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Prolonged Grief Disorder: Symptoms, Causes, & Treatments

Published: February 15, 2023 Updated: February 15, 2023
Published: 02/15/2023 Updated: 02/15/2023
Headshot of Dianne Grande, Ph.D.
Written by:

Dianne Grande

Ph.D.
Headshot of Benjamin Troy, MD
Reviewed by:

Heidi Moawad

MD
  • What Is Prolonged Grief Disorder?Prolonged Grief Disorder
  • Symptoms of Prolonged Grief DisorderSymptoms
  • Prolonged Grief Disorder vs. Persistent Complex Bereavement DisorderPGD vs. PCBD
  • Prolonged Grief Disorder Vs. DepressionPGD Vs. Depression
  • Prolonged Grief Disorder Vs. PTSDPGD Vs. PTSD
  • Causes of Prolonged GriefCauses
  • How Long Is Too Long to Grieve?Grief Timelines
  • Can Prolonged Grief Cause a Loss of Identity?Loss of Identity
  • How to Cope With Prolonged GriefHow to Cope
  • When a Therapist or Grief Counselor Can HelpGet Help
  • How to Help a Loved One With Prolonged Grief DisorderHelp a Loved One
  • Final ThoughtsConclusion
  • Additional ResourcesResources
  • Prolonged Grief Disorder: Symptoms, Causes, & Treatments InfographicsInfographics
Headshot of Dianne Grande, Ph.D.
Written by:

Dianne Grande

Ph.D.
Headshot of Benjamin Troy, MD
Reviewed by:

Heidi Moawad

MD

Prolonged grief disorder (PGD) involves intense, overwhelming grief that doesn’t fade with time; instead, it becomes stronger and prevents the bereaved person from living a normal life. Symptoms of prolonged grief disorder are severe and may include strange thoughts or behaviors, like an inability to accept the loss and even memory problems.

Thankfully, there are effective strategies for coping with grief and managing symptoms, including grief counseling.

Missing a loved one is a horrible feeling. However, you don’t have to face your loss alone. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you.

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What Is Prolonged Grief Disorder?

While “normal” grief fades with time, prolonged grief remains strong and may even intensify. Prolonged grief also includes other unusual symptoms that can occur soon after the death or build slowly over time. They affect the person’s ability to maintain relationships or function normally at work or at home. Due to its broader effects on daily life, prolonged grief has also been called complicated grief. 

Prolonged Grief Disorder as a Diagnosis

Prolonged grief disorder was recently added as an official diagnosis to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).1,2 It clarifies the differences between grief versus depression. Certain symptoms of grief, such as yearning and pining, are not characteristic of depression, but are typical of grief.

PGD’s inclusion in the DSM-5 will allow mental health clinicians to bill insurance companies for treatment. It will also encourage funding for research into effective pharmacological treatments.

Symptoms of Prolonged Grief Disorder

The experience of prolonged grief is similar to the typical experience of grief for at least the first six months. For that reason, a person wouldn’t be diagnosed with prolonged grief disorder unless a minimum of six months have passed since the death of their loved one.4 Beyond that, it isn’t unusual to continue to experience intense sorrow, preoccupation with the person who died, or focus upon the circumstances of the death. An exception, however, could be if a person is in denial of the loss for six months or more.

Continuous yearning and longing for the deceased is also a typical experience, even after six months. In order to be considered prolonged grief, additional symptoms must be present.

Symptoms of prolonged grief disorder include:1

  • Feeling intense and constant longing for the deceased
  • Intense sadness that remains intense after six months
  • Being unable to focus on anything other than the death or how it occurred
  • A sense of emptiness or numbness that won’t let up
  • An inability to accept the fact that the death is permanent
  • Feeling bitter or angry about the loss
  • Becoming irritable or easily frustrated
  • Avoiding reminders of the person who died
  • Feeling that life is meaningless or pointless without the loved one
  • Feeling alone, detached from friends and family
  • Feeling unable to trust friends or family
  • Having difficulty remembering the happy times with the deceased
  • Blaming yourself for what happened to the person who died
  • Being unable to enjoy life and the activities you used to enjoy
  • Having a wish to be with the deceased, and related suicidal thoughts
  • An increase in substance use/abuse, including heavy drinking

Prolonged Grief Disorder vs. Persistent Complex Bereavement Disorder

Research indicates that PGD and persistent complex bereavement disorder are essentially the same, and that the distinction has been mostly a matter of semantics.3 Prolonged grief disorder has been an official diagnosis in the International Classification of Diseases-11 (ICD-11) since its last publication in May 2019. The recent addition of prolonged grief disorder to the DSM-5 aligns it with the ICD-11.4

Prior to this year, the development team of the DSM-5 was using the label of persistent complex bereavement disorder to describe the same disorder as a “condition for further study.”5

Prolonged Grief Disorder Vs. Depression

There can be overlap between people with prolonged grief and depression. However prolonged grief disorder is generally triggered by a traumatic loss or death of a significant other and is not caused by heredity. Complicated grief can last a long time. It is an intense yearning for the person that is now gone. The way this type of grief is experienced is influenced by previous psychiatric history, and environmental factors such as available support, and the nature of the loss. PGD can be treated with therapy to help learn coping mechanisms to work through grief.

Depression is a diagnosed mood disorder that can be caused by chemical changes in the brain. For example people who are depressed have lower amounts of serotonin in their brain. Another cause of depression is a smaller hippocampus which also regulates mood, energy, memory, and learning. There can be a hereditary component linking depression between family members. It can be treated with therapy focusing on causes and ways to cope and recognize changes in mood. Medication management can also be used to help stabilize mood so therapy can be more effective.

Prolonged Grief Disorder Vs. PTSD

PGD and Post Traumatic Stress Disorder (PTSD) are similar in that they both are the result of a traumatic and stressful life event. PTSD can be triggered by violence, abuse, or witnessing a traumatic event. They both can include major losses. Common emotions shared by people with these diagnoses can include anger, guilt, fear and anxiety. Yearning is not a prominent emotion experienced by people with PTSD.

PTSD is usually treated with therapy helping those suffering to learn skills to regain control over their lives and the disabling emotions they are experiencing. PTSD treatment helps people to reframe thoughts that are creating tumultuous emotions and erratic behaviors. PTSD can harm relationships because of its symptoms and disruptive nature.

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Causes of Prolonged Grief

Any loss might result in prolonged grief, but some kinds are particularly difficult and have a higher risk of leading to prolonged grief disorder. Extremely difficult loss situations include the loss of a parent, loss of a child, and loss of a spouse. Any violent or unexpected death, including murder or suicide, creates a risk for prolonged grief, too. Traumatic loss and traumatic grief are particularly difficult to work through.

The stages of grief might occur in any order and they might be repeated throughout the whole grieving process. If the feelings don’t lessen over time, you get “stuck” in a stage or go back again to a previous stage, it could lead to prolonged grief.

How Long Is Too Long to Grieve?

There are no rules for how long a person should grieve. It’s different for everyone and influenced by several factors, including the ability to adapt to change and how much change is happening in other parts of that person’s life. The specific circumstances surrounding the death also affect the time needed for grief to fade. For example, grief that follows a traumatic or violent death can be particularly difficult.

A general conclusion about how long grief “should” last is anywhere from six months to four years.5,6 It’s still regular grief as long as the symptoms aren’t becoming more severe or strange, such as talking about the loved one as if they’re still alive. One study shows that feelings of intense grief and mourning peak between four and six months, and decline over the next two years.7

Can Prolonged Grief Cause a Loss of Identity?

Prolonged grief is usually related to the loss of a significant person. In conjunction with this loss is the loss of that relationship. For example, in the death of a spouse/partner, your identity as a wife, husband, or partner is lost as well. That can be an important and large aspect of how you view yourself. Grief experts note that the severity of someone’s PGD symptoms is linked to the extent to which the loss was considered to be part of someone’s identity.8

How to Cope With Prolonged Grief

Coping with prolonged grief takes effort and some degree of hope that you will feel relief in time. Since grief occurs in emotional “waves,” you will probably have periods of time when the grief is less intense, and other times when it feels overwhelming. There are various ways to cope with grief; some will work better than others for each individual.

Ways to cope with prolonged grief include:9

  1. Identify supportive people in your life and stay involved with them: this will help you manage the sense of loneliness or isolation that can follow the loss of a loved one
  2. Set clear boundaries for yourself: this includes acceptance that you may not feel up to all of your usual commitments, whether in work or social life. It is important to be kind to yourself and make your own emotional well-being a priority when coping with prolonged grief.
  3. Consider pursuing a new hobby or interest: it might be difficult to maintain the activities you once enjoyed with the company of your loved one. It can be helpful to start a new hobby or activity for your enjoyment, whether it’s done as an individual or as part of a group.
  4. Be mindful of any wishful thinking about the deceased: it is natural to miss a loved one, but it isn’t helpful to dwell on what it might be like if they were still with you
  5. Honor the deceased at particular times of the year, such as the anniversary of their birth or death: establishing grief rituals can be a way to keep them in your memories at especially important times like death anniversaries while moving on with your life more generally
  6. Accept your loss and the natural sadness that follows: give yourself safe times and places to grieve deeply. Letting yourself have these feelings will eventually allow them to lift and become less heavy.
  7. Sort through their belongings and donate whatever you don’t need: by donating items such as clothing, books, or sporting equipment, you will be able to benefit others and facilitate your own process of letting go
  8. Ask for help from a mental health professional: most mental health professionals are experienced with providing grief counseling

When a Therapist or Grief Counselor Can Help

In the weeks following loss of a loved one, many people experience shock, disbelief, and denial. If you’re having difficulty getting through your day and functioning at work or home, a grief counselor can help. There’s no need to wait to find out if symptoms lessen or if they become worse. If you’ve been struggling for over six months without improvement, it’s even more important to seek help from a professional.

There are various types of grief counseling available.

  • Cognitive behavioral therapy (CBT) has been successful in the treatment of symptoms of prolonged grief with studies showing that 70% of people treated with CBT benefit.10
  • A second type of grief counseling involves interpersonal therapy. In this form of grief therapy, the person’s relationship with the deceased becomes better understood so symptoms can be resolved.11
  • A third type of grief counseling combines parts of CBT with interpersonal therapy for greater effectiveness than interpersonal therapy alone.11

You can get online help to find a therapist by asking your primary care provider for a referral or by using an online therapist directory where you can search by specialty and location.

How to Help a Loved One With Prolonged Grief Disorder

There are many things you can do to support a loved one suffering from prolonged grief and help them cope with the pain, including:

  • Be available to quietly listen without judgment. Many people tend to self isolate while grieving. Creating availability to listen can be a huge source of comfort and support. The person grieving may need to talk but might not know who to turn to. They may be fearful of being judged by how they are coping (or not coping) with the loss.
  • Use the name of the person that has died. Many people try to avoid using the deceased person’s name for fear of upsetting the one who is grieving. Using the name of the deceased with the grieving person offers comfort and helps them to know that the person remains present in the thoughts of others.
  • Offer help in concrete ways. Follow through on gestures like buying groceries, cooking meals, helping with childcare. If you have a skill, like understanding insurance claims, then use it to offer to help. These gestures can make a huge difference.
  • Be a good friend and observer in your contact with a friend. Look for signs and symptoms getting worse. Watch for  symptoms like increased depression, possible suicide ideation, or increased debilitation. Encourage them to get help from a mental health professional specializing in grief and loss.

Final Thoughts

Prolonged grief is hard to deal with, but there are ways to move forward in life and find meaning again. Each individual grieves in their own unique way, and all types of loss are difficult. There are some types of losses which are particularly difficult for many people. These types of losses create a higher risk of grief which is long lasting and becomes more complex with time. Grief counseling has been shown to be very effective in resolving the symptoms of prolonged grief.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

Online Therapy 

BetterHelp Get support and guidance from a licensed therapist. BetterHelp has over 20,000 therapists who provide convenient and affordable online therapy.  Complete a brief questionnaire and get matched with the right therapist for you. Get Started

Virtual Psychiatry

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For Further Reading

  • Association for Death Education and Counseling
  • The Columbia Center for Complicated Grief
  • The National Foundation for Grieving Children, Teens, and Families
  • CDC Grief and Loss Website
  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov

Prolonged Grief Disorder: Symptoms, Causes, & Treatments Infographics

What Is Prolonged Grief Causes of Prolonged Grief How to Cope With Prolonged Grief

11 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • (2013). American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

  • (2022, March). APA Advisory Board.  The DSM-5 adds a new diagnosis: Prolonged grief disorder. Retrieved from: https://www.advisory.com/daily-briefing/2022/03/23/prolonged-grief

  • P.K., Maciejewski, A., Maercker, P.A., Boelen, H.G., Prigerson. (2016, September). National Institutes of Health. Prolonged Grief Disorder and Persistent Complex Bereavement Disorder, but not Complicated Grief, are one and the same diagnostic entity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032512/

  • World Health Organization (2019, May). International Statistical Classification of Diseases and Related Health Problems (ICD-11th ed.). 6B42 Prolonged Grief Disorder. Retrieved from:  https://icd.who.int/

  • K. Roldan. (2022, February). US Urns Online. How Long Does Grief Last? The Grief Timeline You Can[‘t] Ignore. Retrieved from: https://www.usurnsonline.com/grief-loss/how-long-does-grief-last/

  • A. Benisek. (2021, November). WebMD. What is Prolonged Grief Disorder? Retrieved from: https://www.webmd.com/mental-health/prolonged-grief-disorder

  • H.G., Prigerson, P.K. Maciejewski. (2018, January). Cambridge University Press. Grief and acceptance as opposite sides of the same coin: Setting a research agenda to study peaceful acceptance of loss.

    https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/grief-and-acceptance-as-opposite-sides-of-the-same-coin-setting-a-research-agenda-to-study-peaceful-acceptance-of-loss/F3E88293BAC745834323E0A4D25CB318

  • Celia B. Harris, Ruth Brookman, Maja O’Connor. It’s not who you lose, it’s who you are: Identity and symptom trajectory in prolonged grief. (October 22, 2021). Current Psychology (2021) Retrieved from: https://link.springer.com/article/10.1007/s12144-021-02343-w

  • (2020, June). Centers for Disease Control and Prevention. Grief and Loss. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/stress-coping/grief-loss.html

  • The University of Arizona. (n.d.). Complicated Grief. Retrieved from ttps://mfoconnor.faculty.arizona.edu/sites/mfoconnor.faculty.arizona.edu/files/Complicated%20Grief%20Report%20Resource.pdf

  • (2011, December). Harvard Health Publishing. Coping with Complicated Grief. Retrieved from https://www.health.harvard.edu/newsletter_article/coping-with-complicated-grief

update history

We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

  • Originally Published: June 16, 2022
    Original Author: Dianne Grande, PhD
    Original Reviewer: Heidi Moawad, MD

  • Updated: February 15, 2023
    Author: No Change
    Reviewer: No Change
    Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources. Added “Prolonged Grief Disorder Vs. Depression”, “Prolonged Grief Disorder Vs. PTSD”, “Can Prolonged Grief Cause a Loss of Identity?”, and “How to Help a Loved One With Prolonged Grief Disorder”. New material written by Iris Waichler, MSW, LCSW and reviewed by Dena Westphalen, PharmD.

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Headshot of Dianne Grande, Ph.D.
Written by:

Dianne Grande

Ph.D.
Headshot of Benjamin Troy, MD
Reviewed by:

Heidi Moawad

MD
  • What Is Prolonged Grief Disorder?Prolonged Grief Disorder
  • Symptoms of Prolonged Grief DisorderSymptoms
  • Prolonged Grief Disorder vs. Persistent Complex Bereavement DisorderPGD vs. PCBD
  • Prolonged Grief Disorder Vs. DepressionPGD Vs. Depression
  • Prolonged Grief Disorder Vs. PTSDPGD Vs. PTSD
  • Causes of Prolonged GriefCauses
  • How Long Is Too Long to Grieve?Grief Timelines
  • Can Prolonged Grief Cause a Loss of Identity?Loss of Identity
  • How to Cope With Prolonged GriefHow to Cope
  • When a Therapist or Grief Counselor Can HelpGet Help
  • How to Help a Loved One With Prolonged Grief DisorderHelp a Loved One
  • Final ThoughtsConclusion
  • Additional ResourcesResources
  • Prolonged Grief Disorder: Symptoms, Causes, & Treatments InfographicsInfographics
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