Prolonged Grief Disorder: When Grief Refuses to Let Go

Prolonged Grief Disorder (PGD) is a clinical condition where intense yearning for someone you lost and preoccupation with their death lasts more than 12 months and seriously disrupts daily life. It was added to the DSM-5-TR — the manual mental health clinicians use to diagnose conditions — in 2022. About 7 to 10 percent of bereaved adults develop PGD, with higher rates after sudden, traumatic, or untimely loss. Evidence-based treatments work, and seeking help is not a sign of weakness.

If you lost someone you loved and the grief has not eased — if it has, in fact, taken over your life — you are not alone, and you are not "taking too long." You may be experiencing a recognized medical condition with treatments designed specifically for it. This guide will help you understand what Prolonged Grief Disorder is, how it differs from typical grief, and what your next step can look like.

What is Prolonged Grief Disorder?#

Prolonged Grief Disorder (PGD) is a distinct mental health condition where the natural process of bereavement gets stuck. Unlike typical grief, which gradually softens over months and years, PGD is characterized by persistent, intense yearning for the deceased and a preoccupation with the death — lasting at least 12 months in adults (6 months in children) and significantly impairing your ability to work, maintain relationships, or care for yourself.

The condition was officially added to the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Text Revision) in March 2022, recognizing what hospice workers, grief counselors, and bereaved families had long known: some grief does not move on its own (American Psychiatric Association, 2022).

Research from the National Institute of Mental Health suggests that approximately 7 to 10 percent of bereaved adults develop PGD, with elevated rates following sudden death, suicide loss, the loss of a child, or pandemic-related losses (Prigerson et al., NIH, 2021).

Prolonged Grief Disorder is not weakness. It is not failure to "move on." It is your nervous system, attachment system, and meaning-making system caught in a loop they cannot exit alone.

Prefer to listen? This article is also a podcast episode on the MentalSpace Therapy podcast. Subscribe on Apple Podcasts, Spotify, or your favorite platform.

How Prolonged Grief Disorder Differs From "Normal" Grief#

Typical grief is painful, but it tends to move. The waves come less often and less violently over months. You start to find moments of relief, then days, then most days. The person you lost remains profoundly important to you, but you can re-engage with life, work, relationships, and even joy.

Prolonged Grief Disorder is different in three important ways:

• Duration: symptoms persist more than 12 months (6 months in children) without significant easing.
• Intensity: yearning and preoccupation remain as raw as they were in the first weeks.
• Impairment: it actively prevents you from working, parenting, maintaining relationships, or caring for your basic needs.

The clinical criteria require at least 3 of the following symptoms alongside the persistent yearning and preoccupation:

1. Identity disruption — feeling like "part of me died" or no longer knowing who you are.
2. Disbelief about the death, even months or years later.
3. Avoidance of reminders of the loss — places, people, photos, music.
4. Intense emotional pain (sorrow, anger, bitterness) connected to the loss.
5. Difficulty reintegrating into relationships, work, or activities.
6. Emotional numbness — inability to feel the full range of emotions.
7. Sense that life is meaningless without the person who died.
8. Intense loneliness, as if you are alone in a way no one else can understand.

If you recognize yourself in this list — and the loss happened more than a year ago — a qualified clinician can help you sort out whether you are experiencing PGD, depression, traumatic grief, or some combination.

Why Some People Develop Prolonged Grief Disorder#

No one chooses to get stuck in grief, and developing PGD does not mean you loved "too much" or grieved "wrong." Research has identified several factors that increase the risk:

• Sudden or violent loss — accidents, homicide, suicide, sudden cardiac events.
• Loss of a child at any age.
• A traumatic or contentious dying process — including prolonged ICU stays, contested end-of-life decisions, or being unable to be present at death.
• Strong attachment bond combined with limited social support.
• Pre-existing depression, anxiety, or PTSD.
• Multiple losses in a short period — common during the COVID-19 pandemic.
• Suicide loss, which carries unique complexities of stigma, guilt, and unanswered questions.

In many cases, the cause is not one factor but a combination. The Centers for Disease Control reports that grief became a major mental health concern in the years following the pandemic, with elevated PGD rates among adults who lost multiple loved ones or could not attend funerals due to public health restrictions (CDC, 2022).

Understanding why does not undo the pain, but it does push back on the cruelest myth — that prolonged grief means you are doing something wrong.

Quick answer: People develop Prolonged Grief Disorder when the natural grieving process gets interrupted or overloaded — by trauma, sudden loss, multiple losses, isolation, or pre-existing vulnerability. It is a condition, not a character flaw.

We dove deeper into this on our YouTube channel. Watch the full episode — about 10-15 minutes — for the discussion, examples, and Q&A that didn't fit in this article.

Evidence-Based Treatments That Work#

Prolonged Grief Disorder is treatable. The treatments with the strongest research support are different from general talk therapy and different from depression treatment — they were designed specifically for stuck grief.

Prolonged Grief Disorder Therapy (PGDT)

PGDT is a structured, time-limited therapy (typically 16 sessions) developed in conjunction with the DSM-5-TR recognition of PGD. It combines elements of cognitive behavioral therapy, motivational interviewing, and grief-focused techniques. The protocol helps clients gradually re-engage with reminders of the loss, restructure unhelpful thoughts (especially guilt or blame), and rebuild a life that honors — rather than is paralyzed by — the person they lost.

Complicated Grief Treatment (CGT)

Developed by Dr. Katherine Shear at Columbia University, Complicated Grief Treatment is a 16-session manualized protocol with extensive research support. Randomized controlled trials show CGT outperforms standard interpersonal therapy for prolonged grief, with sustained benefits at 6-month follow-up (NIH PubMed, Shear et al., 2016).

Grief-Focused Cognitive Behavioral Therapy

A modified version of CBT specifically targets the patterns of avoidance, rumination, and "if only" thinking that keep grief stuck. It uses gradual exposure to grief triggers alongside cognitive restructuring of unhelpful beliefs about the death or the deceased.

What Does Not Help (At Least Not Alone)

Many people with PGD spend years in general supportive talk therapy that is genuinely caring but does not move the needle. PGD requires targeted intervention. Antidepressants can help when there is co-occurring depression but do not, by themselves, treat PGD (NIMH, 2023).

What Working With a CHC Therapist Looks Like for Prolonged Grief#

At Coping & Healing Counseling, our grief-focused clinicians offer evidence-based PGD treatment via telehealth to clients across all 159 Georgia counties. A typical course of care includes:

• Initial evaluation (1 session) — confirm PGD vs. major depression, traumatic grief, or normal bereavement using validated screening instruments like the PG-13-R.
• Stabilization and education (2–3 sessions) — understand what PGD is, identify your triggers and avoidance patterns, build a coping toolkit.
• Active treatment (10–16 sessions) — structured protocol work, gradually engaging with the loss without becoming overwhelmed, restructuring guilt or blame, rebuilding a sense of meaning.
• Integration (2–4 sessions) — practice the gains, build a long-term relapse-prevention plan, plan how to maintain a continuing bond with the person you lost while reclaiming your life.

Most clients begin to feel meaningful change by session 6 to 8. Care is 100 percent telehealth, HIPAA-compliant, and most major insurance plans are accepted (Aetna, Cigna, BCBS, UHC, Humana, and Georgia Medicaid with $0 copay).

What You Can Do This Week#

While professional treatment is the most reliable path, here are evidence-supported steps you can take this week:

1. Name what you are experiencing. Read the PGD criteria above out loud. If you recognize yourself, write down which symptoms apply. Naming reduces the shame.
2. Tell one person — a trusted friend, family member, or your primary care doctor — what you have noticed. Isolation is one of the strongest predictors of prolonged grief.
3. Limit avoidance, gently. Pick one small reminder of your loved one you have been avoiding (a song, a photo, a place) and engage with it for a few minutes, with a self-compassion practice afterward.
4. Re-engage with one valued activity. Choose something small you used to enjoy — a 10-minute walk, a coffee with a friend, a hobby — and do it once this week, even if it feels hollow.
5. Reach out to a grief-trained therapist. Search specifically for therapists trained in PGDT, CGT, or grief-focused CBT.

Frequently Asked Questions#

How long is too long for grief?

There is no "normal" timeline for grief, and most people experience waves for years. The clinical concern arises when intense yearning and impairment persist beyond 12 months and significantly disrupt your daily functioning. Persistent grief past 12 months — especially with identity disruption, intense pain, and difficulty reintegrating into life — warrants evaluation for Prolonged Grief Disorder.

Is Prolonged Grief Disorder the same as depression?

No. PGD and depression overlap and can co-occur, but they are distinct. The hallmark of PGD is yearning and preoccupation with the deceased, while depression centers on pervasive sadness, anhedonia, hopelessness, and worthlessness. About half of people with PGD also meet criteria for major depression, but treating depression alone does not resolve PGD. Both conditions require their own evidence-based interventions.

Can therapy actually help when nothing else has?

Yes, especially specialized grief therapy. Studies of Complicated Grief Treatment show about 70 percent of clients experience meaningful symptom reduction, even those who had not improved with prior treatments. The key is matching the treatment to the condition — general supportive talk therapy often does not move PGD, but PGD-specific protocols do (Shear et al., NIH, 2016).

Does insurance cover grief therapy?

Most insurance plans cover grief therapy when it is delivered by a licensed clinician for a recognized condition. PGD is now a billable DSM-5-TR diagnosis (code 309.89 / ICD-10 F43.81). At CHC, we accept Aetna, Cigna, BCBS, UHC, Humana, and Georgia Medicaid (Medicaid has a $0 copay), and we verify benefits before your first session so there are no surprises.

What if I lost someone to suicide?

Suicide loss carries unique grief features — intense guilt, social stigma, unanswered questions, and an elevated risk of PGD. Specialized suicide bereavement protocols exist, and many CHC clinicians have training in this area. Survivor support groups (such as AFSP's Survivor Outreach Program) can complement individual therapy. You are not alone, and your grief makes sense given what you have been through.

Can I attend telehealth grief therapy from home?

Yes. CHC offers 100 percent telehealth therapy across all 159 Georgia counties, including grief-focused care. Many clients find that working from a safe, familiar space at home reduces the activation that comes with going to an office. Telehealth grief therapy has comparable outcomes to in-person care according to recent meta-analyses (APA, 2022).

When to Seek Professional Help#

If grief from a loss more than 12 months ago is preventing you from working, parenting, maintaining your relationships, or caring for yourself — please reach out. You do not need to wait for a crisis, and you do not need to be at your worst to deserve support.

At Coping & Healing Counseling, our grief-focused clinicians offer evidence-based Prolonged Grief Disorder therapy via secure telehealth across all 159 Georgia counties. We accept most major insurance plans, with $0 copay for Georgia Medicaid. Our culturally competent team includes therapists trained in PGDT, CGT, EMDR, and grief-focused CBT.

Visit our Trauma Therapy and Online Therapy in Georgia service pages, or call (404) 832-0102 to schedule an initial consultation. You can also get started here.

If you are in immediate crisis: call or text 988 (Suicide & Crisis Lifeline), call the Georgia Crisis & Access Line at 1-800-715-4225, or go to your nearest emergency room.

References#

• American Psychiatric Association. (2022). Prolonged Grief Disorder added to DSM-5-TR. https://www.psychiatry.org/News-room/News-Releases/APA-Offers-Tips-for-Understanding-Prolonged-Grief
• National Institute of Mental Health. (2023). Prolonged Grief Disorder. https://www.nimh.nih.gov/health/topics/prolonged-grief-disorder
• Prigerson, H. G., et al. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder. World Psychiatry. https://pubmed.ncbi.nlm.nih.gov/34672405/
• Shear, M. K., et al. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry. https://pubmed.ncbi.nlm.nih.gov/27049270/
• Centers for Disease Control and Prevention. (2022). Mental Health. https://www.cdc.gov/mentalhealth/index.htm
• American Psychological Association. (2022). Virtual therapy is effective. https://www.apa.org/monitor/2022/01/special-virtual-therapy

Reviewed by the CHC Counseling Team. Last updated: May 12, 2026.