Grief is not a disorder — it's a natural and necessary response to loss. But for 7-10% of bereaved people, grief becomes prolonged and impairing in ways that go beyond normal bereavement. Prolonged Grief Disorder (PGD), added to the DSM-5-TR in 2022, describes grief that remains intensely disabling more than 12 months after loss (6 months for children).
Normal grief, while painful, tends to evolve over time — the intensity decreases, moments of positive emotion return, and the bereaved person gradually reinvests in life. Complicated grief is characterized by: persistent longing and yearning that doesn't diminish; difficulty accepting the reality of the loss; bitterness or anger about the loss that remains intense; difficulty engaging with memories without overwhelming pain; avoidance of reminders that is pervasive; and significant functional impairment that persists beyond expected timeframes.
Risk factors for complicated grief include: sudden or traumatic deaths, suicide loss, loss of a child, deaths involving violence, ambivalent or dependent relationships with the deceased, prior trauma or psychiatric history, and limited social support.
Complicated Grief Treatment (CGT), developed at Columbia University, is a 16-session evidence-based protocol that combines elements of Interpersonal Therapy and exposure-based approaches. It is significantly more effective than standard grief counseling for prolonged grief. Find a CGT-trained therapist through the Center for Complicated Grief at Columbia.