Verified by Prolonged Grief Disorder
Prolonged grief disorder is intense, persistent grief beyond a year after a loved one’s death. This may involve constant thoughts of the person, missing and longing for them, as well as disbelief, identity disruption, numbness, meaninglessness, loneliness, intense emotional pain, and significant impairment in one’s relationships, profession, or daily life.
The diagnosis was newly created in 2022, with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The previous edition, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was published in 2013 and listed persistent complex bereavement disorder as a condition for further study. In the revision, the diagnosis became prolonged grief disorder. It was the only new diagnosis in the revision. (The World Health Organization’s International Classification of Diseases 11th Revision (ICD-11), which went into effect in 2022, also includes a diagnosis of prolonged grief disorder.)
The term “complicated grief” is another formulation of a grief disorder. Complicated grief and prolonged grief disorder emerged from two different camps of researchers and have different ideologies and symptomatologies. Colloquially, however, the two terms are often used interchangeably.
The diagnosis is controversial. Some clinicians believe that grief doesn’t abide by a prescribed timeline; it’s painful but natural, and shouldn’t be pathologized. Others believe that it’s helpful to label severe grief, especially when support and services can accompany that label.
Prolonged grief disorder can be diagnosed after 12 months of grief for an adult or six months of grief for a child or adolescent. Symptoms include:
- Since the death, the development of a persistent grief response characterized by one or both of the following symptoms, which have been present most days to a clinically significant degree. In addition, the symptom(s) has occurred nearly every day for at least the last month:
- Intense yearning, longing for the deceased person.
- Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation may focus on the circumstances of the death).
- Since the death, at least three of the following symptoms have been present most days to a clinically significant degree. In addition, the symptoms have occurred nearly every day for at least the last month:
- Identity disruption (e.g., feeling as though part of oneself has died) since the death.
- A marked sense of disbelief about the death.
- Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by efforts to avoid reminders).
- Intense emotional pain (e.g., anger, bitterness, sorrow) 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 disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious norms for the individual’s culture and context.
- The symptoms are not better explained by another mental disorder, such as major depressive disorder or post-traumatic stress disorder, and are not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
As a new diagnosis, the prevalence of prolonged grief disorder remains largely unknown. A meta-analysis published in the Journal of Affective Disorders assessed 14 studies and found that the prevalence of prolonged grief disorder among adults was 9.8 percent. Still, further research, with more standardized protocols, is warranted.
Proponents of the new diagnosis argue that adding prolonged grief disorder as a diagnosis benefits patients by leading to more knowledge about grief, more informed clinicians, greater access to services, more public awareness and recognition, and greater consistency in the grief literature.
Everyone struggles in the aftermath of a death, navigating sadness, longing, loneliness, meaninglessness, identity disruption, and other difficulties—the same symptoms of the disorder. For the vast majority of people, these challenges dissipate with time. However, there’s a small minority of individuals for whom symptoms do not seem to abate; these individuals spend the rest of their lives missing the person, wanting to reunite, and not knowing who they are without their loved one. The disorder applies to this subset of people.
Prolonged grief disorder has garnered several critiques. One is that it’s inaccurate and potentially harmful to delineate a precise timeline for grief. Another is that a diagnosis may serve to pathologize the natural pain of grief. Yet another is that the decision may have been influenced by pharmaceutical companies, insurance companies, and others who stand to make money from treating people for a natural human experience.
Prolonged grief disorder results, of course, from the death of a loved one. Everyone experiences grief differently, but certain factors may heighten the likelihood of developing the condition, according to the DSM-5-TR. These include:
- Increased dependency on the deceased prior to the death
- The death of a child
- The death of a spouse or partner
- A violent or unexpected death
- Economic stressors
- Disturbances in caregiver availability and support for bereaved children.
Therapy can help those suffering from prolonged grief. One form of therapy shown to help the bereaved is called complicated grief treatment. This approach uses elements of cognitive-behavioral therapy and attachment theory. It helps patients understand the nature of grief, process their emotions, accept the reality of their loss, develop coping skills, establish new goals, shore up relationships, and build a fulfilling life while honoring their loved one’s memory. Research shows that complicated grief treatment can effectively reduce symptoms among those with prolonged grief disorder.
In addition to therapy, support groups often help the bereaved feel heard, find community, and gain coping skills.
Treatments can also target related symptoms and conditions that can accompany bereavement, such as post-traumatic stress disorder or insomnia.
No medications are approved to treat prolonged grief disorder, although some may benefit from exploring antidepressants or anti-anxiety medications.
