Complicated Grief and Prolonged Grief Disorder: Signs and Treatment

Complicated grief is an older name for what clinicians now call prolonged grief disorder (PGD). It means an intense longing for the person who died, or constant preoccupation with thoughts of them, that continues nearly every day long after the loss and keeps you from living your life. For adults the DSM-5-TR sets the minimum at 12 months after the death, and for children, 6 months. It is treatable, and it is not a sign of weakness or of loving someone "too much".

This guide is general information, not a diagnosis. Only a licensed clinician can assess you.

What is complicated grief?

Most grief changes over time. The pain comes in waves, and between waves you can work, eat, sleep and take pleasure in small things. MedlinePlus describes bereavement as the normal period of grief and mourning after a death, and how long it lasts depends on factors such as how close you were and whether the death was expected.

In some people the grief does not soften. It stays as sharp as it was in the first weeks. Researchers called this "complicated grief" or "persistent complex bereavement disorder". The American Psychiatric Association added prolonged grief disorder to the DSM-5-TR in 2022, and the World Health Organization's ICD-11 also includes it. The names differ, but they describe the same pattern.

What are the signs of prolonged grief disorder?

Under the DSM-5-TR, an adult needs all of the following:

• The death happened at least 12 months ago (at least 6 months for children and adolescents).
• Intense longing for the person who died, and/or preoccupation with thoughts of them, nearly every day for at least the last month.
• At least 3 of these 8 symptoms, also nearly every day for at least the last month:
  1. Feeling that part of yourself has died (identity disruption)
  2. Marked disbelief about the death
  3. Avoiding reminders that the person is dead
  4. Intense emotional pain, such as anger, bitterness or sorrow
  5. Trouble re-engaging with friends, interests or plans
  6. Emotional numbness
  7. Feeling that life is meaningless
  8. Intense loneliness
• The grief lasts longer than the norms of your culture or religion would expect, and it causes real distress or problems at work, at home or in relationships.

The ICD-11 uses a similar picture but a shorter time frame, about six months. A clinician will look at how you are functioning, not just at a date on the calendar.

Normal grief versus prolonged grief

There is no deadline for feeling sad. Crying on an anniversary, or missing someone fiercely years later, is not a disorder. The difference is constant, disabling symptoms.

How common is it, and who is at higher risk?

The American Psychiatric Association estimates that 4% to 15% of bereaved adults experience the persistent symptoms of PGD. A 2017 meta-analysis of 14 studies put the pooled rate at 9.8%.

A 2024 meta-analysis of 120 studies found that the strongest links to prolonged grief were grief symptoms before the death and depression. Other risk factors included unexpected deaths, violent or unnatural deaths, losing a child or a partner, low income, female gender and an anxious attachment style.

None of these guarantees that someone will develop PGD, and most people who lose someone suddenly do not. The list mainly shows who may benefit from early support. Grief that others do not recognize, such as the death of an ex-partner or a secret relationship, can also be harder to work through; see our guide to disenfranchised grief.

How is complicated grief treated?

The treatment with the most research behind it is grief-focused psychotherapy. In a randomized trial published in JAMA in 2005, 95 adults with complicated grief received either complicated grief treatment or standard interpersonal psychotherapy, each over 16 sessions across about 19 weeks. The response rate was 51% with complicated grief treatment and 28% with interpersonal therapy.

The American Psychiatric Association lists these evidence-based options:

• Cognitive behavioral therapy (CBT), including prolonged grief therapy, which helps you accept the loss and rebuild a life around it.
• Online interventions, such as guided writing exercises.
• Bereavement support groups, which reduce isolation.
• CBT for related problems, such as insomnia.

The same source says no medication is currently approved to treat grief symptoms specifically. A doctor may still treat depression, anxiety or sleep problems that occur alongside grief.

For a plain-English comparison of the professionals you might see, read grief counseling versus therapy and types of grief counseling. When you call a therapist, ask whether they have training in grief-focused treatment for prolonged grief.

What about children and teens?

Children grieve differently from adults, and most adapt with support. The National Child Traumatic Stress Network says a child's reaction becomes a concern when it is severe or prolonged and interferes with daily functioning. The DSM-5-TR allows a PGD diagnosis in a child or adolescent 6 months after the death. Our guide to grief at different ages lists what is common at each stage and the signs that a child needs more help.

When should I see a professional?

Consider booking an appointment with your doctor or a licensed mental health professional if, months after the death, you:

• feel intense longing or preoccupation nearly every day,
• cannot work, care for yourself or keep up with people you care about,
• avoid almost everything that reminds you of the person,
• feel that life has no meaning, or
• use alcohol or drugs to cope.

You do not have to wait for the one-year mark to ask for help. Early support is reasonable for anyone who feels stuck or overwhelmed. Peer support can sit alongside therapy; see our guide to online grief support groups.

What can family and friends do?

Stay in touch past the first few weeks, when most of the casseroles and cards stop. Offer specific help, such as "I'll bring dinner Thursday", rather than "let me know if you need anything". Do not set a time limit on grief, and do not tell someone to move on. If you are worried about a person's safety, ask them directly about suicidal thoughts and point them to 988.

What to do next

1. Write down how often the longing or distress occurs and what it keeps you from doing. A record helps a clinician assess you.
2. Book an appointment with your doctor or a licensed therapist and ask about grief-focused treatment.
3. Add a support group for your type of loss if you want company between appointments.
4. Save 988 in your phone in case a hard night turns into a crisis.