Complicated Grief and Prolonged Grief Disorder

Whilst most bereaved individuals will experience intense grief that gradually softens over time with the support of family, friends, and community, a proportion — estimated at approximately seven to ten per cent — develop a persistent, debilitating form of grief that does not follow the expected trajectory. Prolonged grief disorder (PGD), formally recognised in the ICD-11 and DSM-5-TR, is characterised by an intense longing or preoccupation with the deceased person that persists for at least six months (twelve months in the DSM-5-TR) after the death and causes significant impairment in functioning.

Key features that distinguish prolonged grief disorder from normal bereavement include a persistent inability to accept the reality of the death, emotional numbness or a sense of life being meaningless without the deceased, difficulty engaging in activities or relationships, a feeling that part of oneself has died with the person, intense bitterness or anger about the death, and difficulty moving forward with life whilst feeling that doing so would mean betraying the deceased. These symptoms go beyond the expected cultural and contextual norms for bereavement and represent a genuine clinical condition that benefits from targeted treatment.

Several risk factors increase vulnerability to complicated grief, including the nature of the death (sudden, violent, or traumatic deaths carry higher risk), the closeness and nature of the relationship with the deceased, pre-existing mental health conditions, limited social support, multiple concurrent losses, and unresolved difficulties in the relationship with the person who has died. Childhood loss of a parent or caregiver is a particularly significant risk factor.

Effective treatments for prolonged grief disorder include Complicated Grief Treatment (CGT), developed by M. Katherine Shear, which combines elements of CBT and attachment theory with specific techniques for processing the loss, and Cognitive Behavioural Therapy for Prolonged Grief. Both approaches involve gradually confronting avoided aspects of the loss, restoring engagement with life goals and activities, and working through the cognitive processes (such as counterfactual thinking and guilt) that maintain the grieving process in its acute form.