Prolonged grief disorder

Overview

Prolonged Grief Disorder (PGD) is a mental health condition characterized by intense, persistent, and debilitating grief that extends well beyond the typical period of mourning. Unlike normal grief, which gradually eases over time, PGD involves an ongoing preoccupation with the deceased and difficulty in moving forward with life, often lasting for at least 12 months (6 months in children and adolescents). The disorder interferes with daily functioning and can impact a person’s emotional, physical, and social well-being. PGD was officially recognized in the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision) in 2022, distinguishing it as a condition separate from depression, post-traumatic stress disorder (PTSD), or normal bereavement.

Causes

Prolonged Grief Disorder arises from a complex interplay of psychological, social, and biological factors. While grief is a natural response to loss, certain circumstances and vulnerabilities can increase the risk of developing PGD. Common contributing factors include:

• Sudden or traumatic loss: Unexpected deaths, such as from accidents, suicide, or violence, may lead to unresolved emotional shock.

• Loss of a close relationship: Death of a spouse, child, parent, or best friend can have a profound psychological impact.

• History of mental health issues: Individuals with prior anxiety, depression, or PTSD are more susceptible.

• Lack of social support: Isolation or absence of a support system during bereavement increases vulnerability.

• Unresolved past losses: Accumulated grief or prior complicated mourning can contribute to PGD.

• Personality traits: People with high dependency or attachment anxiety may find it harder to accept the loss.

Symptoms

The symptoms of Prolonged Grief Disorder are distinct from normal grief due to their intensity, duration, and impact on functioning. According to DSM-5-TR criteria, symptoms must persist most days for at least 12 months after the loss (or 6 months in youth) and must significantly impair social, occupational, or other important areas of functioning. Common symptoms include:

• Persistent and intense yearning or longing for the deceased

• Preoccupation with thoughts or memories of the deceased

• Difficulty accepting the death

• Emotional numbness or detachment

• Feelings of emptiness or meaninglessness

• Bitterness or anger related to the loss

• Avoidance of reminders of the deceased

• Difficulty trusting others or engaging in relationships

• Impairment in daily functioning and routine activities

• Feeling that life is meaningless without the deceased

These symptoms must not be better explained by depression, PTSD, or another mental disorder.

Diagnosis

Diagnosis of Prolonged Grief Disorder is made through clinical evaluation using specific diagnostic criteria. Mental health professionals will assess the intensity, duration, and functional impact of grief symptoms. Diagnostic steps include:

• Clinical interview: Gathering information about the loss, emotional responses, coping mechanisms, and duration of symptoms.

• Diagnostic criteria: Utilizing DSM-5-TR or ICD-11 criteria to distinguish PGD from typical bereavement or other psychiatric disorders.

• Standardized assessment tools: Instruments like the Prolonged Grief Disorder-13 (PG-13) scale or Inventory of Complicated Grief (ICG) may aid diagnosis.

• Differential diagnosis: Ruling out major depressive disorder, PTSD, and adjustment disorders, which may present similarly but have different treatment paths.

Early recognition and intervention are crucial to prevent further deterioration in quality of life and psychological health.

Treatment

Treatment for Prolonged Grief Disorder focuses on helping individuals process their grief, restore functioning, and re-engage with life. The most effective approaches often include psychotherapy, with or without pharmacologic support.

Psychotherapy

• Complicated grief therapy (CGT): A structured form of therapy designed specifically for PGD that combines elements of cognitive-behavioral therapy (CBT), exposure therapy, and interpersonal therapy.

• Cognitive-behavioral therapy (CBT): Helps patients reframe negative thoughts, address avoidance behaviors, and develop healthy coping strategies.

• Acceptance and commitment therapy (ACT): Encourages acceptance of loss-related emotions and commitment to personal values and goals.

• Supportive counseling: Provides emotional validation and support, especially in early stages of therapy.

Medications

• Antidepressants: May be used in individuals who exhibit concurrent depressive symptoms or severe anxiety, though not typically effective for grief alone.

• Anxiolytics or sedatives: Used cautiously for short-term relief of insomnia or acute anxiety, but not recommended as long-term treatment.

Support Groups and Resources

• Grief support groups offer a sense of community and shared understanding

• Educational resources help normalize the grieving process and reduce stigma

• Family therapy can support better communication and mutual healing within families coping with shared loss

Prognosis

The prognosis for individuals with Prolonged Grief Disorder varies, but many people can recover with appropriate treatment and support. Untreated PGD may lead to serious consequences such as chronic depression, substance abuse, social withdrawal, and suicidal ideation. With early intervention, particularly through psychotherapy like CGT, individuals can gradually process their grief, adapt to life without the deceased, and regain a sense of purpose and connection. Recovery may be gradual, and ongoing support is often necessary to maintain progress and prevent relapse, especially around anniversaries or reminders of the loss.

Awareness and recognition of PGD as a distinct mental health condition have paved the way for more targeted interventions and better outcomes for those experiencing unresolved grief.