Grief is a natural response to the loss of someone close. For most survivors, the symptoms of grief dissipate over time. For a small proportion of people, however, intense and distressing symptoms of grief persist, cause problems in daily functioning, and may even pose challenges to simply getting through the day. Prolonged grief disorder is characterized by intense and persistent grief symptoms which are not only distressing in themselves but also associated with problems in functioning. Thus, those who meet criteria for prolonged grief disorder constitute a group of bereaved persons who are significantly disturbed and disabled by their grief.
An individual with prolonged grief disorder (PGD) may experience intense longing for the person who has died and/or feelings of being preoccupied by thoughts of the death of that person. In children and adolescents, the preoccupation may focus on the circumstances of the death. Additionally, the surviving individual may experience feelings of being in shock or disbelief about the death, of insecurity and uncertainty about where they fit into a world without the deceased person, which often undermines their sense of belonging, meaning, purpose, and self in the survivorship experience. These symptoms are associated with significant distress and/or problems performing daily activities at home, work, or in other important areas such as family life. Prolonged intense grief is disabling and affects every day functioning in a way that typical grieving does not.
For a diagnosis of prolonged grief disorder, the loss of a close other person must have occurred at least a year ago for adults and at least 6 months ago for children and adolescents. In addition, the grieving individual must have experienced at least 3 of the symptoms below nearly every day for at least the last month prior to the diagnosis.
Symptoms of prolonged grief disorder (APA, 2022) include:
- Identity disruption (such as feeling as though part of oneself has died).
- Marked sense of disbelief about the death.
- Avoidance of reminders that the person is dead.
- Intense emotional pain (such as anger, bitterness, sorrow) related to the death.
- Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future).
- Emotional numbness (absence or marked reduction of emotional experience).
- Feeling that life is meaningless without the deceased person.
- Intense loneliness (feeling alone or detached from others).
Also, the person’s grief is required to last longer than might be expected based on social, cultural, or religious norms. An estimated 4%-15% of bereaved adults will experience the persistent symptoms of prolonged grief disorder (Prigerson et al. 2021; Doering et al. 2022).
Risk factors for prolonged grief disorder include sociodemographic and socioeconomic characteristics, history of mental illness, characteristics of the death, lack of social supports and trauma exposure. For example, the risk for prolonged grief disorder is greater when the death of the close other happens very suddenly or under unnatural circumstances (Lenferink and Boelen 2023; Buur et al. 2024). Additionally, prolonged grief disorder severity has been significantly positively associated with older age, female sex, anxious attachment style, lower socioeconomic status, and suicidal ideation (Buur et al. 2024; Musetti et al. 2025). Mourners with a history of depression and those with high levels of grief before the death may be at greater risk of developing PGD (Lichtenthal et al. 2024; Buur et al. 2024) as well as those who were very close to or emotionally dependent on the deceased person (Sekowski and Prigerson 2022). prolonged grief disorder risk has also varied by kinship relationship to the deceased (e.g., higher among those surviving the death of a child or spouse/partners), violent causes of death (e.g., murder), and location of death (e.g., in an Intensive Care Unit as opposed to death at home) (Buur et al. 2024; Rodriguez-Villar et al. 2024; Musetti et al. 2025). Lack of social support is also a risk for prolonged grief disorder (Rodriguez-Villar et al. 2024).
The inclusion of the diagnostic criteria for prolonged grief disorder in DSM-5-TR allows clinicians to use a common standard to differentiate between normal grief and this persistent, enduring, and disabling grief.
Treatment
For most people, grief-related symptoms following the death of a close other decrease over time and do not impact their everyday functioning. Although feelings and symptoms of grief may sometimes increase at different points in time, they do not usually require mental health treatment. However, for people who develop the more intense, ongoing symptoms of prolonged grief disorder, evidence-based treatments are available.
Treatments using elements of cognitive-behavioral therapy (CBT) have been found to be effective in reducing symptoms as have online interventions that permit mourners to express their grief in virtual notes to the deceased person. For example, Prolonged Grief Therapy has focused on how mourners can adapt to the loss by focusing on accepting the reality of the loss and restoration—working toward goals and a sense of satisfaction in a world without the close other (Szuhany et al., 2021). Other approaches have incorporated narrative disclosure and/or targeting experiential avoidance as well as support from those with shared experiences (Lichtenthal et al. 2024; LaPlante et al. 2024).
CBT can also be helpful in addressing symptoms that occur along with prolonged grief disorder, such as sleep problems. Research has shown that CBT for insomnia is effective in improving sleep. Research also suggests that CBT can be effective with children and adolescents experiencing symptoms of prolonged grief (Melhem, et al., 2013; Boelen et al., 2021).
Bereavement support groups and peer support can also provide a useful source of social connection and support. They can help people feel less alone; thus, help avoid the isolation that could increase the risk for prolonged grief disorder (Rodriguez-Villar et al. 2024). There are currently no medications to treat specific symptoms of grief, but research is underway to explore medications that might prove helpful in mitigating prolonged grief disorder.