Prolonged Grief Disorder: When Grief Doesn't Get Better

Q: What are the symptoms of prolonged grief disorder?

People with PGD often describe: - Intense longing for the person who died that doesn't ease - Trouble believing the death really happened - Feeling that part of themselves died too - Avoiding reminders — or being unable to stop seeking them out - Emotional numbness - Feeling that life has no meaning without the person - Loneliness that other people can't reach - Losing interest in plans, hobbies, and relationships they once cared about A common description: going through the motions. Showing up to work, answering texts, making dinner, while something essential stays switched off.

Q: What treatment actually works?

The treatment news is actually good. ### Grief-focused therapy works well There's a structured treatment — Prolonged Grief Disorder Therapy, usually around 16 sessions — built specifically for this condition. It draws on cognitive behavioral therapy, interpersonal therapy, and gradual work with the memories and places people have been avoiding. Across three large government-funded studies, more than 70% of people improved, compared with about 44% treated for depression instead. That gap is the whole argument. Treating prolonged grief as if it were depression gets meaningfully worse results than treating it as what it is. ### Antidepressants treat depression, not grief In the largest of those studies, researchers tested an antidepressant against a placebo. It helped the depression that many grieving people also carry. It did nothing for the grief itself that a placebo didn't do. In my practice, that shapes how I approach this. Medication has a real role when depression or anxiety are riding alongside the grief, and I'll prescribe it when that's the case. A prescription does not stand in for grief-focused therapy. Those are different treatments for different problems. ### Finding a trained therapist is the hard part The treatment is manualized and teachable, but not every therapist knows it. Columbia University's Center for Prolonged Grief keeps public resources and training materials and is a reasonable place to start looking. Online versions of grief-focused therapy are being studied and may make this easier to access.

Yuriy B

Aug 18

4 min read

Updated: Aug 30

A twelve-month calendar with the same mark on every month, for a post on prolonged grief.

Most grief needs time, people, and patience.

But for a small number of people, grief doesn't loosen its grip. A year passes, then two, and the loss still takes up every room in the house. Life stays paused. That experience has a name, prolonged grief disorder, and it has a treatment that works.

What is prolonged grief disorder?

Prolonged grief disorder (PGD) is intense, persistent grief that lasts far longer than expected and keeps someone from living their life.

The central feature is longing. Not just sadness, but a constant pull toward the person who died — thinking about them, wanting them back, feeling that nothing has been right since. It's grief that hasn't moved at all.

PGD was added to the DSM-5-TR, psychiatry's diagnostic manual, in 2022. It's still a relatively new diagnosis, which is part of why so many people who have it have never heard of it.

How long is too long to grieve?

There's no clock on missing someone. But the diagnostic guidelines do use timeframes:

In the U.S. (DSM-5-TR): at least 12 months after the death for adults, 6 months for children and teens.
Internationally (ICD-11): around 6 months.

Those numbers aren't a deadline for feeling better. They're a marker for when clinicians should start asking whether something beyond ordinary grief is happening.

I care less about the calendar than whether anything has shifted at all. Grief that is slowly, unevenly changing is doing what grief does. Grief that is exactly as consuming in year two as it was in week two is different.

What are the symptoms of prolonged grief disorder?

People with PGD often describe:

Intense longing for the person who died that doesn't ease
Trouble believing the death really happened
Feeling that part of themselves died too
Avoiding reminders — or being unable to stop seeking them out
Emotional numbness
Feeling that life has no meaning without the person
Loneliness that other people can't reach
Losing interest in plans, hobbies, and relationships they once cared about

A common description: going through the motions. Showing up to work, answering texts, making dinner, while something essential stays switched off.

Is it just depression?

This is the question that matters most, because it's where people most often get the wrong treatment.

Depression and prolonged grief look similar from the outside and overlap often. But they're shaped differently. Depression tends to flatten everything — nothing feels good, across the board. Prolonged grief organizes itself around one person. The pain has a direction. People with PGD can sometimes still enjoy things that aren't connected to the loss, which is not typical of depression.

PGD is also mistaken for PTSD, especially after a sudden or violent death. PTSD centers on fear and re-experiencing. PGD centers on longing and separation.

Getting this right isn't academic. As you'll see below, the treatments are not interchangeable.

Why does the diagnosis matter?

Prolonged grief is painful, and it is also risky.

Research links PGD to higher rates of suicidal thinking, worse physical health, and significant difficulty functioning. Someone who has been told for two years that grief takes as long as it takes, and who is privately wondering whether to keep going, needs more than more time.

Naming the condition is what makes the right treatment findable.

What treatment actually works?

The treatment news is actually good.

Grief-focused therapy works well

There's a structured treatment — Prolonged Grief Disorder Therapy, usually around 16 sessions — built specifically for this condition. It draws on cognitive behavioral therapy, interpersonal therapy, and gradual work with the memories and places people have been avoiding. Across three large government-funded studies, more than 70% of people improved, compared with about 44% treated for depression instead.

That gap is the whole argument. Treating prolonged grief as if it were depression gets meaningfully worse results than treating it as what it is.

Antidepressants treat depression, not grief

In the largest of those studies, researchers tested an antidepressant against a placebo. It helped the depression that many grieving people also carry. It did nothing for the grief itself that a placebo didn't do.

In my practice, that shapes how I approach this. Medication has a real role when depression or anxiety are riding alongside the grief, and I'll prescribe it when that's the case. A prescription does not stand in for grief-focused therapy. Those are different treatments for different problems.

Finding a trained therapist is the hard part

The treatment is manualized and teachable, but not every therapist knows it. Columbia University's Center for Prolonged Grief keeps public resources and training materials and is a reasonable place to start looking. Online versions of grief-focused therapy are being studied and may make this easier to access.

Isn't this just medicalizing normal grief?

It's a fair worry, and worth answering rather than brushing off.

The concern is that turning grief into a diagnosis pathologizes something universal, ignores that mourning looks different across cultures, and leads to medicating sadness.

The criteria are built to guard against exactly that. They require a full year for adults, a level of distress beyond what someone's own culture and community would expect, and real interference with daily life. They're designed to find the people who are stuck, not the people who are grieving hard.

And for those people, the usual alternative to a diagnosis is not peace. They spend years treated for the wrong condition.

When to reach out

Consider talking to someone if it's been more than a year and:

Your grief feels exactly as intense as it did at the start
You've stopped making plans or imagining a future
You're avoiding people, places, or conversations connected to the loss
You feel disconnected from everyone still here
You've had thoughts that you'd rather not be here either

If that last one applies, please don't wait — you can call or text 988 in the U.S. any time.

Nothing about good treatment erases the person you lost, and nothing should. What it does is make it possible to carry them with you instead of staying frozen at the worst moment. Most people who get the right help get there.

This article is general information, not medical advice. If you're struggling with a loss, a licensed clinician can help you sort out what you're dealing with.