Unifying Concepts

Guidelines for the Diagnosis of Prolonged Grief Disorder

The death of a loved one is one of life’s greatest, universal stressors to which most bereaved individuals successfully adapt without clinical intervention. For a minority of bereaved individuals, grief is complicated by superimposed problems and healing does not occur. The resulting syndrome of complicated grief causes substantial distress and functional impairment even years after a loss, yet knowing when and how to intervene can be a challenge.

Provisional Proposed Guidelines for the Diagnosis of Prolonged Grief Disorder
Essential features

  • History of bereavement after the death of a partner, parent, child, or other loved one
  • A persistent and pervasive grief response characterized by longing for or persistent preoccupation with the deceased, accompanied by intense emotional pain (e.g., sadness, guilt, anger, denial, blame, difficulty accepting the death, feeling one has lost a part of one’s self, an inability to have a positive mood, emotional numbness, or difficulty in engaging with social or other activities)
  • A grief response that has persisted for an abnormally long period of time after the loss, clearly exceeding expected social, cultural, or religious norms; this category excludes grief responses within 6 mo after the death and for longer periods in some cultural contexts
  • A disturbance that causes clinically significant impairment in personal, family, social, educational, occupational, or other important areas of functioning; if functioning is maintained only through substantial additional effort or is very impaired as compared with the person’s prior functioning or what would be expected, then he or she would be considered to have impairment due to the disturbance

Features overlapping with normal bereavement

  • Grief reactions that have persisted for <6 mo or for longer periods that are within a normative period of grieving given the person’s cultural and religious context are viewed as normal bereavement responses and are generally not assigned a diagnosis
  • In assessing whether the duration of the grief reaction exceeds cultural expectations, it is often important to consider whether people in the patient’s environment (e.g., family, friends, and community members) regard the response to the loss or the duration of the reaction as exaggerated or within normal limits

Additional features

  • Persistent preoccupation may be manifested as preoccupation with the circumstances of the death or as behaviors such as the preservation of all the deceased person’s belongings exactly as they were before the death; oscillation between excessive preoccupation and avoidance of reminders of the deceased may occur
  • Other emotional reactions may include difficulty accepting the loss, problems coping without the loved one, difficulties in recalling positive memories of the deceased, difficulty in engaging with social or other activities, social withdrawal, and feeling that life is meaningless
  • Increased tobacco, alcohol, and other substance use, as well as increased suicidal ideation and behavior may be present



  1. Shear MK. Clinical practice. Complicated grief. N Engl J Med. 2015 Jan 8;372(2):153-60. [Medline]
  2. Simon NM. Treating complicated grief. JAMA. 2013 Jul 24;310(4):416-23. [Medline]


Created Mar 27, 2015.

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