Prolonged grief disorder (PGD): Symptoms and treatment options

Reviewed by Robert Bogenberger, PhD

Written by

therapist.com team

Last updated: 05/09/2025

Share this article

Share article

Share this article on Facebook Share this article on Twitter Share this article on LinkedIn Share this article on Messenger Share this article in email Copy the link to this article Print this article

What is prolonged grief disorder?

Prolonged grief disorder (PGD) is a condition where someone experiences intense grief that doesn’t ease with time after losing a loved one. It involves strong yearning for the deceased and being preoccupied with thoughts or memories of them.¹

Grief itself is not a disorder or illness—it’s a natural, necessary response to loss.² While painful, grief tends to gradually change in character and intensity, allowing people to cope and adapt.

With prolonged grief, this natural healing process gets stuck. About 10% of bereaved people will develop this condition, where their grief remains intense and debilitating.³

How long does prolonged grief last?

Prolonged grief is defined as intense grief that lasts a year or more for adults or more than six months for children and adolescents. ⁴ Typically, people begin to adapt to a loss within this timeframe. The pain doesn’t disappear, but it becomes more manageable and doesn’t severely impact daily functioning.

When people experience PGD, painful thoughts and memories continue much longer. Because everyone grieves differently, there’s no rule of thumb for how long prolonged grief can continue. Grief doesn’t follow a strict timeline.

Some people may experience brief periods of intense grief years after a loss, especially during anniversaries, birthdays, or significant life events. These temporary surges of grief are normal and distinct from PGD.

Prolonged grief disorder vs. complicated grief

The term “complicated grief” was previously used to describe grief that doesn’t resolve naturally over time.⁵ While it isn’t an official diagnosis, it may still be used informally to describe symptoms consistent with prolonged grief disorder (PGD). The official diagnosis for this condition is now PGD, as recognized in recent diagnostic updates.

The change in terminology reflects the formal recognition of PGD in updated diagnostic manuals. These manuals include the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) and the “International Classification of Diseases” (ICD-11). Both provide standardized criteria for diagnosing the condition.

The term “persistent complex bereavement disorder” (PCBD) was also a proposed description for this state at one time. It was mentioned as a condition requiring further study in the DSM-5 before PGD was ultimately included in the DSM-5-TR update.

Prolonged grief disorder symptoms

People with prolonged grief disorder experience several distinctive symptoms.⁶ To be diagnosed with PGD, a person must experience a combination of the following:

Separation distress:

• Feeling a strong longing for the deceased
• Constantly thinking about the deceased and your memories of them

Additional symptoms:

• Feeling like you’ve lost a part of yourself
• Having a hard time believing the person is gone
• Avoiding reminders that the person has passed
• Deep emotional pain related to the death (such as anger, bitterness, or sorrow)
• Difficulty engaging with relationships and activities after the loss
• Feeling emotionally numb or less able to feel things
• Feeling that life is meaningless without the deceased
• Intense loneliness as a result of the death

Time criteria:

• For adults: Symptoms continue for at least 12 months after the death
• For children and adolescents: Symptoms continue for at least six months after the death
• Reaction to the loss goes beyond cultural and social expectations

In one research study, difficulty accepting the loss was found to be the most common symptom. It was estimated to affect between 14% to 25% of bereaved people.⁷ Grief-related impairment was the second most common symptom at 10% to 16%.

While not part of the official diagnostic criteria, physical symptoms sometimes accompany prolonged grief, including:⁸

• Chest tightness or choking sensations
• Shortness of breath
• Stomach issues
• Lowered energy
• Physical weakness
• Lasting fatigue

If you believe you’re experiencing PGD, or are struggling with a loss in any form, help is available. Visit our directory to find a therapist who specializes in grief counseling.

Prolonged grief disorder risk factors

Several factors may increase the risk of developing PGD:⁹

Unhelpful thought patterns, such as excessive self-blame, rumination, or catastrophizing. These cognitive patterns can trap people in cycles of painful thinking, making it difficult to process and integrate grief in healthy ways.

Avoidance behaviors, like steering clear of reminders of the deceased or not talking about the loss. While these behaviors may help a person temporarily avoid pain, it prevents the emotional processing necessary in healthy grief.

Difficulty managing painful emotions. When someone struggles to tolerate or regulate intense emotions, they might suppress them or become overwhelmed by them. Both of these actions can complicate healing.

Lack of social support. Grieving in isolation can significantly increase risk for prolonged grief. Grief becomes more manageable when there are other people around to validate you and provide comfort.

Previous mental health challenges. Grief can interact with and worsen conditions like depression or anxiety. It may make symptoms more intense and complicate recovery.

Compounded grief. When a loved one passes, it can create additional losses that complicate grief further. For example, if an elderly person loses their spouse, it may also mean losing the person who helped them compensate for mobility challenges. So, in addition to the grief of losing their partner, they may also lose their ability to live independently.

Other significant risk factors include:¹⁰

Traumatic circumstances surrounding the loss, such as sudden, violent, or unexpected deaths. These situations can create added layers that complicate the grieving process.

Closeness of the relationship. People may be at a higher risk for PGD when they lose someone very close to them. This may be a child, spouse, sibling, or parent (especially if the parent passes while their children are still young).  The more closely the person was tied to your everyday life and sense of self, the harder it will likely be to adjust to their loss.

Personal vulnerabilities. Certain qualities may make people more vulnerable to developing PGD. These traits include low self-esteem, a history of depression or anxiety, or previous struggles with suicidal thoughts. These factors can reduce resiliency when facing the weight of grief.

Nature of the relationship. If you had a complicated relationship with the deceased, it can affect the way you grieve. If the relationship involved ambivalence or dependency, processing grief can be more challenging because of unresolved feelings or the way it disrupts your identity.

How grief impacts well-being

Prolonged grief disorder can seriously affect both mental and physical health in the following ways:

• Physical health problems: In some cases, high levels of traumatic grief may increase risk of cancer, heart issues, and other chronic conditions.¹²
• Substance use: People with complicated grief may be more likely to use alcohol or drugs to cope. Interestingly, the relationship seems to go in both directions: People who misused substances before a loss were also more likely ultimately develop complicated grief.¹³
• Suicidal thoughts and behaviors: Complicated grief is a strong independent risk factor for suicidality, even when controlling for other mental health concerns like depression and posttraumatic stress disorder (PTSD).¹⁴

If you or someone you know is having thoughts of self-harm or suicide, help is available. Call or text the 988 Suicide & Crisis Lifeline at 988 for free, confidential support 24 hours a day, 7 days a week.

Grief’s impacts can also be more subtle and appear in the long-term.¹⁵ People with prolonged grief may:

• Neglect their healthcare needs
• Eat poorly or irregularly
• Exercise less often
• Experience sleep disturbances
• Withdraw from relationships

All of these changes can further harm both mental and physical well-being.

Impact on relationships

Prolonged grief can strain relationships in several ways:

• Friends and family may not understand why a person isn’t “getting better”
• The bereaved person might withdraw from social activities
• Conversations can become uncomfortable when others don’t know how to respond to ongoing grief
• The person may have difficulty forming new relationships due to fear of future loss

These impacts can create a concerning cycle in which a person becomes more and more isolated just when they need social support the most.

Prolonged grief disorder assessment

PGD is a fairly new diagnosis. But healthcare providers have been trained to recognize troubling patterns and distinguish between PGD and other similar conditions.

Clinicians may use specialized tools to evaluate grief symptoms, such as:¹⁶

• The Yearning in Situations of Loss Scale–Bereaved (YSL)
• Typical Beliefs Questionnaire (TBQ)
• Grief-Related Avoidance Questionnaire (GRAQ)

While these tools can be helpful for clinicians, they’re not intended for self-diagnosis. If you have concerns about your mental health, it’s important that you speak with a mental health professional as soon as possible. They can help you recognize and address unhelpful thought patterns and painful emotions.  

Prolonged grief disorder treatment

For those whose grief doesn’t lessen naturally with time, several effective treatments exist:¹⁷

• Complicated grief treatment (CGT), a specialized 16-session therapy that balances processing the loss with rebuilding life after it. CGT is highly effective for reducing prolonged grief symptoms.
• Cognitive behavioral therapy (CBT), which helps identify and change unhelpful thought patterns and behaviors related to grief. Techniques include exposure therapy and cognitive restructuring, with specific protocols for grief-related sleep problems.
• Support groups, which provide social connection and peer support, are valuable in the early stages of grief and may help lower the risk of developing PGD.
• Medication, specifically antidepressants, may help treat co-occurring concerns like depression. It may have limited effects on grief symptoms when used alone, but it can be a helpful part of a well-rounded treatment plan.

When to seek help for grief

A therapist can be a good source of support regardless of how well you feel you’re processing a loss. There’s no length of time or volume of emotion that you need to feel to “justify” seeking help.

Professional guidance may be especially useful if:

• Intense grief hasn’t begun to ease after 6 to 12 months
• You’re having trouble functioning in daily life
• Grief is interfering with your ability to work, maintain relationships, or care for yourself
• You’re experiencing thoughts of suicide or feeling that life isn’t worth living
• You’re using alcohol or drugs to cope with your feelings
• You feel stuck in your grief with no improvement over time

Remember that seeking help for grief is a sign of strength and self-awareness. Find a therapist who specializes in grief and loss near you.