Prolonged Grief Disorder: Diagnostic Criteria, Treatment Approaches, and Psychological Impact
Introduction
"Grief is a natural response to the loss of a loved one, but for some individuals, this emotional process becomes intense and persistent, leading to significant impairments in daily functioning. Prolonged Grief Disorder (PGD), recently recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), captures this phenomenon. PGD represents a pathological response to bereavement, distinct from depression or post-traumatic stress disorder (PTSD), and requires specialized attention for effective treatment. This report explores the diagnostic criteria of PGD, its psychological ramifications, and current treatment methodologies, highlighting the importance of clinical awareness and intervention strategies.
Diagnostic Criteria of Prolonged Grief Disorder
Prolonged Grief Disorder was formally included in the DSM-5-TR in 2022, reflecting an evolution in clinical understanding of bereavement-related psychopathology. The DSM-5-TR defines PGD as a condition that occurs following the death of someone close, where the individual experiences intense grief that lasts for at least 12 months (or 6 months in children and adolescents) and is disruptive to daily life (American Psychiatric Association [APA], 2022).
Core Symptoms
The core diagnostic symptoms include:
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Persistent longing or yearning for the deceased.
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Intense emotional pain, including sorrow, bitterness, or anger.
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Preoccupation with thoughts of the deceased or circumstances of the death.
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Difficulty engaging in social or occupational activities due to grief.
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Feelings of meaninglessness or identity disturbance.
To meet the diagnostic threshold, the individual must exhibit at least three out of eight defined cognitive, emotional, or behavioral symptoms in addition to the core grief criteria (APA, 2022).
Differentiation from Other Disorders
It is crucial to distinguish PGD from Major Depressive Disorder (MDD) and PTSD. While MDD is characterized by a pervasive low mood and lack of interest, PGD is rooted in attachment and the intense yearning for the lost individual. PTSD often follows traumatic events and includes hypervigilance, flashbacks, and avoidance of trauma-related stimuli, whereas PGD centers on the personal meaning of the loss (Boelen & Lenferink, 2020).
Epidemiology and Risk Factors
Studies estimate that 5–10% of bereaved individuals develop PGD (Prigerson et al., 2009). Risk factors include:
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Sudden or violent deaths.
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Loss of a child or spouse.
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Previous history of mental health conditions.
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Lack of social support.
Cultural and individual differences also influence grief expression and the likelihood of developing PGD. Hence, culturally sensitive assessments are vital (Killikelly & Maercker, 2017).
Psychological Impact of Prolonged Grief Disorder
PGD significantly disrupts mental, emotional, and social functioning. The persistence and intensity of symptoms often leave individuals trapped in their grief, unable to integrate the loss into their life narrative.
Mental Health Implications
PGD is associated with a heightened risk of:
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Depression and anxiety: Comorbidity rates are high, and individuals may exhibit suicidal ideation.
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Substance use: Some turn to alcohol or drugs as a maladaptive coping strategy (Lannen et al., 2008).
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Sleep disturbances: Insomnia and nightmares are frequently reported (Hardison et al., 2005).
A study by Shear et al. (2011) found that individuals with PGD exhibit altered brain activity, especially in the nucleus accumbens, which is linked to reward processing and attachment. This neural response suggests that prolonged grief might involve addiction-like mechanisms to memories of the deceased.
Functional Impairment
People with PGD often find it difficult to maintain employment, care for others, or engage in previously enjoyable activities. They may socially withdraw, exacerbating isolation and prolonging distress (Simon et al., 2007). For children and adolescents, PGD can lead to academic failure and developmental delays (Melhem et al., 2011)
PGD can lead to poor physical health outcomes, including:
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Weakened immune functioning.
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Cardiovascular problems.
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Increased mortality risk, especially in older adults (Stroebe et al., 2007).
These effects highlight that PGD is not just a mental health issue but a whole-person condition with systemic consequences.
Treatment Approaches for Prolonged Grief Disorder
Effective treatment of PGD is crucial for restoring well-being and functionality. While no universal treatment fits all, several evidence-based approaches have been developed, including psychotherapeutic and pharmacological interventions.
Developed by Shear et al. (2005), Complicated Grief Therapy is a manualized, targeted form of psychotherapy combining cognitive-behavioral, interpersonal, and attachment-based strategies. CGT encourages patients to confront painful memories, re-engage with life goals, and process the reality of the loss.
A randomized controlled trial by Shear et al. (2005) demonstrated that CGT was significantly more effective than traditional interpersonal psychotherapy, leading to greater symptom reduction and functional improvement.
CBT adapted for grief focuses on identifying and challenging maladaptive thoughts, such as self-blame or catastrophizing. It often includes:
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Exposure therapy to memories of the deceased.
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Cognitive restructuring of irrational beliefs.
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Behavioral activation to promote re-engagement with life.
Boelen et al. (2007) found that CBT significantly reduced PGD symptoms in a clinical population, suggesting its applicability across settings.
While medications are not the frontline treatment, antidepressants such as SSRIs may alleviate comorbid depression or anxiety, making psychological treatment more effective. However, there is limited evidence that medications alone can resolve PGD symptoms (Zisook et al., 2010).
Support groups offer shared experiences, emotional validation, and communal healing. These can be especially beneficial for those who lack familial or social support (Neimeyer et al., 2014).
Emerging Therapies
Recent explorations include:
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Mindfulness-based interventions: Useful for enhancing emotional regulation.
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EMDR (Eye Movement Desensitization and Reprocessing): Promising results in grief tied to traumatic death.
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Somatic therapies: Address the bodily component of grief through physical awareness and movement.
Challenges in Diagnosis and Treatment
Cultural Considerations
Grief norms vary significantly across cultures. What may be considered pathological in one society may be normal in another. For example, prolonged mourning is accepted in some Eastern cultures as a sign of respect (Rosenblatt, 2008). Clinicians must be culturally competent to avoid misdiagnosis.
Stigma and RecognitionMany individuals suffering from PGD do not seek help due to stigma or because they believe their symptoms are "normal." Raising public awareness and training healthcare providers is essential to improving early detection and intervention (Lichtenthal et al., 2022).
Barriers to Access
Limited mental health resources, especially in rural or underserved areas, hinder access to evidence-based care. Teletherapy and community health models may help bridge this gap.
Conclusion
Prolonged Grief Disorder is a debilitating condition that impacts every aspect of a person’s life—emotionally, cognitively, physically, and socially. With its inclusion in the DSM-5-TR, PGD has gained long-overdue recognition as a legitimate mental health condition requiring specialized care. Accurate diagnosis, culturally sensitive assessment, and access to effective treatment modalities such as CGT and CBT are vital for supporting those affected. As our understanding of grief evolves, so must our compassion and commitment to helping individuals navigate one of life’s most profound experiences—the loss of a loved one." (ChatGPT 2025)
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 75(2), 277–284. https://doi.org/10.1037/0022-006X.75.2.277
Boelen, P. A., & Lenferink, L. I. (2020). Symptoms of prolonged grief, posttraumatic stress, and depression in recently bereaved people: Symptom profiles, predictive factors, and correlates. Journal of Affective Disorders, 277, 856–864. https://doi.org/10.1016/j.jad.2020.08.041
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