Symptoms and Therapies for Prolonged Grief Disorder| Blog

Symptoms and Therapies for Prolonged Grief Disorder

November 18 2025 TalktoAngel 0 comments 888 Views

Grief is a natural emotional response to loss, whether it’s the death of a loved one, the end of a relationship, or another deeply personal loss. However, for some individuals, the pain of loss does not lessen with time. Instead, it persists and interferes significantly with daily functioning, giving rise to what clinicians now recognize as Prolonged Grief Disorder (PGD). Classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), PGD represents a distinct mental health condition marked by intense yearning, persistent sorrow, and difficulty accepting the loss for an extended period often beyond 12 months for adults. Understanding its symptoms and therapeutic interventions is vital to fostering emotional healing and psychological resilience.

Understanding Prolonged Grief Disorder (PGD)

Prolonged Grief Disorder, sometimes referred to as complicated grief, extends far beyond the normal grieving process. While grief is an expected emotional journey, PGD involves maladaptive thoughts and behaviors that hinder adaptation to life after loss. According to the American Psychiatric Association (2022), PGD is characterized by persistent and pervasive grief responses that are disproportionate to cultural or situational norms.

People with PGD often feel “stuck” in their grief. They may replay the loss repeatedly in their minds, avoid reminders, or feel as though their life has lost meaning. While it is natural to mourn deeply, prolonged and debilitating grief signals that the individual may need professional support.

Symptoms of Prolonged Grief Disorder

The symptoms of PGD can manifest emotionally, cognitively, and behaviorally. Below are the common features:

Intense and Persistent Yearning: Individuals experience an overwhelming sense of longing or preoccupation with the deceased. This yearning can dominate thoughts and emotions for months or even years.
Difficulty Accepting the Loss: People may struggle to believe that their loved one is truly gone. They may act as though the person is still alive or avoid discussions about the loss altogether.
Emotional Numbness or Detachment: Many report feeling emotionally “frozen,” unable to connect with others or find joy in previously enjoyable activities.
Identity Confusion: The bereaved may feel as if a part of their identity has died along with their loved one, leading to uncertainty about their future or purpose.
Avoidance Behavior: Some individuals avoid places, people, or activities associated with the deceased, which reinforces isolation and prolongs grief.
Physical and Somatic Symptoms: Chronic fatigue, sleep disturbances, appetite changes, and psychosomatic pain are often reported. According to Shear et al. (2016), prolonged grief is linked to elevated cortisol levels and weakened immune function, highlighting its physiological impact.

Risk Factors for Developing PGD

Not everyone who experiences loss develops PGD. Several factors, however, can increase vulnerability:

Sudden or traumatic loss, such as accidents or suicides.
Loss of a child or life partner, which often represents the most intense emotional attachment.
Preexisting mental health conditions, like depression or anxiety.
Lack of social support or a history of multiple losses.
Cultural or societal suppression of grief, where individuals feel pressured to “move on” prematurely.

Understanding these risk factors allows mental health professionals to identify those who may benefit from early intervention and supportive care.

Therapeutic Interventions for Prolonged Grief Disorder

While PGD can be emotionally paralyzing, various psychotherapeutic interventions have demonstrated success in promoting recovery.

1. Complicated Grief Therapy (CGT)

Developed by Katherine Shear and colleagues, Complicated Grief Therapy is one of the most effective, evidence-based treatments for PGD. CGT combines elements of cognitive-behavioral therapy (CBT), exposure therapy, and interpersonal therapy. The primary goal is to help the bereaved integrate the reality of loss while restoring the capacity for joy and purpose.

Key techniques include:

Retelling the story of the loss to confront painful memories safely.
Imaginal conversations with the deceased to resolve unfinished emotional business.
Re-engagement in meaningful life goals to foster adaptation.

Research indicates that CGT leads to significant symptom reduction compared to supportive counseling alone (Shear et al., 2005).

2.Cognitive Behavioral Therapy (CBT)

CBT focuses on identifying and restructuring maladaptive thoughts associated with guilt, anger, or self-blame. People with PGD often harbor thoughts such as “I should have prevented it” or “Life isn’t worth living without them.” CBT helps challenge these beliefs and replace them with adaptive coping mechanisms. A study by Boelen et al. (2019) demonstrated that CBT interventions targeting avoidance behavior and cognitive restructuring significantly improve emotional regulation and daily functioning among individuals with PGD.

3.Mindfulness-Based and Acceptance Therapies

Mindfulness approaches, such as Acceptance and Commitment Therapy (ACT), emphasize being present with one’s emotions rather than suppressing them. ACT encourages individuals to accept their grief while committing to behaviors that align with their personal values.

Mindfulness also reduces rumination, helping individuals break the repetitive cycles of sadness and guilt. According to Hielaman and Cacciatore (2020), integrating mindfulness practices in grief therapy fosters self-compassion and emotional resilience, which are key to recovery.

4.Group Therapy and Support Groups

Social isolation exacerbates grief, while connection fosters healing. Group therapy provides a safe space to share experiences, validate emotions, and gain a sense of belonging. Support groups whether in-person or online can normalize the grieving process and reduce stigma. Research suggests that peer support groups are particularly beneficial for widowed individuals and parents who have lost children, as shared experiences promote empathy and mutual understanding (Strobe et al., 2017).

5.Pharmacological Support (When Needed)

While therapy remains the cornerstone of PGD treatment, medication may be used to manage co-occurring symptoms like depression or anxiety. Selective serotonin reuptake inhibitors (SSRIs) are sometimes prescribed under psychiatric supervision. However, medication alone cannot resolve grief; it should complement, not replace, psychotherapy.

Self-Care and Supportive Strategies

In addition to formal therapy, individuals can adopt several strategies to aid healing:

Establish a daily routine to rebuild structure and stability.
Engage in creative expression, such as journaling or art.
Practice self-compassion rather than guilt over “moving on.”
Seek social connection with supportive family, friends, or communities.
Honor the deceased through rituals, memory boxes, or acts of service.

These small, consistent actions gradually reintroduce meaning and joy into life after loss.

Conclusion

Prolonged Grief Disorder is not a sign of weakness it is a mental health condition that deserves understanding, compassion, and evidence-based treatment. Healing from profound loss does not mean forgetting the loved one; it means finding ways to carry their memory while embracing life again. With the right blend of therapy, social support, and self-compassion, individuals can rebuild their emotional world and rediscover purpose beyond pain.

Contributed by: Dr (Prof.) R K Suri, Clinical Psychologist & Life Coach, & Ms. Tanu Sangwan, Counselling Psychologist

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author.
Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2019). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 77(2), 270–280. https://doi.org/10.1037/a0014869
Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. (2005). Treatment of complicated grief: A randomized controlled trial. JAMA, 293(21), 2601–2608. https://doi.org/10.1001/jama.293.21.2601
Shear, M. K., Reynolds, C. F., Simon, N. M., & Zisook, S. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry, 73(7), 685–694. https://doi.org/10.1001/jamapsychiatry.2016.0892
Thieleman, K., & Cacciatore, J. (2020). Mindfulness and bereavement: An integrative review. Death Studies, 44(9), 539–548. https://doi.org/10.1080/07481187.2019.1596947
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