Prolonged grief disorder, added to DSM-5-TR in 2022, is grief that persists at high intensity 12+ months after the loss (6+ months in children) with significant functional impairment. The disorder is distinct from major depression and from normal bereavement, and it has specific evidence-based treatment.
DSM-5-TR criteria: persistent yearning or longing for the deceased, intense emotional pain or sorrow, marked emotional reactivity to reminders, preoccupation with the deceased or circumstances of the death. Plus at least three of: identity disruption (sense of self diminished), marked disbelief about the death, avoidance of reminders, intense emotional pain, difficulty reintegrating into life, emotional numbness, feeling life is meaningless without the deceased, intense loneliness. Duration: 12 months post-loss with significant impairment.
Roughly 10% of bereaved individuals develop prolonged grief disorder. Higher risk: unexpected or violent loss, loss of a child, suicide loss, multiple losses, prior psychiatric illness, attachment-related vulnerabilities. The disorder is not the same as normal long-term grief — most bereaved people integrate their losses over months to a couple of years even when grief remains a presence.
The phenomenology is different from MDD. The patient's distress is organized around the loss rather than generalized worthlessness. Identity is fused with the absent person rather than self-critical. Suffering is real and persistent, but the orientation is toward the deceased rather than toward generalized hopelessness.
Complicated grief therapy (Shear protocol) is the most evidence-based treatment. 16-session manualized treatment combining loss-focused work (revisiting the death, processing the meaning of the loss, addressing avoidance) with restoration-focused work (rebuilding life, relationships, identity beyond the loss). Multiple RCTs show CGT outperforms both supportive grief counseling and standard depression treatment (interpersonal therapy) in prolonged grief disorder.
Pharmacotherapy: limited evidence specifically for prolonged grief disorder. SSRIs may help when superimposed depression is present but don't substitute for grief-specific therapy. Hypnotics short-term for severe insomnia, with caution.
When you encounter a patient whose grief remains intense, life-narrowing, and identity-disrupting more than a year after loss, prolonged grief disorder may apply. The diagnosis is treatment-relevant — complicated grief therapy works specifically for this presentation. The patient often has been told "give it time" by everyone for years; recognition that this is a distinct treatable disorder is itself therapeutic.