Prolonged Grief Disorder

Lisa Young, Paul Nestadt, M.D.
Prolonged Grief Disorder is a topic covered in the Johns Hopkins Psychiatry Guide.

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DEFINITION

  • Newly introduced formal diagnosis in ICD-11 in 2018 and DSM-5-TR in 2022
  • Prolonged grief disorder (PGD) is a persistent, incapacitating form of complicated grief.
    • Early diagnosis is essential; however, the duration threshold varies as PGD must last at least 12 months after loss based on the DSM-5-TR but only 6 months based on the ICD-11.
  • People with PGD often experience life-altering effects, including:
    • Persistent yearning/longing for the deceased
    • Intense emotional pain (such as sadness, guilt, and anger)
    • Preoccupation with the deceased
    • Preoccupation with the circumstances of the death
    • Inability to experience a positive mood and difficulty engaging in social or regular activities
  • PGD is distinct from bereavement-related depression or anxiety and grief due to symptoms’ intensity and frequency (e.g., most of the day, nearly every day for months).
    • Most bereaved individuals eventually cope effectively with loss and do not experience adverse bereavement-related health effects in the long term.
      • A period of acute grief that peaks in the 6 months after the death, followed by integrated grief (acceptance and adaption to the loss), is common.[1]
      • However, a significant minority experiences intense, chronic, and disabling grief lasting several months or years.
    • Importantly, grief is a normal reaction/process to irrevocable loss, including the death of a loved one.[2]
      • Grief is multidimensional, with physical, behavioral, and meaning/spiritual components, and is characterized by a complex set of cognitive, emotional, and social adjustments that follow the loss.
      • The intensity of grief, its duration, and its expression are often intertwined with cultural and societal norms or expectations. Common elements include distress, anxiety, yearning, sadness, and preoccupation.
  • Intense, prolonged grief is a severe threat to the survivor’s ability to function in everyday life and may lead to:
    • Clinically significant distress and impairment in work and social functioning
    • Sleep disturbance
    • Disruption in daily activities
    • Suicidal thinking, and behavior
    • Impairment in relationship functioning
    • Increased use of tobacco, alcohol, or other substances

-- To view the remaining sections of this topic, please or --

DEFINITION

  • Newly introduced formal diagnosis in ICD-11 in 2018 and DSM-5-TR in 2022
  • Prolonged grief disorder (PGD) is a persistent, incapacitating form of complicated grief.
    • Early diagnosis is essential; however, the duration threshold varies as PGD must last at least 12 months after loss based on the DSM-5-TR but only 6 months based on the ICD-11.
  • People with PGD often experience life-altering effects, including:
    • Persistent yearning/longing for the deceased
    • Intense emotional pain (such as sadness, guilt, and anger)
    • Preoccupation with the deceased
    • Preoccupation with the circumstances of the death
    • Inability to experience a positive mood and difficulty engaging in social or regular activities
  • PGD is distinct from bereavement-related depression or anxiety and grief due to symptoms’ intensity and frequency (e.g., most of the day, nearly every day for months).
    • Most bereaved individuals eventually cope effectively with loss and do not experience adverse bereavement-related health effects in the long term.
      • A period of acute grief that peaks in the 6 months after the death, followed by integrated grief (acceptance and adaption to the loss), is common.[1]
      • However, a significant minority experiences intense, chronic, and disabling grief lasting several months or years.
    • Importantly, grief is a normal reaction/process to irrevocable loss, including the death of a loved one.[2]
      • Grief is multidimensional, with physical, behavioral, and meaning/spiritual components, and is characterized by a complex set of cognitive, emotional, and social adjustments that follow the loss.
      • The intensity of grief, its duration, and its expression are often intertwined with cultural and societal norms or expectations. Common elements include distress, anxiety, yearning, sadness, and preoccupation.
  • Intense, prolonged grief is a severe threat to the survivor’s ability to function in everyday life and may lead to:
    • Clinically significant distress and impairment in work and social functioning
    • Sleep disturbance
    • Disruption in daily activities
    • Suicidal thinking, and behavior
    • Impairment in relationship functioning
    • Increased use of tobacco, alcohol, or other substances

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Last updated: August 1, 2022