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Grief

Grief is a normal emotional response to loss. Prolonged grief, a mourning period that you cannot shake, is a signal that you may need some help.

Key points

  • Grief is normal after losing a loved one.
  • Each of us grieves differently.
  • Prolonged Grief Disorder describes an inability to get life back on track after a mourning period.
  • Recognize when you need help to manage grief.

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Overview

Grief is a normal human emotion to a significant loss. Mourning is the process of feeling or expressing grief. Some expressions of grief — such as low energy — are similar to the symptoms of depression. When grief is very intense and lasts for an extended period it may meet the criteria for Prolonged Grief Disorder.

Grief typically involves apathy and dejection, loss of interest in the outside world, and diminution in activity and initiative. These reactions are similar to depression but are less persistent and are not considered pathological.

Adapted from the APA Dictionary of Psychology

Prolonged Grief Disorder (PGD)

After losing a loved one, the intensity of painful feelings and thoughts tends to diminish after six months (twelve months for children and teens). If the feelings and thoughts remain intense after this period and are hard to control, you may be experiencing PGD. Prolonged grief interferes with your ability to function in your daily life.

Some researchers prefer the term complicated grief to prolonged grief.

Woman looking out window reflecting during mental health therapy journey

Researchers estimate that 7%-10% of bereaved adults will experience prolonged grief disorder. 5-10% of children who have lost a loved one will experience depression, PTSD, or prolonged grief disorder.

Symptoms of Prolonged Grief Disorder

According to the American Psychiatric Association, the conditions for prolonged grief are met when at least three symptoms are experienced nearly every day for at least the last month after at least six months have elapsed (for children or teens) or twelve months for adults.

  1. Feeling as though part of oneself has died.
  2. Difficulty believing that the death actually occurred.
  3. Avoiding reminders that the individual is deceased.
  4. Death-related intense emotional suffering (such as rage, resentment, and grief).
  5. Difficulty engaging with friends, pursuing hobbies, or planning ahead.
  6. Feeling numb emotionally. 
  7. Feeling that life has no purpose or value.
  8. Loneliness (feeling detached from other people).

Risk factors for prolonged grief

Risk factors for PGD include:

  • Having been a primary caregiver for the person who died, especially for the spouse or partner of the deceased.
  • When death occurred suddenly, unexpectedly, or under traumatic circumstances.
  • Advanced age.
  • Prior history of depression or bipolar disorder.

Treatment for prolonged grief

Research has shown that treatments using elements of cognitive-behavioral therapy (CBT) can be effective in reducing the symptoms of prolonged grief.

Complicated grief treatment works toward accepting the reality of the loss and toward realizing a sense of satisfaction. Complicated grief treatment incorporated elements of cognitive-behavioral therapy and other approaches.

EMDR (Eye Movement Desensitization and Reprocessing) is an evidence-based therapy with a growing body of research supporting its use for prolonged grief. Rather than relying on conversation alone, EMDR helps you process the memories, emotional pain, and beliefs that can keep you feeling stuck in your grief. In grief therapy, EMDR may focus on the moment of the loss, distressing memories that replay in your mind, or the challenges of adjusting to life without the person you lost. As these experiences are processed, many people find they can remember their loved one with less overwhelming emotional pain while continuing to honor their connection. Learn more about EMDR therapy.

Brainspotting is a body-based therapy that helps access and process deeply held emotional experiences related to grief and loss. Using specific eye positions, Brainspotting can help you connect with emotions that may feel difficult to reach through conversation alone. For grief that has become prolonged or feels stuck, this approach offers a gentle way to process the emotional pain your mind and body have been carrying, making it easier to move forward while still holding onto the love and meaning of your relationship.

CBT can help address symptoms such as insomnia that occur along with prolonged grief disorder.

Bereavement support groups can help avoid social isolation that could increase the risk for prolonged grief disorder. A support group can provide social connection and support. 

Are the “five stages of grief” accurate for all mourners?

The five stages of the grief model advanced by Swiss-American psychiatrist Elisabeth Kübler-Ross in her 1969 book On Death and Dying have been much criticized. While the criticism is certainly valid in that not all people experience all the stages, the model can be valuable to you in understanding where you may be stuck.

  1. Denial: refusing to accept that the person’s actually gone
  2. Anger: It’s not fair that this happened
  3. Bargaining: Let this somehow not be true and I promise to____
  4. Depression:  Low motivation, hopelessness
  5. Acceptance: Coming to terms with the loss

Working through your feelings can build increased resilience and healing. Recognizing the emotions that you feel can keep you from getting stuck.

Disenfranchised grief or hidden grief

Disenfranchised grief or hidden grief is a type of grief that society may not allow or may discourage a person from expressing. Examples of disenfranchised grief can include grief for stillborn babies, of doctors or nurses for the death of patients, or of people who have lost an animal companion. Disenfranchised grief can be isolating and the isolation can impede recovery.

Allow yourself to grieve: 7 tips

Give yourself permission to mourn.

  1. Experiencing loss undermines our sense of stability. We are not permanent! Grieving helps you adjust to a new reality.
  2.  You’re on an emotional rollercoaster. It’s okay. 
  3. There is no set timeline for grief. Be patient with yourself. 
  4. Take care of your health. Get enough sleep. Eat well. Stay hydrated.
  5. Leverage your social support network. Reach out to friends and relatives. They are likely to want to share memories.
  6. Consider joining a support group. People who are in mourning can provide the support that your friends may not be able to offer.
  7. Consider reaching out for professional help, especially if you feel that your grief is prolonged or if you need extra support.

Related information

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing. https://www.psychiatry.org/psychiatrists/practice/dsm

Boelen, P. A., Lenferink, L., & Spuij, M. (2021). CBT for Prolonged Grief in Children and Adolescents: A Randomized Clinical Trial. The American journal of psychiatry, 178(4), 294–304. https://doi.org/10.1176/appi.ajp.2020.20050548

Craig, D. J. (2021, June 20). When Grief Won’t End. Columbia Magazine. Retrieved April 11, 2023, from https://magazine.columbia.edu/article/when-grief-wont-end

Coping With Grief. National Institutes of Health. Retrieved April 11, 2023, from https://newsinhealth.nih.gov/2017/10/coping-grief

Lichtenthal, W. G., Nilsson, M., Kissane, D. W., Breitbart, W., Kacel, E., Jones, E. C., & Prigerson, H. G. (2011). Underutilization of mental health services among bereaved caregivers with prolonged grief disorder. Psychiatric services (Washington, D.C.), 62(10), 1225–1229. https://doi.org/10.1176/ps.62.10.pss6210_1225

Melhem, N. M., Porta, G., Walker Payne, M., & Brent, D. A. (2013). Identifying prolonged grief reactions in children: dimensional and diagnostic approaches. Journal of the American Academy of Child and Adolescent Psychiatry, 52(6), 599–607.e7. https://doi.org/10.1016/j.jaac.2013.02.015

Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. Focus (American Psychiatric Publishing), 19(2), 161–172. https://doi.org/10.1176/appi.focus.20200052

The Columbia Center for Prolonged Grief. Columbia University. Retrieved April 11, 2023, from https://prolongedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/

Get support for grief that feels too heavy to carry alone

If grief has left you feeling isolated, numb, or unable to get life back on track, Triple R Counseling & Consulting offers compassionate grief counseling for adults coping with loss and prolonged grief.

Reach out today to begin grief therapy that helps you process painful emotions, reduce isolation, and take gentle steps toward healing.