Prolonged grief: when grief doesn’t ease

For most people, the pain of a loss softens with time even though it never fully goes away. For some, it stays as sharp a year later as it was in the first weeks, and life doesn’t start moving again. In 2022 psychiatrists recognized this as a condition of its own, prolonged grief disorder, and it can be treated. This note explains the signs and what to do.

Ordinary grief and prolonged grief

Prolonged grief isn’t a different kind of grief. The difference is how much distress and disruption it causes, and how long it lasts.¹ Most people adapt to a loss within six months to two years.¹ When grief stays intense and keeps someone from living their life well beyond that, it may be prolonged grief.

The signs doctors look for

Psychiatry’s diagnostic manual added prolonged grief disorder in 2022. For adults, it applies at least 12 months after the death of someone close.² The central sign is an intense longing for the person who died, or thoughts of them that take over, nearly every day for at least the past month.²

Alongside that, a person with prolonged grief has at least three of these: feeling that part of themselves died; disbelief that the death happened; avoiding reminders that the person is gone; intense emotional pain; trouble getting back to relationships and activities; numbness; feeling that life has no meaning; and intense loneliness.² The grief also has to be causing real problems in daily life, and to go beyond what the person’s culture or faith would expect.²

Only a clinician can make the diagnosis. If several of these sound familiar a year or more after a death, it’s worth a conversation.

Children and teenagers

Children’s grief comes and goes, and it can be harder to read. The older criteria for children used a shorter time frame of six months.¹ If a child’s grief seems stuck, or their schooling and friendships are falling apart, talk to their doctor.

Treatment helps

Prolonged grief responds to treatment. Grief-focused therapy, a form of cognitive behavioral therapy that helps people face the loss and the reminders they’ve been avoiding, has been tested in randomized trials and helps many people.¹ When depression is part of the picture, combining an antidepressant with grief-focused therapy has done best in studies.¹

Treatment doesn’t ask anyone to stop loving or remembering the person. The aim is to let grief settle into a form a person can live with.

How to start

Talk to your doctor, and say plainly that your grief hasn’t eased since the death. Ask for a referral to someone who treats grief. If your loved one was on hospice, call the hospice’s bereavement team: they can connect you to grief counselors and groups, and at HealthView we stay in touch with families for thirteen months.

If you have thoughts of ending your life, or of wanting to die to be with the person you lost, call or text 988 at any hour.³