What Is Complicated Grief or Prolonged Grief Disorder?

Over the past decade, researchers have found that some bereaved people suffer more intensely and for longer periods of time than people experiencing “normal” grief. While still emphasizing that grief is an individual and unpredictable process, they have noted that these people have much more trouble coping with their reactions to a significant loss. Despite the passage of what is typically considered to be an adequate period of time (6 months to 2 years) they do not recover physically or emotionally and continue to experience intense, disabling distress. These people are said to be suffering from prolonged grief disorder or complicated grief.. 

Prolonged grief occurs in about 10% of people who have experienced the loss of a loved one, and appears to be unrelated to the circumstances of the person’s death. 

After a great deal of consideration and debate (much of which is still ongoing) in 2022, the authors of the Diagnostic and Diagnostic and Statistical Manual of Mental Disorders or DSM added Prolonged Grief Disorder to its list of diagnosable mental health conditions. This decision “officially” differentiated prolonged grief disorder from “normal” grief and categorized it as a pathological process requiring intervention and treatment. 

According to the American Psychiatric Association, the criteria for diagnosis of prolonged grief disorder includes:

• The loss of a loved one that occurred at least one year ago for adults and 6 months ago for children and adolescents
• At least three of the following symptoms for at least one month:
  • Identity disruption (e.g., feeling as though part of oneself has died).
  • Strong disbelief that the person has died
  • Avoidance of reminders of the death
  • Intense emotional anguish, such as sorrow, anger, bitterness
  • Difficulty engaging with friends, pursuing  interests or planning for the future
  • Emotional numbness
  • Feeling life is meaningless or not worth living
  • Extreme loneliness or feelings of isolation from others
  • Difficulty managing painful emotions

The symptoms should be consistently present and cause disruption in the person’s day to day functioning at home, school, and/or work. 

Predisposing Factors 

Prolonged grief disorder can occur in anyone who has experienced a loss. However, research shows that certain individuals are more likely to develop PGD. This includes:

• A history of depression, anxiety or bipolar disorder
• Perceived lack of social support
• Poor physical health 
• Being a caregiver for the person who died, especially those who were caring for a spouse or partner
• Family conflict or difficulties at end-of-life
• A lack of education 
• People whose loved one died a sudden or traumatic death

It is also important to note that prolonged grief disorder may co-occur with other mental health conditions, which may make diagnosing and treating the condition more challenging. Specifically, researchers have found that a significant percentage of individuals with prolonged grief disorder also suffer from major depressive disorder, anxiety disorders and PTSD. 

If you believe you need help coping with your grief, use this tool from the Center for Prolonged Grief at  Columbia University to find a therapist in your area. If you want to locate additional resources, the CCG offers a number of self-assessment tools and handouts in the Resources section of its website. 

Sources

“Complicated Grief and Related Bereavement Issues for DSM-5”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC3075805/ 

“Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)”. American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm 

“Prolonged Grief Disorder”. American Psychiatric Association. https://www.psychiatry.org/patients-families/prolonged-grief-disorder 

“Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment”. Psychiatry Online. https://psychiatryonline.org/doi/10.1176/appi.focus.20200052 

“Find a Therapist”. The Center for Prolonged Grief. https://prolongedgrief.columbia.edu/find-a-therapist-contact-us/