What Makes Grief “Prolonged”?

In March 2022, the American Psychiatric Association added Prolonged Grief Disorder (PGD) to the DSM-5-TR—the diagnostic manual mental health clinicians use to identify and treat mental health conditions. It was a significant recognition that for some people, grief can become clinically impairing in ways that go beyond ordinary bereavement.

The core diagnostic criteria center on two main experiences: an intense, persistent yearning or longing for the person who died, and a preoccupation with thoughts or memories of them. These feelings need to be present most of the day, nearly every day, for at least 12 months after the loss in adults (six months for children and adolescents). Alongside that, the person experiences significant disruption in daily life—difficulty working, socializing, or imagining a meaningful future.

One important distinction: PGD is not diagnosed based on how deeply someone loved the person who died. The depth of grief is not the issue. PGD is about whether grief has become so impairing that it’s preventing someone from rebuilding their life.

Signs You Might Be Experiencing Prolonged Grief Disorder

PGD looks different from person to person, but researchers and clinicians have identified a recognizable cluster of symptoms that tend to appear alongside that persistent yearning for the person who was lost:

Identity disruption—a feeling that part of yourself died with the person you lost, and you no longer know who you are without them

Difficulty reintegrating into life—pulling back from friendships, hobbies, work, or any planning for the future

Emotional numbness—a flat, disconnected quality to daily experience, even during moments that should feel meaningful or joyful

Intense loneliness—feeling profoundly alone or cut off from others even when surrounded by people who care about you

Disbelief about the reality of the death—a sense that it can’t really be true, even long after the loss

Bitterness or anger about the death that doesn’t soften over time

A pervasive sense that life has no meaning or purpose without the person who died

These symptoms are not signs of weakness, insufficient resilience, or failure to “move on.” They often reflect that the psychological work of integrating a major loss has become stuck—and that additional support can make a real difference.

Who Is at Higher Risk—and Why It Matters

While PGD can follow any significant loss, research consistently shows that certain circumstances carry elevated risk. People who have lost a child or a spouse/partner are among the most vulnerable. So are those whose loved one died suddenly, violently, or unexpectedly—including accident, suicide, homicide, or medical crisis with little warning. Some studies have found PGD rates as high as 49% among those bereaved by non-natural causes.

Other risk factors include a prior history of depression or anxiety, a very close emotional dependence on the deceased, and losses where the circumstances prevented any opportunity for goodbye. The COVID-19 pandemic prompted significant research in this area, with many bereaved families navigating deaths that were sudden, isolated, and stripped of normal mourning rituals—all of which compound grief’s complexity.

For first responders and others who work in fields with repeated exposure to death and loss—law enforcement, fire, EMS, emergency medicine—the picture can be even more layered. Cumulative exposure to loss, combined with a professional culture that often discourages help-seeking, can leave grief unprocessed for years before it surfaces as something that clearly needs attention.

Here in Longmont and across Northern Colorado, we see these patterns regularly. Geographic and occupational context matters when it comes to grief—and so does having access to a therapist who understands it.

What Treatment for Prolonged Grief Disorder Looks Like

The most well-researched treatment for PGD is Complicated Grief Therapy (CGT)—a structured, 16-session approach developed by researchers at Columbia University. CGT draws on attachment theory, cognitive-behavioral techniques, and grief-specific interventions, working along two parallel tracks simultaneously: helping clients accept the reality of the loss, and helping them reengage with a life that still has meaning.

Randomized controlled trials have shown CGT to be more effective than standard supportive counseling for PGD, including reductions in grief symptoms, depression, and suicidal ideation. Broader CBT-based approaches have also demonstrated strong outcomes, and newer research is exploring online and written expression interventions as accessible adjuncts.

What treatment does not do is erase grief. The goal is not to stop missing the person you lost—that’s not possible, and it’s not the point. The goal is to help you carry that grief in a way that doesn’t prevent you from living. There’s a meaningful difference between grief that is present and grief that is paralyzing.

Current evidence does not support any specific medications for PGD itself, though medication may be appropriate for co-occurring depression or anxiety that develops alongside it. A thorough clinical assessment can help clarify what’s going on and what combination of supports makes the most sense.

Ready to talk to someone?

If you’re in Longmont or the Northern Colorado area and what you’ve read here sounds familiar—whether your grief is recent or years old—reaching out is a meaningful step. At Valor Counseling & Holistic Services, we work with clients navigating grief, trauma, and loss, including those whose grief has felt stuck far longer than they expected. You don’t have to wait until things feel unbearable to ask for support.

Contact Valor Counseling in Longmont, CO to schedule a free consultation.

References

American Psychiatric Association. (2022). Prolonged grief disorder. Psychiatry.org.

American Psychiatric Association. (2022). APA offers tips for understanding prolonged grief disorder. Psychiatry.org.

Prigerson, H.G., et al. (2021). Prolonged grief disorder: Course, diagnosis, assessment, and treatment. PMC/NCBI.

Lundorff, M., et al. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders.

Shear, M.K., et al. (2014). Prolonged grief disorder: Diagnostic, assessment, and treatment considerations. APA Journals.

University of Michigan School of Public Health. (2023). A public health perspective on prolonged grief disorder. Pursuit.