience of grief extends beyond what is appropriate for their culture, religion, age, or social norms, prolonged grief disorder may be the reason.

Complicated grief can impact a person's life in a variety of ways. It can feel all-consuming and come to the surface many times a day. A person may start to notice issues at home, work, school, in their relationships, and in their mental and physical well-being.

Grief vs. Complicated Grief

Grief describes our responses to distressing or traumatic events. We often think about grief in connection with death. However, a person can experience grief following other types of events, such as:

• Change in financial status
• Loss of a job
• Ending of a friendship, romantic relationship, or marriage
• Physical illness
• Mental health concerns
• Losing sense of independence or mobility 
• Accidents
• Near-death experiences
• Natural disasters

Grief responses include a range of emotions like anger, loneliness, profound sadness, guilt, and helplessness.

In addition, a person in the midst of grieving may experience:

• Changes in their eating and sleeping habits
• Crying
• Lack of energy
• Feel withdrawn or isolated
• Trouble concentrating
• Questioning their thoughts and beliefs about the world

Grieving people may have difficulty integrating information about and accepting that the loss has occurred.

Though a person may continue to think about and miss someone they've lost, grief responses generally begin to improve within six months.

However, others may become preoccupied with the loss of their loved one, and these thoughts and feelings can disrupt their daily lives. This is when grief becomes complicated or prolonged. In these cases, a person may struggle to accept that the loss has occurred, be focused on their death, and have intense feelings of longing for the individual.

Learning to take care of yourself as you grieve is essential. Prolonged grief has been linked to problems with sleep, cardiovascular disease, accidents, professional and interpersonal issues, and depression.

Symptoms

Prolonged grief disorder can be diagnosed when symptoms persist for more than 12 months after the passing of a loved one in adults and at least six months in children.

Symptoms associated with complicated grief include, but are not limited to:

• Intense emotional pain related to the death (e.g., anger, sadness, helplessness)
• A marked sense of disbelief about the death
• Difficulty with reintegration
• Emotional numbness
• Struggling to find meaning in life
• Intense feelings of loneliness or detachment from others
• Identity disruption (e.g., feeling as if you've lost part of yourself) 

Grief may look different in children and adults. For example, adolescents and children may experience mood changes, sadness and fear, concern about losing others, and separation anxiety. 

Adults may experience social issues, feeling unable to accept the loss, drug or alcohol use, or suicidal thoughts.

The loss of someone we love and care about is distressing. Before their passing, our thoughts and emotions about them may have been positive. However, one study showed that losing someone complicates matters, as our experience of them then becomes shrouded in difficult and strong emotions.

Diagnosis

Talking to a healthcare provider is a significant first step when dealing with grief. They will conduct an evaluation by asking about symptoms you're experiencing and how you're managing. This helps them get a sense of the issues at play and rule out other possible diagnoses, like post-traumatic stress disorder and depressive disorders. 

Your healthcare provider may consider prolonged grief disorder if your symptoms don't align with the criteria for other conditions. Prolonged grief disorder is diagnosed when a person reports intense longing and preoccupation with their loved one, and when significant disruptions in their daily functioning are present.

Treatment

Seeking help from a mental health professional can provide an accurate diagnosis and symptom management. A therapist can help you process your loss in a compassionate, safe, and non-judgmental environment, and talk about how to improve your emotional well-being and functioning. 

Cognitive behavioral therapy (CBT) is an effective treatment for prolonged grief therapy. A study that examined the use of CBT and exposure techniques with grieving people found that these interventions helped reduce symptoms of grief and depression. Additionally, the participants noted an increase in their psychological well-being and social functioning.

Other psychotherapeutic approaches, such as psychodynamic psychotherapy, can also be effective.

Therapy for prolonged grief may include:

• Talking about the death and processing related thoughts and feelings
• Discussing positive memories of the person and your relationship
• Working to address unresolved issues or problems
• Developing emotional regulation and coping skills
• Examining attachment and relationships

Before getting started with a therapist, you can take steps to make sure they are a good fit for you and your concerns. As you consider therapists, you can ask about their background, education, training, and experience treating grief.

Summary

Prolonged grief is a new DSM-5 diagnosis that refers to the preoccupation with a deceased person. This can lead to significant emotional distress and make it difficult to get through the day and function in important ways.

Seeking support from a healthcare provider and support system can help a grieving person develop coping skills and examine thoughts and feelings about their loss.

A Word From Verywell

The pain we experience after losing a loved one is sometimes indescribable. Grief involves complex emotions and reactions. It may feel like you'll never be able to cope with the loss. However, grief can be something you learn to walk with, so you can start to move forward.