What Is Complicated Grief (Prolonged Grief Disorder) and How Is It Treated?
By CRYSTAL BAI •
The short answer: Complicated grief — now clinically called Prolonged Grief Disorder (PGD) — is an intense, prolonged form of grief that significantly impairs daily functioning for more than 12 months after a loss. It affects approximately 7–10% of bereaved adults and is treatable with specialized therapy.
What Is Prolonged Grief Disorder?
In 2022, Prolonged Grief Disorder was formally added to the DSM-5-TR (the diagnostic manual used by mental health professionals). It is characterized by:
- Intense longing or yearning for the deceased that persists beyond 12 months
- Difficulty accepting the death
- Feeling that life is meaningless without the person
- Emotional numbness or bitterness
- Difficulty engaging in activities or relationships
- A sense of disbelief or emotional shock that doesn't diminish over time
How Is Complicated Grief Different From Normal Grief?
| Factor | Normal Grief | Prolonged Grief Disorder |
|---|---|---|
| Duration | Acute phase fades over months | Severe symptoms persist 12+ months |
| Functioning | Gradually returns | Significantly impaired long-term |
| Social engagement | Slowly resumes | Marked withdrawal persists |
| Response to support | Helps over time | Standard support insufficient |
| Prevalence | Universal human experience | ~7–10% of bereaved adults |
Who Is at Higher Risk?
Risk factors for Prolonged Grief Disorder include:
- Sudden, traumatic, or violent death (accident, suicide, homicide)
- Loss of a child
- Loss of a spouse or life partner
- History of depression, anxiety, or previous losses
- Lack of social support
- Highly dependent relationship with the deceased
- Feeling responsible for or unable to prevent the death
How Is Prolonged Grief Disorder Treated?
Standard grief support and general psychotherapy have limited effectiveness for PGD. The evidence-based treatment is:
- Complicated Grief Treatment (CGT): A structured 16-session protocol developed at Columbia University that combines elements of cognitive-behavioral therapy with grief-specific techniques including exposure to loss reminders and imaginal conversations with the deceased
- Prolonged Grief Disorder Therapy (PGDT): A similar structured approach
- Medication: Antidepressants (particularly escitalopram) may help symptoms but do not address the grief process alone
How to Find Help
- Ask your primary care provider for a referral to a grief specialist
- Look for therapists trained in Complicated Grief Treatment (CGT)
- The Center for Complicated Grief at Columbia University (complicatedgrief.columbia.edu) maintains a therapist directory
- The American Foundation for Suicide Prevention offers support for those who lost someone to suicide