When Grief Becomes Complicated: Understanding Prolonged Grief Disorder

12 September 2025

Grief is one of those things we all wish we could skip. It’s messy, painful, and incredibly personal. Losing someone you love flips your world upside down, and even though time is said to heal, sometimes, that healing feels like it never happens.

If you've ever watched someone struggle to pick up the pieces after a loss—or maybe you've felt that unbearable weight yourself—you might wonder: “Is this still normal?” That’s exactly where the idea of Prolonged Grief Disorder (PGD) comes in.

Let’s peel back the layers of grief and talk honestly about when grief doesn’t ease with time and instead lingers like a storm cloud that just won’t move on.

What Is Grief, Really?

Before diving into when grief becomes “complicated,” it helps to first understand what healthy, typical grief looks like.

Grief is a normal emotional response to loss. It shows up in all kinds of ways—crying, sadness, anger, numbness, even guilt. There’s no one-size-fits-all path for grieving. Some people feel better after a few months. Others take longer.

But here’s the thing: even though grief is painful, it usually fades with time. You start adjusting. You laugh again. You function. The memory of your loved one doesn’t disappear—of course not—but the raw pain doesn’t punch you in the gut every single day.

What Makes Grief “Complicated”?

Now, imagine that after many months (even over a year), someone still can’t get through the day without being crushed by sorrow. They’re stuck, like grief hit the pause button on their life. Work becomes impossible. Relationships start to drift. The future feels pointless.

That’s not just grief anymore. That’s Prolonged Grief Disorder (PGD).

We’re talking about grief that lasts beyond the expected time frame, interferes with daily life, and doesn’t show signs of easing up. It’s like being emotionally frozen in your moment of loss.

Prolonged Grief Disorder: The Basics

Prolonged Grief Disorder is now officially recognized in mental health diagnostic manuals like the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision). That’s a big deal because it means the psychological community sees this as more than just “being sad for a long time.”

Here’s how the American Psychiatric Association defines it:

- The individual experiences intense yearning or longing for the deceased.
- Symptoms must last more than 12 months for adults (6 months for children/adolescents).
- The grief must significantly interfere with social, occupational, or other important areas of functioning.
- The reaction is out of proportion to or inconsistent with cultural, religious, or age-appropriate norms.

So, it’s grief on overdrive. Grief that gets stuck and becomes a debilitating part of someone’s life.

Signs You Might Be Dealing with PGD

How do you tell if someone is just grieving deeply—or if something more serious might be going on?

Here are some common signs of Prolonged Grief Disorder:

- Persistent, intense sorrow and emotional pain about the loss
- Feeling numb or empty much of the time
- Difficulty moving on or re-engaging with life
- Avoidance of reminders of the deceased (or, in contrast, clinging to them in an unhealthy way)
- Extreme loneliness or detachment from others
- Bitterness about the loss
- Feeling that life has no meaning without the deceased
- Suicidal thoughts related to wanting to reunite with the loved one

It’s not about ticking all the boxes—but if you or someone you know is stuck in this pattern for a prolonged period, it’s worth paying attention to.

Why Some People Get Stuck in Grief

You might wonder: why do some people develop PGD while others, even after similar losses, don’t?

Well, grief isn’t just about what happened—it’s also about the person who’s grieving. Here are some risk factors:

1. The Nature of the Loss

Losses that are sudden, violent, or traumatic (like a car accident or suicide) increase the risk. Deaths involving children or very close loved ones also hit harder.

2. Personal History

People with past mental health issues, unresolved trauma, or a history of depression or anxiety may struggle more with grief.

3. Lack of Support

Having a strong circle of support is protective. When someone feels isolated or doesn’t have anyone to lean on, grief can fester.

4. Cultural Factors

Some cultures have clear mourning rituals and timelines for grief. Others don’t talk about it at all. If someone feels like they can't express or process their grief openly, it can become internalized and toxic.

The Weight of Unprocessed Grief

Think of grief like laundry. If you don’t deal with it, it just keeps piling up—and eventually, you’re buried under a mountain of socks and sadness. PGD affects more than just emotions. It can impact your physical health, immune system, sleep, appetite, and even memory and focus.

Left untreated, prolonged grief can increase susceptibility to major depression, anxiety disorders, substance use, and even suicidal ideation. That’s serious stuff.

How PGD Differs from Depression

Here's where things can get tricky.

Prolonged Grief Disorder and Major Depression often look similar because both involve deep sadness, lack of interest in life, and trouble functioning. But there are differences.

- In depression, the sadness is more generalized—you might feel worthless, hopeless, and nothing brings joy.
- In PGD, the sadness is laser-focused on the loss. People might still find joy in other areas—if they weren’t so preoccupied by the absence of the person they lost.

That nuance matters when it comes to treatment. Getting the diagnosis right means choosing the right approach.

Treatment Options: Hope Through Help

Thankfully, PGD is treatable. No one has to live in emotional limbo forever. Here are the main treatment paths:

1. Grief-Focused Therapy

This is often the first choice. Therapies like Complicated Grief Therapy (CGT) are specifically designed to help people process delayed or dysfunctional grief. It combines elements of cognitive behavioral therapy (CBT), exposure therapy, and techniques to rebuild meaning and connection.

2. Cognitive Behavioral Therapy (CBT)

CBT helps by identifying and challenging unhelpful thoughts (“I shouldn’t laugh anymore,” “It’s my fault they’re gone.”) and gradually encourages behavior that promotes healing.

3. Medication (in Some Cases)

While there’s no “grief pill,” antidepressants may help manage accompanying depression or anxiety, especially if therapy alone isn’t effective.

4. Support Groups

Talking to others who understand that kind of pain can be healing in itself. Many communities and online platforms offer grief-specific groups that provide validation, comfort, and hope.

How to Support Someone with Prolonged Grief

Not everyone who’s struggling wants help—but that doesn’t mean they don’t need it. If someone you care about seems stuck in an endless loop of grief:

- Be patient—avoid saying, “You should be over it by now.”
- Offer support, not solutions—just being there counts.
- Encourage professional help, especially if their grief is interfering with everyday life.
- Watch for red flags—like talk of giving up, or extreme isolation.

And if you’re the one in the thick of it? Please know this: you’re not broken. This isn’t your fault. Grief isn’t a race, but if you're in the same emotional spot a year later, it's okay to get help. Healing doesn’t mean forgetting—it means learning to live again, even with the loss.

Moving Forward: Healing is Possible

Grief isn’t something we conquer. It’s something we learn to carry.

But when grief becomes complicated—when it sticks around too long, too deeply—it doesn’t mean you’re weak or wrong. It just means your heart is still trying to make sense of a world that’s missing someone you love.

Prolonged Grief Disorder doesn’t have to define your life story. With the right support, understanding, and care, even the deepest wounds can soften. Not disappear entirely, no. But enough that you can breathe again. Laugh again. Love again.

And isn’t that what your loved one would want for you?

Final Thoughts

If anything in this article made you pause and think, “That sounds like me,” or “That sounds like someone I care about," take it as a gentle nudge. You’re not alone, and help exists. Prolonged Grief Disorder is real, but so is the possibility of healing.

Let’s keep the conversation going—because the more we talk about grief, the less power it has to isolate us.