Prolonged Grief Disorder: When Grief Needs Treatment

Grief becomes prolonged grief disorder when, at least a year after a death (6 months for children and teens), intense longing or preoccupation with the person is still present nearly every day, along with other symptoms, and it keeps you from functioning at home, at work or with others. Most grief does not need treatment; for most people, symptoms ease over time. When grief stays this intense and disabling, a specific therapy built for it has the strongest evidence, and medication is used mainly for co-occurring depression rather than for grief itself.

You do not need to wait for the one-year mark to get help. Depression, anxiety, sleep problems and thoughts of joining the person who died can all be treated at any point after a loss.

If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Normal grief vs prolonged grief disorder

Grief after the death of someone close is a natural response, and it can come in waves for years, especially around anniversaries and holidays. The American Psychiatric Association (APA) notes that grief symptoms may rise at certain times without needing mental health treatment. What sets prolonged grief disorder apart is not how much you loved the person or how long you miss them, but whether grief is so intense and persistent that it disables daily life in a way typical grieving does not.

The diagnostic criteria

Prolonged grief disorder was added to the text revision of the DSM-5 (DSM-5-TR), released in March 2022, making it the newest diagnosis in the manual. The World Health Organization's ICD-11 also includes it, with a minimum of more than 6 months after the loss. The ICD-11 authors describe that 6-month figure as an approximation rather than a strictly validated cutoff.

Under DSM-5-TR, as summarized by the APA, the hallmark is intense longing for the person who died and/or preoccupation with thoughts of them; in children and adolescents the preoccupation may center on the circumstances of the death. The loss must have occurred at least a year ago for adults or 6 months ago for children and adolescents, and at least 3 of the following symptoms must have been present nearly every day for at least the last month:

1. Identity disruption, such as feeling that part of yourself has died
2. A marked sense of disbelief about the death
3. Avoidance of reminders that the person is dead
4. Intense emotional pain, such as anger, bitterness or sorrow, related to the death
5. Difficulty reintegrating into life, such as engaging with friends, pursuing interests or planning for the future
6. Emotional numbness
7. Feeling that life is meaningless without the person
8. Intense loneliness

The grief must also cause significant distress or impairment and last longer than expected for your social, cultural or religious context. A diagnosis is made by a clinician, not a checklist. Validated questionnaires such as the PG-13-Revised, which was designed to match the DSM-5-TR criteria, can help a clinician measure symptoms over time.

How common it is and who is at higher risk

The APA estimates that 4% to 15% of bereaved adults develop the persistent symptoms of prolonged grief disorder. A 2021 clinical review put it at approximately 10%. Risk is higher in some circumstances, according to the APA's summary of the research:

• A sudden or unnatural death, including violent death
• The death of a child or a spouse or partner
• A death in an intensive care unit rather than at home
• A history of depression or other mental illness, or very high grief before the death
• Very close or emotionally dependent relationships with the person who died
• Lack of social support and trauma exposure

None of these means you will develop the disorder. They are reasons to check in with yourself, or with someone you are worried about, as the months go on.

Grief, depression and PTSD: how they differ

Prolonged grief disorder often coexists with depression, PTSD or anxiety, but research supports treating it as a separate condition. In the study that validated the DSM-5-TR criteria, the diagnosis was distinct from PTSD, major depressive disorder and generalized anxiety disorder, while also being linked to them, to suicidal thoughts, and to worse quality of life and functioning.

This matters because the treatment differs. An antidepressant can help depressive symptoms but did not improve grief itself in the largest trial (described below). If the death was traumatic, trauma-focused therapy may also be needed; see CPT vs prolonged exposure vs EMDR. For depression on its own, depression treatment options compared lays out the menu.

Treatment: grief-targeted therapy has the best evidence

The APA notes that therapies using elements of cognitive behavioral therapy reduce prolonged grief symptoms, and describes approaches that focus on accepting the reality of the loss and on restoration, meaning working toward goals and satisfaction in a world without the person. The most-studied of these was developed by Katherine Shear and colleagues. Originally called complicated grief treatment, it is now often called prolonged grief disorder therapy (PGDT).

What the trials show

Interpersonal psychotherapy, a well-supported treatment for depression, helped in these trials too, but less. That is part of why a grief-specific approach is preferred when prolonged grief is the main problem. If depression is the main problem, interpersonal therapy for depression remains a strong option.

What sessions involve

In the trials, treatment ran 16 sessions, usually about weekly. Grief-targeted therapy works on two tracks that the APA describes: accepting the reality of the loss, and restoration, meaning rebuilding goals and satisfaction in a life without the person. In practice that often means gradually approaching reminders and situations you have been avoiding, which is why sessions can feel hard at moments. A trained therapist paces this with you, and the aim is not to stop loving or missing the person.

Other approaches the APA describes include narrative disclosure, work on experiential avoidance, and online interventions that let mourners express grief in written notes to the person who died. CBT has also been studied for children and adolescents with prolonged grief symptoms. For a sense of how long therapy usually takes for different problems, see how long therapy takes.

Support groups

Bereavement support groups and peer support can reduce isolation, which is itself a risk factor. They are valuable alongside treatment, but they are not a substitute for grief-targeted therapy when criteria for the disorder are met.

Where medication fits

There are currently no medications that treat the specific symptoms of grief, according to the APA. The largest placebo-controlled trial, published in 2016, tested citalopram, an SSRI, with and without grief-targeted therapy in 395 adults. Its findings:

• Adding citalopram to grief therapy did not improve the grief response (83.7% with citalopram vs 82.5% with placebo).
• Citalopram alone was not significantly better than placebo for grief.
• Depressive symptoms decreased more when citalopram was added to grief therapy.
• Suicidal thoughts decreased more in people who received grief therapy than in those who did not.

In practice, this means a prescriber may recommend an antidepressant if you also have major depression, and may treat sleep or anxiety problems, while grief-targeted therapy addresses the grief. No medication is FDA-approved for prolonged grief disorder, so using an antidepressant for grief alone would be off-label. Decisions about starting or stopping a medication belong with your prescriber. The article on medication, therapy or both explains how the two are combined.

Sleep often breaks down after a loss. CBT for insomnia works well and can be added to grief treatment; see insomnia treatment options and the site's article on therapy for sleep.

When to get help, and how urgently

If you are worried about someone else

Many people who meet criteria for prolonged grief disorder do not seek help themselves. They may feel that treatment would betray the person who died, or that nobody could understand. Family members and friends are often the first to notice that grief has stopped moving.

Signs that suggest it is time to say something include withdrawing from nearly everyone, keeping the person's room or belongings untouched for a long time while avoiding any mention of them, talking as if life has no point now, drinking more, or neglecting health and responsibilities. Any talk of wanting to die, or of joining the person, calls for an immediate response: stay with them and contact 988 or emergency services.

When you raise it, lead with what you have noticed and why you care, rather than a diagnosis. Offer specific help: finding a therapist, making the call together, or going to the first appointment. Expect hesitation, and come back to it. The guide on helping someone who refuses psychiatric help has more on conversations that stall.

Grief also changes families. One person may want to talk about the death constantly while another avoids it, and each can read the other's way of grieving as uncaring. A clinician can help a family see these as different styles of grieving rather than different amounts of love. If a child in the family is struggling, ask a pediatrician or child therapist about grief-focused support suited to the child's age.

Questions to ask a therapist or psychiatrist

• Do my symptoms fit prolonged grief disorder, depression, PTSD, or a mix?
• Have you been trained in a grief-targeted therapy, such as PGDT, and how many sessions do you expect?
• How will we measure whether it is helping?
• Would medication help any part of what I am experiencing, such as depression or sleep, and what are the tradeoffs?
• What should I do if things get worse around the anniversary?

Grief care at Dr. Lewis's practice

The practice's psychotherapists and prescribers provide psychotherapy, including CBT and DBT, psychiatric evaluation and medication management. The site's article on grief and loss covers bereavement more broadly. If you are considering care, a free discovery call by phone or text is a way to ask about care options, scheduling and insurance; it is not an emergency service. Ask on that call whether a therapist on the team works with grief-targeted therapy. The practice is out of network with all insurance plans; if you need in-network care, ask the team on the discovery call about options. The Choosing Psychiatric Care guide explains other routes into care.

Frequently asked questions

Is it prolonged grief disorder if I still cry about my mother two years later?

Not by itself. Missing someone and feeling waves of sadness for years is common. The disorder involves intense longing or preoccupation nearly every day, plus other symptoms like numbness or loss of identity, that significantly disrupt your life.

Can prolonged grief disorder follow the death of a pet, a divorce or a job loss?

As defined in DSM-5-TR, the diagnosis applies to the death of a person close to you. Other losses can cause real grief and depression that deserve care, but they are evaluated under other diagnoses.

Should I take an antidepressant for grief?

In the largest trial, an antidepressant did not improve grief itself but did help depressive symptoms. If you also have major depression, your prescriber may recommend one. That decision belongs with a prescriber who knows your history.

Will therapy make me forget or let go of the person?

No. Grief-targeted therapy aims to help you accept the reality of the death and rebuild a meaningful life, while keeping a connection to memories of the person.

Can children have prolonged grief disorder?

Yes. For children and adolescents, the time criterion is 6 months after the death, and the preoccupation may focus on how the person died. CBT has been studied for children and teens with prolonged grief symptoms.

Is insurance likely to cover treatment?

Prolonged grief disorder is a recognized DSM-5-TR diagnosis, but coverage depends on your plan. Ask your insurer about mental health benefits, including out-of-network benefits if you see an out-of-network clinician.

Sources

1. What is Prolonged Grief Disorder?. American Psychiatric Association, 2026. psychiatry.org
2. Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European Journal of Psychotraumatology (Killikelly C, Maercker A), 2018. pmc.ncbi.nlm.nih.gov
3. Treatment of complicated grief: a randomized controlled trial. JAMA (Shear K, et al.), 2005. pubmed.ncbi.nlm.nih.gov
4. Treatment of complicated grief in elderly persons: a randomized clinical trial. JAMA Psychiatry (Shear MK, et al.), 2014. pubmed.ncbi.nlm.nih.gov
5. Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial. JAMA Psychiatry (Shear MK, et al.), 2016. pubmed.ncbi.nlm.nih.gov
6. Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry (Prigerson HG, et al.), 2021. pubmed.ncbi.nlm.nih.gov
7. Exploring Differences in Presentation and Treatment Outcomes Between Black and White American Adults With Prolonged Grief Disorder. Cognitive and Behavioral Practice (Gacheru M, et al.), 2025. pubmed.ncbi.nlm.nih.gov
8. Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. Focus (Szuhany KL, et al.), 2021. pubmed.ncbi.nlm.nih.gov

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.