When Grief Needs Help: Prolonged Grief Disorder (DSM-5-TR)
Prolonged Grief Disorder was included in DSM-5-TR in 2022. Here are the diagnostic criteria, the difference with typical grief, and evidence-based treatments.
When Grief Needs Help: Prolonged Grief Disorder (DSM-5-TR)
Immediate crisis: If you are having thoughts of harming yourself or not wanting to be here, call 988 (USA), 123 (Colombia), or 116 123 Samaritans (UK) right now. This article can wait.
Grief is a normal human response to loss. But sometimes grief becomes something more: a clinical condition that prevents functioning, that sustains itself over time without diminishing, and that requires specialized treatment.
In 2022, the DSM-5-TR officially included Prolonged Grief Disorder (PGD) — validating decades of research led by Holly Prigerson and colleagues.
DSM-5-TR Diagnostic Criteria
For a PGD diagnosis, all of the following must be met:
Criterion A — The Loss
Death of someone emotionally close.
Criterion B — Core Symptoms (at least one, daily or to a disruptive degree)
- Intense yearning for the deceased
- Persistent preoccupation with the deceased interfering with functioning
Criterion C — Cognitive/Emotional/Behavioral Symptoms (at least 3 of the following)
- Identity disruption since the death
- Marked disbelief about the death
- Avoidance of reminders that the person died
- Intense emotional pain
- Difficulty reintegrating into life
- Emotional numbness
- Feeling that life is meaningless without the deceased
- Intense loneliness
Criterion D — Duration
- 12 months or more after the death (adults)
- 6 months or more in children and adolescents
Criterion E — Functional Impairment
Clinically significant distress or impairment in social, occupational, or other functioning areas.
Prolonged grief vs typical grief
The difference is not the intensity of pain but the pattern over time:
| Typical grief | Prolonged Grief (PGD) | |
|---|---|---|
| Trajectory | Gradually diminishes | Remains intense or worsens |
| Functioning | Progressively recovers | Sustained impairment |
| Relief moments | Present | Rare or absent |
| Duration | Improves for most in 12-24 months | 12+ months without improvement |
Evidence-based treatments
Complicated Grief Treatment (CGT) — Shear, 2014
The most validated treatment. JAMA 2014 RCT reported 72% response to CGT vs 32% supportive therapy. Includes:
- Psychoeducation about PGD and the Dual Process Model
- Guided revisits to memories of the deceased
- Intentional restoration work (RO activities with tracking)
- Imaginal conversations with the deceased to process unsaid things
Grief-specific CBT
Cognitive-behavioral approaches adapted for grief address thoughts that perpetuate grief, avoidance behaviors, and progressive restoration activities.
When to seek help
Seek professional evaluation if:
- It has been more than 12 months since the loss and pain remains as intense as the early months
- You have difficulty working or functioning in daily life
- You actively avoid everything that reminds you of the deceased
- You have lost the sense that life has meaning
- You have thoughts of wanting to be with the deceased or of harming yourself
You don’t need to “be worse” to seek help. If grief is preventing you from living, that is enough reason.
Keep exploring
- Wave Map 7-Day Program →
- Grief is not linear: 5 current theories →
- Grief rituals: cross-cultural evidence →
Crisis line: 988 (USA) · 123 (Colombia) · 116 123 Samaritans (UK) — available 24/7.