Prolonged Grief Disorder

One’s grief severity can determine how long a person experiences normal grief. Prolonged grief disorder happens when intense grief remains over an extended period of time (defined by the mental health community as 12 months for adults and 6 months for children). It’s grief that’s so deep it interferes with your daily life and can become debilitating. 

PGD can be so extreme that you may become fixated on the person you lost. For those living with PGD, it can be incredibly challenging to function every day. Things like work, social functions, or even just getting through your days might seem impossible. 

Grief symptoms manifest differently for each person. But for prolonged grief disorder, PGD symptoms can include: 

• Emotional numbness 
• Intense loneliness
• Emotional pain
• Finding it challenging to go on
• Being preoccupied with thoughts of a loved one
• Finding it hard to engage with friends
• Having a hard time being productive at work
• Avoiding any type of reminder of the person who died
• Keeping a loved one’s belongings as if they’ll soon be returning
• Not being able to believe someone is gone
• Talking about the person who’s gone

“Prolonged grief disorder can be diagnosed when a person reports having an intense longing for someone who has passed away. They might often be preoccupied with thoughts about that person and may talk about them often with others. When these symptoms become intense, it’s good to seek help and support from a therapist.” - Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Children experience PGD somewhat differently. Symptoms of PGD in children include: 

• Becoming fearful that other people in their life might also leave  
• Waiting for or expecting loved ones to return 
• Going back to places where they were with their loved one
• Developing intense separation anxiety

Beyond these common PGD symptoms, it’s also normal for people with PGD to leave a loved one’s items exactly as they were at the time of their death. They might have a hard time trusting others or find it difficult to remember any of the good times they had with their loved one. Some people begin using or abusing substances — like drugs or alcohol — as coping mechanisms, and in very extreme cases, they might have thoughts of self-harm or suicide. Some might consider this pathological grief.

It’s not known exactly what causes PGD. Nor do we fully understand why the condition may affect one bereaved individual but not another. However, several factors are believed to contribute to PGD. They can include:

• A sudden or violent death (thereby caused by traumatic grief)
• Death by suicide
• The death of a child
• Being the caregiver of the person who passed away
• A history of depression or another mental health condition (e.g. anxiety, post traumatic stress disorder, etc.)
• Other life stressors (such as financial hardship) 
• Lack of a positive support system 
  
  

Loss from a “prolonged disaster,” such as COVID-19, is also thought to potentially contribute to PGD, and newer research suggests that it seems to be more common for older adults to experience it. 

“Individuals who are at higher risk of suffering from prolonged grief disorder include older adults or people with a history of a mood disorder diagnosis. Individuals who were caregivers of the person who passed away are also at higher risk. During this time, therapy can help them process through their negative thoughts and feelings so they can cope with the grief.” - Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Diagnosing PGD has historically been somewhat tricky for clinicians, since some expressions of grief are, in fact, healthy. Adding to the complication is the fact that many of the symptoms of PGD are similar to those of depression, allowing for a misdiagnosis.

However, the recent classification of PGD as a distinct mental health condition will make diagnosis more streamlined, as there’s a definitive guide now for mental health professionals to use when diagnosing.

DSM-5-TR criteria

According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR), to be diagnosed with prolonged grief disorder, a person must be experiencing grief over the loss of a loved one for at least 12 months (6 months for a child). 

They must also be feeling an intense longing for the deceased or be preoccupied with thoughts or memories of them. Finally, at least 3 of the following 8 prolonged grief disorder symptoms must be present for at least 1 month:

• Identity disruption (feeling like part of you has died with your loved one)
• Disbelief about the death
• Avoidance of any reminders of the person who passed away
• Intense emotional pain
• Difficulty moving on — not being able to engage with friends or make future plans
• Emotional numbness
• A sense that life is meaningless since the person died
• Extreme loneliness

These last symptoms must be what’s known as clinically significant. This means they need to be more intense than could be reasonably expected of the general population.