Prolonged Grief Disorder Explained

Prolonged grief disorder isn't just intense sadness that stretches out over weeks and months. It's a form of complicated grief in which the grieving process does not proceed in a healthy manner. After a loss, acute grief is typically the first reaction, followed by an adaptation that allows a person to integrate the loss and adapt to life without the loved one. But where does the diagnosis of prolonged grief disorder differ from a typical grief process?

What is prolonged grief disorder*

The word grief is an umbrella term for a range of emotions from deep sadness to intense yearning. It can be triggered by a variety of different losses, including death, separation, or divorce. Grief is typically defined as the normal human emotional response to the loss of a loved one, while mourning is the socially recognized expression of grief and is subject to cultural norms. Prolonged grief, or complicated grief, is a type of grief that persists and significantly impairs one's life months or years after the loss of a loved one. Prolonged grief disorder is characterized by a persistent and pervasive longing for the deceased, a preoccupation with the deceased or the circumstances of the death, and a feeling that life has no meaning or purpose. It can also be characterized by a belief that part of oneself has died or is permanently lost. While everyone experiences grief differently, in the early stages of the prolonged grief disorder, this condition presents the feeling that the person who has died has never left and that their memory is permanently engraved. The diagnostic criteria for prolonged grief disorder are largely unchanged from what was outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria include a diagnosis of intensely profound grief for someone who is deceased, an inability to function socially, and the presence of symptoms that cause significant impairment in social and occupational functioning for at least 12 months. The symptoms of prolonged grief disorder are highly variable. Some grieving individuals may experience intense anger and bitterness. Some people may feel emotionally numb and disconnected from others. Others may feel as though life is meaningless and, in the worst cases, must be highly cautious about encountering memories of the deceased or things that are associated with the death. Some people with prolonged grief disorder report feeling like the deceased person has died and that a part of their own life has ceased. Some people reinterpret their grief in positive ways, seeing it as a meaningful experience that leads to personal growth and spiritual enlightenment. Some describe the condition as a kind of 'emotional double life.' The distinction between prolonged grief disorder and other mental health conditions is that prolonged grief disorder is characterized by the persistent preoccupation with, and longing for, the deceased and by a general sense of one's life as empty, meaningless, or without any future. The diagnosis of prolonged grief disorder is complex and requires a thorough evaluation by a mental health professional. However, not everyone who experiences prolonged grief will meet the criteria for this disorder. Some people may experience prolonged grief but are not debilitated by their grief. The diagnosis of prolonged grief disorder is based on the presence of intense grief for at least six months, followed by at least three of the following symptoms: a persistent and intense feeling of longing for the deceased, a preoccupation with thoughts or images of their death or the circumstances of their death, a marked sense of disbelief or a feeling that the person is not really dead, avoidance of reminders of the loss and a sense of emptiness or hollowness, or a feeling that one is cut off from others, and a persistent feeling that life is empty and meaningless. It is important to note that prolonged grief disorder is a medical diagnosis and can only be made by a qualified medical professional.

Why mental health professionals recognize it

Prolonged grief disorder is an often misunderstood condition, but it’s important to recognize its significance in mental health. Its inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates that it is distinct and serious enough to require specific attention. If you walk into the office of an experienced mental health professional today, they will know about prolonged grief. Furthermore, in the tenth revision of the International Classification of Diseases (ICD-10), prolonged grief disorder was first introduced as a condition for further study in the DSM-5. The ICD is a globally used diagnostic tool for epidemiological, health management, and clinical purposes. In the 11th revision, the term prolonged grief disorder was introduced to reflect the severity of the condition. The World Health Organization (WHO) has included prolonged grief disorder in the ICD-11. The condition is defined as a persistent and severe form of grief that lasts more than six months and is associated with significant impairment in social, occupational, or other functioning. WHO recognizes that it is distinct from other mental health disorders, such as major depressive disorder and post-traumatic stress disorder. If a person is diagnosed with prolonged grief disorder, they may benefit from the attention of a trained mental health professional.

The hidden complexity

What exactly does prolonged grief disorder look like? It might involve feeling intense yearning for the deceased, struggling to connect with everyday activities, and seeing the future as devoid of joy. Over time, this can severely hinder one's ability to function and engage in daily tasks. The disorder is more than the normal cycle of sadness, shock, and anger—it is a prolonged and extreme form of grief that gets in the way of a person's ability to function and thrive. Grieving is not something that can be fixed in a short period of time, as it might involve feelings of intense sadness, shock, feeling of anger, and guilt. Moreover, grief is a complicated process, the intensity of which might vary from one person to another. The symptoms and signs of prolonged grief disorder are such that they might be seen as a sign of the person still grieving. Because of this, the full complexity of the disorder is often missed or overlooked. The condition can also be seen as a subset of complicated grief, which refers to grief that doesn't follow a linear course and involves intense symptoms that interfere with daily functioning. Unlike normal grief, prolonged grief disorder is characterized by a host of symptoms that affect an individual's ability to function in daily life. These symptoms include a persistent and intense longing for the deceased, avoidance of reminders of the loss, and a sense of emptiness or meaninglessness in life. These symptoms are considered symptoms of prolonged grief disorder, as they can affect one's ability to function in daily life, including work and family life. The symptoms of prolonged grief disorder can also prevent a person from feeling a connection to themselves or others, and it can make it difficult for a person to find meaning and purpose in life. These symptoms can also affect how an individual thinks, feels, and behaves in social, occupational, and personal situations, and it can make it difficult for a person to carry out daily tasks.

Feeling stuck

The distinction between prolonged grief and a more typical grieving process is subtle, but crucial. In a typical grieving process, a person might experience acute grief, which involves intense sadness and yearning. This is followed by a period of adaptation, during which the person begins to integrate the loss and adjust to life without the deceased. However, in the case of prolonged grief disorder, the person may experience intense yearning, constant thoughts of the deceased, a sense of feeling empty, and a loss of hope for the future. For people experiencing prolonged grief disorder, daily life activities such as eating, sleeping, and working can become extremely difficult. The loss seems so immense that the person dealing with it might be unable to adjust to life without the presence of the person who has died. This is mainly because the person with prolonged grief disorder may find it difficult to engage in activities that do not involve the deceased, making it seem impossible to form new relationships. The person also finds it difficult to connect with others in a meaningful way. This difficulty in adjusting to life without the deceased is a major characteristic of prolonged grief disorder. In a more typical grieving process, a person would experience a sense of hope for the future and be able to engage in activities that do not involve the deceased. However, this is not the case for people with prolonged grief disorder, as the loss seems so immense that they are unable to find anything worthwhile in life.

The specific diagnostic challenges

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) describes prolonged grief disorder as a persistent and pervasive condition, which involves intense longing for the deceased, marked distress, and feelings of sadness and yearning. The condition is characterized by a persistent and intense longing for the deceased, a marked sense of disbelief or feeling that the person is not really dead, and a marked sense of emptiness. People with this disorder may be unable to carry out daily tasks and may experience a sense of feeling disconnected from others. The condition is also characterized by a sense of feeling disconnected from one's body, a lack of energy, and a feeling of being out of touch with reality. The symptoms of prolonged grief disorder can affect a person's ability to carry out daily tasks. People with this disorder may experience a decline in their mental health, which can leave them feeling overwhelmed and unable to function. In such cases, it is important that mental health professionals who work with people with prolonged grief disorder understand the complexity of the condition and are aware of the unique challenges it presents. And yet, the diagnostic criteria for this condition are nonspecific, which can lead to confusion in diagnosis. One of the most significant challenges in diagnosing this condition is that individual symptoms can vary from person to person.

Current therapeutic approaches

The most common treatment for prolonged grief disorder is psychotherapy. This typically includes engaging with support groups, and cognitive behavioral therapy (CBT). Treatments may also include exposure therapy, in which the individual is gradually exposed to the memory of the deceased, and interpersonal therapy, in which the individual is helped to address issues that may have been present in the relationship with the deceased. This disorder is a serious condition that requires the attention of a trained mental health professional. No matter the therapeutic approach, effective treatment requires working with a professional who is well-versed in the unique complexities of prolonged grief.

Treatment modalities might be tailored

It is extremely important for the mental health professional to tailor the treatment to the individual needs of the person being treated. The treatment may involve a combination of therapies such as cognitive behavioral therapy (CBT) and interpersonal therapy, which aim to address the underlying issues that cause the grieving process to be prolonged or complicated. Treatment may also include exposure therapy, in which the individual is gradually exposed to the memory of the deceased, and interpersonal therapy, in which the individual is helped to address issues that may have been present in the relationship with the deceased. In some cases, medication may be prescribed to help manage symptoms such as anxiety and depression. Medications that might be prescribed include antidepressants, anxiolytics, and antipsychotics. In some cases, a combination of these medications may be prescribed to manage the symptoms of prolonged grief disorder.

When it finds you

Recognizing the signs of prolonged grief disorder is the first step toward seeking and receiving the necessary help. If you find that you or a loved one is experiencing prolonged grief, it is important to seek the help of a mental health professional. If you experience intense yearning for the deceased, feel unable to connect with others, find it difficult to engage in daily activities, and experience a sense of emptiness or hopelessness, it is important to seek the help of a professional. If your life feels consumed by the loss of a loved one, if you are unable to find joy in anything, or if you feel disconnected from others, it is important to seek help and support. If you are experiencing a loss and are having trouble moving on, it might be time to seek the help of a mental health professional. If you are experiencing prolonged grief, it is important to take the first step and seek help. Sometimes, however, it may be difficult to know when to seek help. According to a PBS News expert, the line between prolonged grief and a more typical grieving process can be a subtle one. However, a key distinction is that prolonged grief disorder can make it difficult to engage in daily activities and find meaning in life. If this is the case, it is important to seek the help of a mental health professional.