What Is Complicated Grief or Prolonged Grief Disorder?
By CRYSTAL BAI •
The short answer: Complicated grief (now officially termed Prolonged Grief Disorder in the DSM-5-TR) is a clinically recognized condition in which grief becomes persistent, intense, and functionally impairing beyond what is expected for the loss — affecting approximately 10 percent of bereaved people and requiring specific targeted treatment.
What Is Prolonged Grief Disorder?
Prolonged Grief Disorder (PGD) — also called complicated grief, traumatic grief, or pathological grief — was officially added to the DSM-5-TR (the diagnostic manual for mental health conditions) in 2022. It is defined by persistent, intense grief lasting more than twelve months after loss (six months for children), accompanied by significant functional impairment. It affects an estimated 7-10 percent of bereaved people — approximately 10 to 20 million Americans at any given time.
How PGD Differs From Normal Grief
Normal grief is painful, disruptive, and follows a general (though not linear) trajectory toward adaptation over months to years. PGD is distinguished by: persistent yearning for the deceased that does not diminish; preoccupation with the circumstances of the death; bitterness and anger around the loss; avoidance of reminders or alternatively excessive proximity to reminders; a sense that life is meaningless without the deceased; difficulty imagining a future; and functional impairment (unable to work, maintain relationships, or care for self) that persists beyond twelve months.
Risk Factors for Complicated Grief
Not everyone who experiences a significant loss develops PGD. Risk factors include: traumatic or sudden deaths (suicide, homicide, accident, overdose); loss of a child; loss of a spouse or life partner; a history of depression, anxiety, PTSD, or prior grief complications; insecure attachment styles; social isolation; and lack of social support. Losses that involve ambiguity, stigma (AIDS, overdose, suicide), or conflict (estrangement) carry elevated PGD risk.
Treatment: Complicated Grief Treatment (CGT)
The most evidence-based treatment for PGD is Complicated Grief Treatment (CGT), developed by Dr. M. Katherine Shear at Columbia University. CGT is a sixteen-week structured psychotherapy that addresses both grief processing and restoration of meaning and functioning. It uses imaginal revisiting (talking about the death in detail), situational revisiting (re-engaging avoided situations), and work on personal goals and aspirations. CGT produces significantly better outcomes than non-specific therapy for PGD.
Other Effective Approaches
Other treatments with evidence for PGD include: Cognitive Behavioral Therapy for grief (CBT-G); EMDR (Eye Movement Desensitization and Reprocessing) for traumatic loss components; meaning-making therapy; and medication (antidepressants may help co-occurring depression but do not directly treat PGD). The Shear lab at Columbia maintains a CGT therapist training program and referral network.
When to Seek Help
If grief has been persistently intense for more than six months and significantly impairs your ability to work, maintain relationships, or care for yourself, it is time to seek an evaluation from a grief-specialized therapist. PGD is treatable. You do not need to remain in that level of pain indefinitely. The Association for Death Education and Counseling (ADEC) directory and Psychology Today's therapist search with a grief filter can help find appropriate clinicians.
Frequently Asked Questions
What is the difference between normal grief and complicated grief?
Normal grief is painful but follows a general trajectory toward adaptation. Complicated grief (Prolonged Grief Disorder) is characterized by persistent intense yearning, avoidance, bitterness, and functional impairment lasting more than twelve months. It affects roughly 10 percent of bereaved people.
Is complicated grief a mental illness?
Yes. Prolonged Grief Disorder was officially added to the DSM-5-TR in 2022, recognizing it as a clinically significant condition that causes substantial suffering and functional impairment and responds to specific treatment.
What is the treatment for complicated grief?
The most evidence-based treatment is Complicated Grief Treatment (CGT), developed by Dr. Katherine Shear at Columbia University. CGT is a 16-week structured psychotherapy addressing grief processing, avoidance, and restoration of meaning and functioning.
What percentage of bereaved people develop complicated grief?
Approximately 7-10 percent of bereaved people develop Prolonged Grief Disorder. Risk is higher after traumatic or sudden deaths, loss of a child, loss of a spouse, or in people with prior trauma or depression history.
Where can I find a therapist who treats complicated grief?
Search the Association for Death Education and Counseling (ADEC) directory, Psychology Today with a grief specialization filter, or contact the Columbia University Complicated Grief Treatment research program for therapist referrals.
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