PROLONGED GRIEF DISORDER | Persistent Complex Bereavement Disorder (2023)


Prolonged Grief Disorder | Persistent Bereavement or complex bereavement occurs when the normal grieving process does not resolve and the bereaved person experiences feelings of excessive guilt, depression, and possibly suicidal ideation. Dr. Wendla discusses the grief process, as well as signs of complicated grief, and reviews treatment and help available.
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Welcome! I am Dr. Wendla Schwartz. I started PsychTalk to provide mental health information to folks (mostly patients and family members) who might otherwise have no access. In the process, I've discovered my videos are helpful to medical students, social workers, therapists, residents, (just about anyone interested in learning more about psychiatric signs and symptoms, psychiatric medications, mental illness, DSM 5 TR diagnostic criteria, brain development, childhood trauma, personality disorders, etc.) Through these videos, we will explore the brain & human behavior on all levels. I will be interviewing other experts on topics such as depression, bipolar disorder, suicide, PTSD, eating disorders, child therapy, substance use, educational testing, learning disorders & autism.

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About Dr. Wendla:
Dr.Wendla Schwartz has a biochemistry degree from California Polytechnic and has studied literature at UC Davis and Stanford. She earned her medical degree at UC San Diego and completed her training in psychiatry and then child psychiatry at UCLA and LSU New Orleans. She is a board-certified psychiatrist, published author of fiction (novels, short stories, and poetry), and has been court recognized as a forensic expert in child psychiatry. She currently lives in Northern California where she writes books and practices medicine.

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The following anger, denial, bargaining, depression and acceptance grief is a period of time spent adjusting to the loss those stages.

I just mentioned can occur in any order we move in and out of the stages.

We repeat the stages, not everyone experiences all of the stages.

There's, no rules.


No rule book.

Everyone does it differently.

And grief is a very personal process.

That's important to remember I'm going to say it, again, grief is very personal.

Everyone does it differently? And every grief is unique.

So one person might experience grief, one way when they lose one person and an entirely different way when they lose somebody else, normal bereavement and I'll say that, again, normal bereavement includes a whole variety of symptoms.

Those include feelings of shock and sadness, numbness yearning for the lost person.

Severe fatigue, insomnia dreams nightmares, lots of agitation, guilt, self-blame.

But the common denominator of normal grief is ultimately an acceptance of the new reality that doesn't mean we like it.

It doesn't mean, it's comfortable, but there is an acceptance that ultimately comes into play.

So what happens when this is not the case sometimes the grieving person is completely unable to move through the grief process and acceptance doesn't occur.

Even after a really long period of time, they get stuck in any one of the stages of grief, very often depression.

So what do we call this when someone gets stuck in this way? We call this complicated bereavement.

We are really focused on the loss to the exclusion of other interests.

People with this complicated bereavement are generally incapacitated by their grief to the point of being unable to participate in in their lives and they're incapacitated.

They are completely unable to accept the loss, and they feel unable to move on from the loss.

And a lot of times.

What happens is people feel really guilty and almost like moving on from the loss or accepting.

The loss is a betrayal of the lost person of the deceased person.

One of the criteria for this diagnosis is that these symptoms have been going on for at least six months.

Most concerning of all is a general desire to join the deceased, which obviously becomes suicidal thoughts or ideation.

And sometimes even a plan for suicide other symptoms of complicated, bereavement can include the following a preoccupation with the circumstances surrounding the death difficulty trusting other people difficulty trusting in the world, detachment or isolation, wanting to be alone, all the time persistent feelings of loneliness and emptiness.

A negative view of the world, lots of ruminations about death, recurrent thoughts that life as a whole has become meaningless hallucinations, seeing or hearing the loved one or experiencing the pain that, um, this the deceased one might have suffered toward the end of life, prolonged grief and complicated bereavement has been associated with suicidal ideation suicide, attempts and increased risk for a variety of medical problems, including cancer cardiac events immune disorders and other issues in general about a fifth to a third of people who have experienced grief are at risk for develop their lifetime.

That's pretty significant some risk factors that put you at higher risk for a complicated.

As opposed to normal bereavement are having had a previous mood disorder, high stress levels in your life at the time of a bereavement, low social support certain personality characteristics, having a generally negative attitude and having lost someone to violent death, such as murder or suicide.

There are numerous other risk factors.

And I've most significantly are having had an emotionally dependent relationship on the deceased losing a loved one in the hospital.

There seems to be a relationship between death and a hospital and the development of a complicated bereavement disorder.

This is particularly important looking at particularly important, looking at hospice care so treatment.

What can we do? It turns out there's a lot that we can do to prevent this from happening, or if it does happen to help people to recover first of all medication, including antidepressants can be very helpful.

Oftentimes when people have developed a complex bereavement disorder, they have actually developed a depression on top of the grief, and that depression should be treated.

This requires evaluation by a professional for the appropriateness of such medications, psychotherapeutic techniques, such as cognitive behavioral therapy can be enormously helpful in this situation group support and particularly supportive and grief therapy.

There are many groups that provide this sort of therapy.

This can be very helpful.

These types of groups are particularly helpful and many are available for teens and children who have lost a loved one, especially if they have lost a primary member of their family, a parent or a sibling, how can you best help yourself if you have lost someone and are experiencing a grief process, whether normal or more complicated bereavement process, first acknowledge your pain it's, very important to allow yourself to be sad or whatever feelings, you might be having to allow them to happen, except that grief can trigger lots of complicated emotions, not all of them sadness.

Some of them paradoxical.

Some of them, numbness, anger relief all kinds of feelings.

None of them are wrong.

All of them are valid.

Be okay, with the fact that everyone grieves differently.

And your grief is unique.

Take good care of yourself, physically emotionally, psychologically, make that a priority in your life during this time, seek out people who love you.

If you ever need someone.

This is the time in your life when you need those people allow your feelings to roll over you in waves like like the tide.

This is really how grief works.

It comes and it goes.

It comes and it goes in pieces that you can tolerate allow it to come.

And it won't drown, you know, the signs of complex bereavement as I went over them in this video know what they are and seek help if you need it, give yourself time.

All the time you need grief is not laid out in a certain order.

And it is not time.


You will get to acceptance.

If you give yourself the time to heal breathe.

Thank you for listening.

This is psych talk, I'm.

Dr, schwartz, if you like this video, remember, please like it and subscribe.

Thank you for listening.



Is persistent complex bereavement disorder the same as prolonged grief? ›

Normal grief - Both normal grief and persistent complex bereavement disorder may cause similar symptoms. Persistent complex bereavement disorder usually lasts longer, however, interfering with the sufferer's functioning long after the death.

What is prolonged grief disorder persistent complex bereavement disorder? ›

This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble recovering from the loss and resuming your own life. Different people follow different paths through the grieving experience.

How does prolonged grief disorder differ from normal bereavement? ›

Prolonged grief is the most common form of complicated grief in adults (5). It is different from normal grief in that the immediate grief reactions persist over time with more or less undiminished strength, causing a considerable loss of everyday functioning (2).

How long is complex bereavement disorder? ›

This syndrome is diagnosed when persistent and severe grief symptoms continue beyond 6–12 months after the death of a loved one and are associated with functional impairment.

Is complicated grief a form of PTSD? ›

Complicated grief is a significant health concern for older adults, resulting in significant psychological and physical morbidity. Elements of post traumatic stress disorder (PTSD) are often present in individuals with complicated grief.

What percentage of people have persistent complex bereavement disorder? ›

Persistent Complex Bereavement Disorder Statistics

4.8% of people will experience persistent complex bereavement disorder symptoms. Yearning for the deceased is the most common symptom – reports by 88% of people surveyed.

What is the best treatment for prolonged grief disorder? ›

Psychotherapy. Complicated grief is often treated with a type of psychotherapy called complicated grief therapy. It's similar to psychotherapy techniques used for depression and PTSD, but it's specifically for complicated grief. This treatment can be effective when done individually or in a group format.

Which mental disorder is more likely to be caused by persistent grief? ›

It is likely that having a psychiatric diagnosis, especially a mood or anxiety disorder, is a risk factor for the development of complicated grief and that rates of CG are elevated among psychiatric outpatients.

How long should the symptoms last before prolonged grief disorder may be diagnosed? ›

The ICD-11 and DSM-5 both now have approved diagnostic criteria sets for prolonged grief disorder, which can be diagnosed 6–12 months following a loss and involves hallmark symptoms of yearning or preoccupation with the deceased.

Why is the second year of widowhood harder than the first? ›

Often the second year is the hardest as that's when the real grief work might begin. This is the time when you may be ready to face your grief head on and deal with any issues that are holding you back. If you're not ready yet though, don't feel guilty. There is no deadline and everyone grieves in their own time.

What is the most intense type of grief? ›

Chronic grief

This type of grief is when a person experiences intense reactions that don't get better over time. The distress may even intensify rather than lessen. A person with chronic grief should seek help from a professional grief counselor.

Who is most likely to experience prolonged grief? ›

Conversely, PGD is less common in cases where the bereaved death was due to natural disasters. PGD has higher prevalence in women. There is a high comorbidity rate with somatic symptom disorders, depression, anxiety and post-traumatic stress disorder, with PGS being observed as heterogenous.

Can you get disability for complex grief? ›

However, for those with Prolonged Grief Disorder those feelings are not eased with time. For some, Prolonged Grief Disorder will be disabling and can make them eligible for Social Security Disability.

At what point in time after a death should prolonged grief disorder be diagnosed? ›

For a diagnosis of prolonged grief disorder, the loss of a loved one had to have occurred at least a year ago for adults, and at least 6 months ago for children and adolescents.

What does unresolved grief look like? ›

With prolonged grief, you may have an intense feeling of longing for a person who has died. You may have trouble thinking about anything other than the person who died. These feelings may interfere with your ability to take care of your daily responsibilities.

Is complicated grief a mental illness? ›

Despite not being a clinical disorder, complicated grief is recognized as a serious condition by mental health professionals.

What are the four types of complicated grief? ›

According to the ELNEC, there are four types of complicated grief, including chronic grief, delayed grief, exaggerated grief, and masked grief.

Can grief cause brain damage? ›

Grief and loss affect the brain and body in many different ways. They can cause changes in memory, behavior, sleep, and body function, affecting the immune system as well as the heart. It can also lead to cognitive effects, such as brain fog.

Do some people never get over grief? ›

Accumulating research within psychiatry and psychology has shown that a significant minority of people – approximately one in 10 – do not recover from grief. Instead, the acute reaction persists over the longer term, leading to trouble thriving socially, mentally and physically.

Is prolonged grief disorder billable? ›

F43. 81 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

Why was bereavement removed from the DSM-5? ›

The bereavement exclusion was eliminated from the DSM-5 for two main reasons: 1) there have never been any adequately controlled, clinical studies showing that major depressive syndromes following bereavement differ in nature, course, or outcome from depression of equal severity in any other context—or from MDD ...

Which antidepressant is best for grief? ›

I think the SSRIs in particular help with the stress of grieving as well as the symptoms of anxiety and depression commonly seen.

Can you still be grieving after 20 years? ›

Having dealt with her loss for nearly 20 years I can tell you that grief does not go away. The intensity of grief may change over time and the characteristics of grief you experience change as well. Yet grief rooted in the death of a loved one never goes away and that is a good thing.

What drugs can help with grief? ›

Common medications used in grief treatment regimens include antidepressants, anti-anxiety meds and medications to promote sleep.

Can extreme grief cause psychosis? ›

Depression isn't the only connection between grief and mental illness. In rare cases, grief can cause psychosis or the development of psychotic symptoms.

What does complicated grief look like? ›

A person with complicated grief feels intense emotional pain. They can't stop feeling like their loved one might somehow reappear and they don't see a pathway forward. A future without their loved one seems forever dismal and unappealing.

What is the average age of a widow? ›

The reality is, according to the U.S. Census Bureau, the average age of a widow or widower in the U.S. is currently 59-years-old.

Do most widows remarry? ›

According to a study by the Pew Research Center, 61% of widows and widowers eventually choose to remarry. The study also revealed that men are more likely to remarry than women.

What percentage of widows never remarry? ›

Approximately 2% of older widows and 20% of older widowers ever remarry (Smith, Zick, & Duncan, 1991). The U.S. Census Bureau estimates that each year, out of every 1,000 wid- owed men and women ages 65 and older, only 3 women and 17 men remarry (Clarke, 1995).

What is the most painful grief? ›

The death of a husband or wife is well recognized as an emotionally devastating event, being ranked on life event scales as the most stressful of all possible losses.

Can grief change your personality? ›

Grief can change your personality on a temporary or more permanent basis based on various factors including how profound the loss was, your internal coping skills, your support system, your general temperament, your general stress tolerance, and your outlook on life.

What is shadow grief? ›

The person living in the shadow often has symptoms that suggest that the pain of grief has been inhibited, delayed, converted or avoided altogether.

What grief does to your brain? ›

Grief can rewire our brain in a way that worsens memory, cognition, and concentration. You might feel spacey, forgetful, or unable to make “good” decisions. It might also be difficult to speak or express yourself. These effects are known as grief brain.

What mental illness is caused by the death of a loved one? ›

Grief can be the starting point of a variety of mental illnesses, including depression, alcohol or substance use disorders, or anxiety disorders, such as PTSD, phobias, or panic disorder. Grief can also trigger the onset of bipolar disorder, often with the manic phase coming soon after the death.

Can grief cause narcissism? ›

Loss is a fact of life for all of us—whether it is failing to achieve a goal we set out for ourselves, losing a football game, having a friend move away, or experiencing the death of a loved one. Such losses can be a blow to our egos and create the emotional pain known as narcissistic injury.

What is masked grief? ›

Masked grief occurs when someone tries to suppress their feelings of grief and not deal with them or allow them to run their natural course. In the very early moments after a loss, our bodies and minds are clever in that the initial feelings of shock and denial are useful to us.

What does the DSM-5 now allow for prolonged bereavement to be diagnosed as? ›

'Prolonged grief disorder' as a diagnosis

Prolonged grief disorder was added to the DSM-5 for people who are still grieving one year after experiencing a loss, unable to return to everyday activities.

What is the difference between complicated grief and prolonged grief disorder? ›

Prolonged grief is the most common form of complicated grief in adults (5). It is different from normal grief in that the immediate grief reactions persist over time with more or less undiminished strength, causing a considerable loss of everyday functioning (2).

What are the four symptoms of complicated grief? ›

Signs and symptoms of complicated grief may include:
  • Intense sorrow, pain and rumination over the loss of your loved one.
  • Focus on little else but your loved one's death.
  • Extreme focus on reminders of the loved one or excessive avoidance of reminders.
  • Intense and persistent longing or pining for the deceased.
Dec 13, 2022

Is prolonged grief disorder the same as persistent complex bereavement disorder? ›

Persistent complex bereavement disorder (PCBD) is a disorder of grief that newly entered DSM-5. Prolonged grief disorder (PGD) is a disorder of grief included in ICD-11. No prior studies examined and compared the dimensionality, prevalence, and concurrent validity of both conditions among bereaved children.

What happens if you never grieve properly? ›

Grief that is withheld and not recognised can have a negative impact on us emotionally as well as physically. If we unconsciously delay the grieving process and withhold emotions, this can manifest itself in physical ways such as headaches, difficulty sleeping, ailments and stomach problems.

What is the treatment for prolonged grief disorder? ›

Psychotherapy. Complicated grief is often treated with a type of psychotherapy called complicated grief therapy. It's similar to psychotherapy techniques used for depression and PTSD, but it's specifically for complicated grief. This treatment can be effective when done individually or in a group format.

What is maladaptive grieving? ›

This occurs when an individual is unable to progress satisfactorily through the stages of grieving to achieve resolution and usually gets stuck with the denial or anger stages. Prolonged response- preoccupation with memories of the lost entity for many years.

What is another name for prolonged grief disorder? ›

Complicated grief

What is prolonged grief? ›

Prolonged grief disorder is characterized by this intense and persistent grief that causes problems and interferes with daily life. Grief is a natural response to the loss of a loved one. For most people, the symptoms of grief begin to decrease over time.

What category is persistent complex bereavement disorder in the DSM-5? ›

Prolonged grief disorder was added to Section 2, trauma- and stressor-related disorders chapter. DSM-5 included a category of persistent complex bereavement disorder as a “condition for further study” in Section 3 of the manual.

What is the DSM-5 criteria for prolonged grief disorder? ›

DSM-5 PGD is present when, after the death of someone close at least 12 months earlier (Criterion A), a person experiences intense yearning or preoccupation (Criterion B), plus at least 3 of 8 symptoms of identity disruption, disbelief, avoidance, emotional pain, difficulties moving on, numbness, a sense that life is ...

What medication is used for prolonged grief disorder? ›

Naltrexone has the theoretical potential to be another form of treatment that can improve the mental health, physical health, and well-being of the bereaved with PGD.

What is one protective factor for prolonged grief disorder? ›

Additional protective factors that lead to more adaptive bereavement include spiritual and religious practices or rituals, prior adaptive psychological well-being, personal and financial control, and no co-occurring losses (Mancini et al., 2015; Piper et al., 2011).

What is usually the longest and most difficult stage of grief? ›

What is the hardest stage of grief? Depression is usually the longest and most difficult stage of grief. Depression can be a long and difficult stage in the grieving process, but it's also when people feel their deepest sadness.

How long is too long to grieve? ›

There is no set length or duration for grief, and it may come and go in waves. However, according to 2020 research , people who experience common grief may experience improvements in symptoms after about 6 months, but the symptoms largely resolve in about 1 to 2 years.

Why did the DSM remove bereavement? ›

To prevent the denial of diagnosis and the consideration of sometimes much needed care, even after bereavement or other significant losses, the DSM-5 no longer contains the bereavement exclusion.

What is the differential diagnosis for persistent complex bereavement disorder? ›

Common differential diagnoses to consider when evaluating the potential presence of prolonged grief include major depressive disorder, PTSD, and normative or acute grief.

How many months are required to pass before prolonged grief disorder can be diagnosed in the DSM-5 TR? ›

In order to be sensitive to the concern expressed in the public commentary about pathologizing normal grieving and diagnosing a grief‐related disorder “too soon” after the death, the DSM‐5‐TR PGD criteria specify that 12 months must elapse since the death.

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