What is prolonged grief disorder?
Prolonged grief disorder describes grief that remains intense and disabling long after a death, rather than gradually easing. The American Psychiatric Association added it to the text revision of the fifth edition of its diagnostic manual, the DSM-5-TR, released in March 2022, and calls it the newest disorder in the manual. The World Health Organization's ICD-11 also includes a prolonged grief diagnosis.
The diagnosis exists to identify a minority of people who are stuck, not to label grief itself. Most people who lose someone they love grieve hard and for a long time, and that is not an illness. This page explains the idea so you know it exists. It cannot tell you whether it applies to you or someone you love; only a clinician who knows the person can do that.
How is it different from ordinary grief?
Grief does not have a deadline, and it is normal for it to resurface for the rest of a person's life, around anniversaries, holidays and unexpected reminders. Grief does not run to a schedule and what grief feels like describe that ordinary course.
What clinicians look for in prolonged grief is different in kind. A 2021 review in the American Psychiatric Association journal Focus describes most bereaved people passing through a period of intense acute grief that lessens with time. In prolonged grief, the acute phase does not lessen. The longing and pain stay much as they were in the first weeks, and the person cannot find a way back into their own life.
Another way to put the difference: in ordinary grief, the loss slowly becomes something a person carries while still taking part in their life. In prolonged grief, the loss remains the whole of life, and work, relationships and plans for the future stay on hold. Friends and family are often the first to notice, sometimes before the grieving person does.
What do clinicians look for?
According to the American Psychiatric Association, the DSM-5-TR criteria require that the death happened at least 12 months ago for adults (at least six months for children and adolescents). The person may feel intense longing for the person who died, or be preoccupied by thoughts of them or of the death, and has at least three of the following symptoms nearly every day for at least the last month:
- Identity disruption, such as feeling as though part of oneself has died.
- Marked disbelief about the death.
- Avoidance of reminders that the person is dead.
- Intense emotional pain, such as anger, bitterness or sorrow, related to the death.
- Difficulty reintegrating into life, such as problems with friends, interests or planning for the future.
- Emotional numbness.
- Feeling that life is meaningless because of the death.
- Intense loneliness, feeling alone or detached from others.
Why this list is not a self-test
These symptoms are listed so you know what the diagnosis covers. A clinician also weighs how much the grief interferes with daily life, whether it goes beyond what is expected in the person's culture and religion, and whether something else, such as depression or post-traumatic stress, better explains it. If parts of the list sound familiar, that is a reason for a conversation with a professional, not a conclusion.
How common is it, and who is more at risk?
The American Psychiatric Association estimates that 4% to 15% of bereaved adults experience the persistent symptoms of prolonged grief disorder. The 2021 Focus review gives a figure of approximately 10%. Either way, the large majority of grieving people do not develop it.
The Focus review discusses risk factors, and clinicians commonly mention sudden or violent deaths, the death of a child or partner, a very close or dependent relationship, and limited support afterward. Grief after a sudden death and losing a spouse or partner look at two of those situations.
What helps?
The American Psychiatric Association describes several approaches with research behind them. One is a form of talking therapy developed specifically for prolonged grief, which focuses on accepting the loss and on rebuilding goals and satisfaction in life without the person. Other approaches based on cognitive behavioral therapy have also been found effective, and support groups and peer support can help alongside them.
The same page notes there are currently no medications for grief symptoms themselves, though research is under way. Depression, anxiety or sleep problems that come with grief are a separate matter to raise with a physician or psychiatric prescriber. Laura Bass does not prescribe medication.
At Laura Bass Counseling in Charlotte, North Carolina, Laura works with adults on grief in individual counseling. Whether her approach is the right fit for prolonged grief in a particular case is a question to ask Laura directly; what to expect from grief counseling describes the work more generally.
If grief has become dangerous
Intense grief can bring thoughts of wanting to be with the person who died, or of not wanting to go on. If those thoughts feel close to action, or you are worried about someone else, call 911, or call or text 988 to reach the 988 Suicide and Crisis Lifeline at any hour.
Common questions
Is prolonged grief the same as complicated grief?
They describe much the same territory. Complicated grief was the term widely used by researchers and clinicians before the formal diagnosis. Prolonged grief disorder is the name now used in the DSM-5-TR and in the World Health Organization's ICD-11, with defined criteria. You will still see both terms in articles and on clinic websites.
Does grieving for more than a year mean something is wrong?
No. Missing someone for a very long time, even for the rest of your life, is ordinary. The 12-month mark in the DSM-5-TR is only one part of the criteria. What matters is whether grief has stayed at its most intense, nearly every day, and is making it very hard to live your life. A clinician can help sort that out.
Can I diagnose myself with prolonged grief disorder?
No, and this page is not meant to help you try. A diagnosis needs a qualified clinician who can rule out other explanations, such as depression or trauma, and consider your culture and circumstances. If the description sounds close to your experience, take that as a reason to talk with a professional or your doctor.
Is there medication for prolonged grief?
According to the American Psychiatric Association, there are currently no medications for grief symptoms themselves, though research is ongoing. Medication may still be appropriate for depression or other conditions that occur alongside grief, which is a decision for a physician or psychiatric prescriber. Laura Bass does not prescribe; her work is talking therapy.