Why 'Prolonged Grief Disorder' Has Mental Health Professionals Split (2023)

The American Psychiatric Association last week officially introduced a new diagnosable mental health condition: prolonged grief disorder. The news, while welcomed by some clinicians and researchers, has also been controversial. At the heart of the debate is the long-running question of how to define suffering, as well as how best to help people cope with the inevitable reality of experiencing loss.


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Prolonged grief disorder was codified in a revision to the APA’s fifth edition of the Diagnostic and Statistical Manual of Mental Health Conditions (DSM), though it was previously announced last fall. The basic definition of prolonged grief, according to the APA, is when someone experiences “intense longings for the deceased” that last longer and are more disruptive to a person’s daily functioning than typical grief. Specifically, prolonged grief should only be diagnosed in children if they’re still experiencing these feelings at least six months after a death or loss, and at least a year after for adults.


Some mental health professionals have been calling for the disorder to be added to the DSM for more than a decade. Their research has argued that a small percentage of people—perhaps under 5% of the population—experience feelings of grief that are profoundly different, longer-lasting, and much more harmful from the “normal” mourning we feel after the death of a loved one. What’s more, they add, this grief can be reliably distinguished through screening tools from other conditions that could arise or be triggered by loss, such as depression or post-traumatic stress disorder.

“So, it diverges from normal grief in its duration and intensity as well as in its impact on everyday life,” Maarten Eisma, an assistant professor in clinical psychology at the University of Groningen in the Netherlands who has studied the condition, told Gizmodo in an email.



But for as long as prolonged grief has been held for consideration in the DSM, there have been some professionals aghast at the notion of making it an official condition. Despite assurances from advocates, they fear that the diagnosis will undoubtedly blur the lines of how we talk about and manage grief in unhelpful ways.

“The criteria unfairly target a subset of grieving people to be diagnosed with a mental illness,” Joanne Cacciatore, a trained social worker, researcher, and grief counselor for over 25 years, told Gizmodo in an email. “For example, the criteria states that at one year, you can be diagnosed with PGD if you are intensely yearning for the person who died. What parent would not yearn for a child who died? Intense emotional pain? After such traumatic losses, what person would not feel intense emotional pain one year later?”

Cacciatore’s own research with bereaved parents has suggested that a majority of them can experience the sort of symptoms that could result in a diagnosis of prolonged grief disorder or other psychiatric diagnoses up to four years after their child’s death. And if so many parents can feel this amount of grief that it’s considered not normal, she asks, then “perhaps it is the measures that are flawed, not the grievers.”

There has also been some data to suggest that the inclusion of PGD will further stigmatize those who are visibly having a harder time dealing with their grief than others. Eisma’s research has found that members of the general public reading vignettes were more likely to stigmatize people diagnosed with prolonged grief after a loved one’s death than they were after hearing about someone in a similar scenario who was not diagnosed with the disorder. Another study of his found a higher level of public stigma for PGD patients compared to those mourning the loss of someone to suicide, which has previously been shown to cause stigma in other studies.


“Compared to people with normal grief reactions, people judge people with severe grief more negatively, react with anger, anxiety, and pity towards them, and prefer to keep their distance from them. In as far as the diagnostic label PGD will gradually come to signal such severe grief reactions, we can expect such labeling to elicit stigmatization,” he said. At the same time, he added, “many grief experts regard such stigmatization as a necessary evil.”

There’s long been a tension about the meaning of illness in medicine, with prolonged grief disorder only the latest to spark arguments between practitioners. This debate isn’t simply academic. Insurance companies will rely on the DSM codes, as well as those from the much broader International Classification of Diseases (ICD), to decide whether to cover treatments for someone’s symptoms. So even if the criteria of PGD isn’t perfect or its validation could lead to some unintended consequences, advocates argue that its inclusion will at least allow some people with severe grief to get help that they otherwise wouldn’t have been able to access.


There’s something to be said about that need, according to Sheila Vakharia, a former clinical social worker and currently the deputy director of the Department of Research and Academic Engagement at the Drug Policy Alliance. But she argues that the diagnosis is far from a real structural solution, especially today. She notes that, in a world where thousands of Americans a week continue to die to an ongoing pandemic, how can anyone’s ongoing grief over the losses they’ve experienced be considered abnormal?

“For a diagnosis such as this to be released at this moment, it just feels tone deaf, and it feels decontextualized, both within the broader policy environment and with the fact that we are in a mass disabling and a mass death event—we’re in a global pandemic,” she told Gizmodo by phone. “I think in the midst of a global pandemic, there is a degree of what would be reasonable shock and disbelief that the conditions that allowed our loved ones to pass have been allowed to continue.”


For the foreseeable future, prolonged grief disorder is here to stay. Not only is it now in the DSM, but it was added to the ICD in 2018. There are already some dedicated existing treatments, like grief-focused therapy, available to those newly diagnosed with it, while Eisma is involved with several randomized clinical trials testing online forms of cognitive behavioral therapy. Elsewhere, researchers plan to test whether naltrexone, a drug used to treat alcohol and opioid dependence, could help those with prolonged grief—the theory being that severe grief may work along the same neural pathways as addiction.

Though Vakharia may have issues with PGD, she at least hopes it can shine a light on the greater forces that animate our collective grief, like the pandemic or the still worsening overdose crisis, as well as how we’re allowed to express it.


“If we’re gonna make protracted grief disorder a diagnosis, for instance, are there human resources policies and employment policies and school-based policies that we need to have, so people can have the space to even grieve during that window of time when it immediately happens? Because if we don’t give people enough space to experience the grief in the moment of the loss, then it never really goes away, and it compounds,” she said. “I think another issue is that we’ve all been told to keep moving. In terms of covid, in terms of the overdose crisis, there hasn’t been a lot of space for people to process and feel grief. Instead, there’s been so many calls for us to go back to normal, for us to go back to work, for us to not let so-called fear take over.”

For her part, Cacciatore argues that we shouldn’t have to settle for the best of an imperfect system and for imperfect diagnoses like prolonged grief disorder.


“The system is absolutely broken, and we need an ethical change. Psychological care should not be predicated solely on a diagnosis,” she said. And these reforms shouldn’t just extend to psychology but to our world in general, she added, in order to address the underlying factors that can lead to severe grief, like a lack of social support.

“We need better grief support education in our culture. We need more facilitators and facilities to care for people who are grieving—really care and support, without judgment or coercion—and we need an overhaul of the insurance payment system,” Cacciatore said.


What is the criticism of prolonged grief disorder? ›

However, there are many critics of the move. They believe everyone grieves differently and categorizing some experiences as a “disorder” only goes to pathologize what is a normal, common human emotion that probably everyone experiences in their lifetimes.

Should prolonged grief be considered a mental illness? ›

In the case of prolonged grief disorder, the duration of the person's bereavement exceeds expected social, cultural or religious norms and the symptoms are not better explained by another mental disorder. Prolonged grief disorder is the newest disorder to be added to the DSM.

How does prolonged grief disorder differ from other psychological disorders or human conditions? ›

In depression, the patient will experience a generally lowered interest in or ability to enjoy everyday activities, while prolonged grief will involve a persistent preoccupation with the deceased, often accompanied by positive emotions or an intense longing.

Why was prolonged grief disorder added to DSM? ›

The inclusion of the diagnostic criteria for prolonged grief disorder in DSM-5-TR allows clinicians to use a common standard to differentiate between normal grief and this persistent, enduring, and disabling grief.

What is complicated or prolonged grief disorder that interferes with everyday functioning? ›

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.

What is the most common treatment for prolonged grief? ›

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? ›

For example, major depression, post-traumatic stress disorder and sleep disorders often occur and need treatment.

What is the DSM criteria for prolonged grief? ›

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 ...

How is prolonged grief disorder treated? ›

There is help for people with prolonged grief disorder.

Prolonged Grief Disorder Therapy (PGDT) can make a big difference in their life. PGDT (previously called complicated grief therapy: CGT) was the first proven efficacious treatment for this condition and remains the approach most extensively tested.

What two factors increase the risk of experiencing prolonged grief disorder? ›

Estimates are that between 10 and 20 percent of those who lose a loved one will experience an extended period of complicated bereavement. The risk factors for developing the disorder include: Experiencing more than one death within a short period of time. Being highly dependent on the individual who passed away.

What is the best description of prolonged grief disorder? ›

The ICD-11 describes prolonged grief disorder as persistent and pervasive longing for, or preoccupation with, the deceased that lasts at least six months after loss.

Which emotions are most common to an individual who is experiencing prolonged grief? ›

Since the death, the development of a persistent grief response characterized by one or both of the following symptoms, which have been present most days to a clinically significant degree: intense yearning/longing for the deceased person, and preoccupation with thoughts or memories of the deceased person (in children ...

Can you get disability for prolonged grief disorder? ›

A diagnosis alone of Prolonged Grief Disorder will not automatically qualify someone for Social Security Disability. Instead, it will depend on the severity of the symptoms.

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

As many as 20% of the grieving population experiences that their grieving difficulties persist and even grow, rather than diminish, over time (Kersting, Brahler, Glaesner, & Wagner, 2011). Often these individuals suffer from Prolonged Grief Disorder (PGD) also known as Complicated Grief.

Is there a new diagnosis called prolonged grief disorder in the DSM-5? ›

'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 are the criticisms of grief and loss theory? ›

Many of the criticisms can be boiled down into 4 major categories: Misrepresenting the grieving process, negative consequences to bereaved people, lack of depth, and lack of evidence.

What is prolonged grief disorder also known as? ›

Prolonged grief disorder (PGD), or complicated grief, can happen after a person close to you has died within at least 6 months (12 months for children and teens).

What is the incidence of prolonged grief disorder? ›

Background Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population.

Is prolonged grief disorder the same as complex grief? ›

“Prolonged grief disorder” and “persistent complex bereavement disorder”, but not “complicated grief”, are one and the same diagnostic entity: an analysis of data from the Yale Bereavement Study.

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