Understanding and Navigating Prolonged Grief Disorder

4 practical steps for moving beyond prolonged grief.

Key points

• Prolonged Grief Disorder is an internationally recognized condition and is included in diagnostic manuals.

• Prolonged grief can cause significant negative impacts.

• Understanding the signs and symptoms of PGD and seeking help are key to recovery.

Woman going through grief.

Grief is the intense pain that follows a profound loss. Grieving is an unavoidable, painful, and profound reaction and process in the aftermath of the loss of someone or something deeply meaningful and loved. While we typically associate grief with the death of a loved one, we can also experience grief through other significant losses, like the loss of a job, the loss of a beloved pet, the loss of a significant relationship, a life-changing accident, or diagnosis (your own or of a loved one), and significant, definitive life-changing transitions, like the end of active parenting, when children leave the family home, retirement or the end of a career.

At some point in our lives, we will all experience loss. How we process our loss can have a profound impact on our health, our relationships, and our ability to reintegrate and return to living a full and meaningful life.

Grief and the grieving process

In the 1960’s, psychiatrist Elizabeth Kübler-Ross introduced the five stages of loss, including denial, anger, bargaining, depression, and acceptance, a framework that, over time, has been widely discussed, reframed, and revisited, with many mental health experts and researchers adding to the discussion. (Why the Five Stages of Grief are Wrong, by David B. Feldman, Ph.D., offers an excellent exploration of the limitations of Kübler-Ross’ stages of grief.)

In On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss, Kübler-Ross offers this poignant summation of the need for time to process loss: “We need time to move through the pain of loss. We need to step into it, really, to get to know it.”

University of Arizona associate professor of clinical psychology and psychiatry Mary-Frances O'Connor, PhD, who researches the range of physical and emotional responses in the aftermath of loss, characterizes the grieving process as “the way that grief changes over time without ever actually going away,” emphasizing that time is essential to processing and recovering from loss.

When it comes to the grieving process, do we know when we have been grieving too long?

Recognizing Prolonged Grief Disorder

Prolonged Grief Disorder (PGD) is the latest diagnosis included in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published in 2022, and in a number of other international diagnostic manuals. The DSM-5-TR defines "too long" as “at least a year for adults and at least 6 months for children and adolescents.” While statistics vary, a 2024 cross-national analysis of 16 countries estimates the prevalence of PGD at 5-16 percent of people experiencing grief.

A PGD diagnosis, in addition to its defined timeframe, requires the ongoing presence of three of the following eight criteria for at least one month: intense emotional pain directly related to a significant loss, a persistent disbelief or difficulty in dealing with a significant loss, a loss of identity, avoidance of people, situations, and settings that trigger painful emotions, overwhelming difficulties in returning to daily routines and activities, emotional numbness, prolonged feelings of despair and hopelessness, and prolonged feelings of detachment from others, loneliness, isolation, and a loss of meaning and purpose.

PGD is linked to “serious health outcomes, including increased suicide risk, cardiovascular disease, cancer, substance use, sleep problems, and chronic illness.”

Furthermore, while research on the impact of PGD on the brain is relatively new, recent studies have observed “neurobiological circuitry of PGD [which] overlaps with that of anxiety and depression,” as well as macroprocesses “related to the brain’s reward system,” unique to PGD.

Seeking treatment for Prolonged Grief Disorder

The first step to navigating PGD for yourself or someone you love is building an awareness of its persistent and troubling signs and symptoms.

If you or someone you love is struggling with loss, and stuck in recurring patterns of isolation, despair, emotional pain, and patterns of avoidance, and/or struggling to reintegrate into social situations, working life, or handle daily life tasks and responsibilities it is important to seek the help of a mental health professional who can offer evidence-based treatments, such as Cognitive Behavioral Therapy (CBT), strategies and tools to help process grief, manage avoidance and self-isolating behaviors, reestablish daily routines, and rediscover a sense of purpose and meaning in life.

It is important to understand that we are more than our losses, our traumas, and our setbacks. We need to realize that there are effective, evidence-based treatments and interventions to help individuals suffering from prolonged grief move beyond their pain. With awareness, self-compassion, and the help of a mental health professional, we can reconnect with our sense of joy and purpose and create the life we want and deserve.

Four Key Steps to Moving Beyond Prolonged Grief

1. Build an awareness around the signs and symptoms of PGD. As with any serious mental health disorder, awareness is the first step to positive change and recovery.

   
   

2. Reflect on the persistent distressing thoughts, overwhelming feelings, choices, and behaviors that keep you stuck, isolated, and feeling hopeless and alone.

   
   

3. Make a commitment to yourself to take positive steps to process your pain and move beyond your prolonged grief.

   
   

4. Seek the help of a mental health professional if you are struggling with prolonged grief. (Your GP or family doctor is often a key resource and can refer you to a mental health professional.)

Monica Vermani, C. Psych.-Blog, Link