Prolonged Grief Disorder: Signs, Causes and When to Get Help
Prolonged grief disorder is intense, disabling grief lasting a year or more after a death. Learn the symptoms, risk factors, how it differs from normal grief and treatment.
Prolonged grief disorder (PGD) is a diagnosis for grief that remains intense and disabling at least 12 months after a death (6 months in ICD-11). Its core feature is persistent yearning for or preoccupation with the person who died, along with symptoms such as identity disruption, disbelief, avoidance of reminders, intense emotional pain, numbness, meaninglessness and loneliness. It affects about 7% to 10% of bereaved adults and responds to targeted therapy.
Key takeaways
- PGD was added to the DSM-5-TR in 2022 and ICD-11.
- It is defined by intense yearning or preoccupation nearly every day.
- Risk is higher after sudden, violent or unexpected deaths and the loss of a child or partner.
- PGD differs from depression and PTSD, though they can co-occur.
- Prolonged grief disorder therapy is effective in about 16 sessions.
Grief has no deadline, and for most people the pain softens gradually even as love and memories remain. But for some, a year or more after a death, every day still revolves around the loss. Life feels frozen, the future meaningless, and part of you feels like it died too. That may be prolonged grief disorder.
This guide explains how PGD is defined, its symptoms, who is at risk, how it differs from normal grief and depression, and how it is treated. See also grief therapy and grief counseling.
What is prolonged grief disorder?
Prolonged grief disorder was added to the DSM-5-TR in 2022, after years of research showing that a minority of bereaved people experience persistent, impairing grief that does not resolve naturally. It is diagnosed when, at least 12 months after the death of someone close (at least 6 months in ICD-11), grief causes significant distress or impairment and exceeds cultural and religious norms.
Symptoms of prolonged grief disorder
Nearly every day for at least the last month, with either intense yearning or preoccupation, plus at least three of:
- 01Identity
Identity disruption
Feeling part of yourself has died.
- 02Belief
Disbelief
Marked sense of disbelief about the death.
- 03Avoidance
Avoiding reminders
Avoiding places, objects or thoughts linked to the loss.
- 04Emotion
Intense emotional pain
Anger, bitterness or sorrow about the death.
- 05Engagement
Difficulty moving on
Trouble re-engaging with friends, interests or plans.
- 06Emotion
Emotional numbness
Absence or reduction of emotional experience.
- 07Meaning
Life feels meaningless
Feeling life has no purpose without the person.
- 08Connection
Intense loneliness
Feeling alone or detached from others.
Normal grief vs prolonged grief vs depression vs PTSD
| Typical grief | Prolonged grief | Depression | PTSD | |
|---|---|---|---|---|
| Core | Waves of sadness that soften | Persistent yearning and preoccupation | Pervasive low mood and loss of interest | Fear and re-experiencing trauma |
| Focus | The person and the loss | The person; longing to be reunited | Self and the world | The traumatic event |
| Self-worth | Intact | Identity disrupted | Worthlessness and guilt | Shame or self-blame possible |
Who is at risk?
- Sudden, unexpected or violent deaths (accidents, suicide, homicide, overdose)
- Loss of a child or spouse
- Very close or dependent relationships
- Previous losses or mental health conditions
- Limited social support
- Deaths during difficult circumstances, such as pandemics or ICU stays
How prolonged grief disorder is treated
Prolonged grief disorder therapy (PGDT)
About 16 sessions combining revisiting the story of the death, gradually approaching avoided reminders, imaginal conversations with the deceased, and restoring life goals and relationships. Randomized trials show it outperforms standard interpersonal therapy.
Grief-focused CBT
Addresses guilt, avoidance and unhelpful beliefs.
Treat co-occurring conditions
Depression, PTSD, insomnia and alcohol use. Medication may help co-occurring depression.
Support
Bereavement groups and connection with others who understand.
When to get help
Seek help if grief remains overwhelming a year after a loss, prevents you from functioning, or comes with hopelessness, heavy drinking or thoughts of wanting to die. Call or text 988 if you have thoughts of suicide.
How GraceBridge Psychiatry can help
GraceBridge Psychiatry provides secure online psychiatric care for adults in Texas, Arizona and Washington. Care starts with a comprehensive psychiatric evaluation, followed by a personalized treatment plan that may include therapy referrals, lifestyle strategies and medication management when appropriate. Most new patients are seen within days. See insurance we accept and self-pay pricing.
- Free consultation call: tell us what is going on.
- Book your evaluation: meet a board-certified provider by secure video.
- Get your plan: clear next steps and follow-up until you feel better.
Frequently asked questions
What is prolonged grief disorder?
A diagnosis for intense, disabling grief lasting at least 12 months after a death, centered on yearning or preoccupation.
When was prolonged grief disorder added to the DSM?
It was added to the DSM-5-TR in 2022.
How common is prolonged grief disorder?
About 7% to 10% of bereaved adults, higher after violent or unexpected deaths.
What are the symptoms?
Intense yearning or preoccupation plus symptoms like identity disruption, disbelief, avoidance, emotional pain, numbness, meaninglessness and loneliness.
Is prolonged grief disorder the same as depression?
No. It focuses on the loss and longing for the person, while depression is pervasive low mood. They can co-occur.
Can prolonged grief disorder be treated?
Yes. Prolonged grief disorder therapy is effective in about 16 sessions.
Is it normal to grieve for more than a year?
Yes. Grief often lasts longer. PGD applies only when grief remains intense and disabling.
What causes prolonged grief disorder?
Sudden or violent deaths, very close relationships, prior losses and limited support increase risk.
Does medication help prolonged grief?
Medication may help co-occurring depression; therapy is the main treatment for PGD.
Can children have prolonged grief disorder?
Yes, with the timeframe adjusted for children.
Is prolonged grief disorder the same as complicated grief?
They are closely related; PGD is the formal diagnosis.
Can grief cause physical health problems?
Yes. Prolonged grief is linked to sleep problems, heart disease risk and weakened immunity.
How can I help someone with prolonged grief?
Stay present, talk about their loved one, encourage professional help and gently support re-engagement.
Can prolonged grief therapy be done online?
Yes, it can be delivered effectively by telehealth.
What if I want to die after a loss?
Please call or text 988 or go to the nearest emergency room right away.
Sources
- American Psychiatric Association. Prolonged Grief Disorder
- Shear MK, et al. Optimizing treatment of complicated grief. JAMA Psychiatry. 2016;73(7):685-694.
- Lundorff M, et al. Prevalence of prolonged grief disorder in adult bereavement. J Affect Disord. 2017;212:138-149.
- 988 Suicide & Crisis Lifeline