Prolonged grief disorder

Grief is a natural response to loss, and it can be painful for a long time. For most people, the most intense pain gradually softens, even though they continue to miss the person and have moments of deep sadness. Life slowly makes room for both the loss and the future.

In prolonged grief disorder, this process gets stuck. Intense yearning for the person or preoccupation with them continues nearly every day, alongside other symptoms that make it very hard to function. Diagnostic guidelines generally describe this as grief lasting at least 12 months after the death for adults, and at least six months for children and adolescents, though clinicians also consider cultural and religious norms.

Other terms you may come across include chronic grief, unresolved grief and traumatic grief, which often refers to grief following a sudden, violent or unexpected death. If you feel you can't get over a death after a long time, you are not alone, and support is available.

Prolonged grief disorder involves persistent yearning or preoccupation with the person who died, along with symptoms such as:

• Intense emotional pain, sorrow, guilt, anger or bitterness about the death
• Feeling as though part of yourself has died
• Difficulty accepting that the death happened
• Avoiding reminders of the loss, or being consumed by them
• Feeling emotionally numb or unable to experience joy
• Difficulty reengaging with friends, activities or plans
• Feeling that life is meaningless without the person
• Intense loneliness or a sense of disconnection from others

These symptoms cause significant distress and interfere with work, relationships or daily life, far beyond what's expected given the person's culture and circumstances. Some people also experience sleep problems, physical health issues or increased alcohol use. Thoughts of wanting to join the deceased person can also occur and should be discussed with a professional.

Anyone can develop prolonged grief disorder, but certain factors can increase the risk:

• A sudden, violent or traumatic death, such as an accident, suicide, homicide or disaster
• The death of a child or partner
• A very close or dependent relationship with the person who died
• A difficult or conflicted relationship, which can leave unresolved feelings
• Limited social support or isolation after the loss
• Previous losses, trauma or mental health conditions such as depression or anxiety
• Additional stresses, such as financial problems or caregiving burdens
• Circumstances that disrupted mourning rituals, such as not being able to say goodbye

Understanding these risk factors can help people recognize when their grief may need extra support, without blaming themselves for how they're feeling.

Grief has no fixed timetable, and the well-known stages of grief are not a strict sequence everyone follows. Normal grief often comes in waves that become less overwhelming over time, and people gradually find meaning and engagement again.

Prolonged grief disorder differs in its persistence, intensity and impact. The yearning and preoccupation don't ease, and the person remains unable to move forward in their life.

It also differs from depression. Depression tends to involve a pervasive low mood and loss of interest in nearly everything, along with feelings of worthlessness. In prolonged grief, the pain centers specifically on the loss and the person who died. Prolonged grief can overlap with PTSD after a traumatic death, especially when there are intrusive images or memories of how the person died. The conditions can occur together, and a careful assessment helps guide treatment.

Specialized grief therapies have shown good results. Prolonged grief disorder therapy, sometimes called complicated grief treatment, combines elements of cognitive behavioral therapy (CBT), interpersonal therapy and exposure-based techniques. It typically helps people:

• Understand grief and what may be keeping it stuck
• Gradually face painful memories and reminders that they have been avoiding
• Reconnect with the relationship to the person in a way that brings comfort rather than only pain
• Set goals and rebuild a meaningful life

Other helpful approaches include grief-focused CBT, acceptance and commitment therapy and, after traumatic deaths, trauma-focused therapies such as EMDR. Group support can reduce isolation. When depression or anxiety is also present, a psychiatrist may consider medication as part of the plan.

A clinical psychologist, psychotherapist or psychiatrist experienced in grief and bereavement is well placed to help. At the first session, you'll talk about the person who died, the circumstances of the death, how you've been coping and what feels most difficult. You won't be asked to "let go" of the person. The aim is to help you carry the loss in a way that allows you to live again.

Consider seeking help if grief remains overwhelming after many months, if you can't function in daily life, if you're avoiding everything related to the loss, or if you're using alcohol or drugs to cope.

If you have thoughts of ending your life or wanting to be with the person who died, please seek help immediately. In the US, call or text 988. In the UK and Ireland, call Samaritans on 116 123. If you are in immediate danger, call 911 or your local emergency number.