Prolonged Grief, a New Psychological Disorder?

Last updated: August 12, 2009
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Say it's been two years since your father died and your mom still won't socialize or quit talking about wanting to join him. Or you can't shake a sense of meaninglessness to your life as the anniversary approaches of the death of someone close to you. Sounds like prolonged grief disorder, psychiatrists might say.

Prolonged grief disorder (PGD) -- previously called complicated grief "“ may soon be a recognized mental disorder. Researchers at the Dana-Farber Cancer Institute in Boston developed and tested standard criteria for identifying the condition, based on the input of a team of experts in bereavement and mood/anxiety disorders. That's a major hurdle on the way to inclusion in the next edition of the Diagnostic Statistical Manual of Mental Disorders (DMV-5), the psychiatric care bible for diagnosing problems. The research was done with widows and widowers but is thought to be applicable to the general population.

None of this is to say that grieving is unhealthy or unnatural. To the contrary: Mourning is a necessary process that also happens to be hard and horrible, and takes many different shapes, depending on the individuals and their relationship. But with prolonged grief disorder, the grief reaction is so prolonged and causes such psychological distress as to create substantial disability. Laypeople tend to say someone is "paralyzed with grief" or "unable to move on."

Wait, you may be thinking. Is this just medicalizing grief? The psychiatrists make a persuasive case that the answer is no. For one thing, along with poorer quality of life, the health risks associated with prolonged grief disorder include increased rates of suicide, cancer, immunological dysfunction, hypertension, heart problems, and other adverse health behaviors.

And the good news: Talk therapy geared to this prolonged grief can successfully treat it. (Not a new "instant-fix" pill.) Not to make the griever "get over" the loved one, but to allow him or her to be able to cope with the loss in functional, healthful ways. That's why diagnosis is so important. It can steer those in need to the right kind of support.

What to watch out for

Warning signs of prolonged grief disorder include yearning to be reunited to the extent that it causes physical or emotional suffering, as well as at least five of the nine following symptoms still being experienced six or more months after the loss:

  • Emotional numbness
  • A stunned, dazed, or shocked feeling
  • A feeling that life is meaningless
  • Bitterness or anger over the loss
  • Mistrust of others
  • Difficulty accepting the loss
  • Avoidance of reminders of the deceased
  • Difficulty moving on with life
  • A feeling that part of oneself has died

Some people don't begin to have symptoms until six months after the loss; they have higher incidence of thinking about suicide and lower quality of life. Others experience acute symptoms immediately that continue for a year or more; they also tend to experience major depression, post-traumatic stress disorder, and generalized anxiety. People in both situations have a 10-times higher risk for a depressive disorder than those whose grief runs a more conventional course or who are treated.

Final food for thought:

Is our current "way of death" contributing to an uptick in prolonged grief disorder? There's no data (because this isn't yet a recognized disorder). But that's what Canadian doctor Stephen Workman theorizes in a related commentary in the journal Public Library of Science. He notes that the modern emphasis at the end of life on hope, survival, and high-tech "fighting" to prolong life, even in final-stage disease where the prognosis is clear, may leave families all the more unprepared for eventual death.

Workman writes: "I remember a middle-aged man whose father was dying; each day shorter of breath and one day closer to death. His son was continually requesting treatments his father did not want or need. "How long do you hope for your father to live?" I asked.

"I don't ever want my father to die," [the man said].

Therein lies a rough road.

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4 Comments So Far. Add Your Wisdom.

5 months ago

I have this. Diagnosed it, described it, and learned how to deal with it myself years ago. I learned how to "put my grief away." Because I know I get stuck in a phase of grief and I know I won't move on from it, there's no sense in staying in that place. So I box it up and put it away. An outside observer will think that I have gotten over my grief quickly, but has no idea that I've just walled i off internally. It's still all in there, but I have to go looking for it for it to affect me. So it's ironic that my coping mechanism actually has an effect that's the opposite of prolonged grief. BTW - "Shorter of breath and one day closer to death" is a line from Pink Floyd's "Time." I am a road cyclist and I have a decal of that line on my bike. (I also have "Skating away on the thin ice of a new day" on my bike, from Jethro Tull's "Skating Away.")

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10 months ago

My wife passed away in October 2012 and January 1st was the 2 year anniversary of the start of her illness. I miss just as badly today as I did the day she passed. I love you Margo.

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about 5 years ago

April died 3/21/95....i'm her mom....i'm still trying to stay alive....prolongued grief is real

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about 5 years ago

Since the death of my brother, 1989, then my sister, 1990, 8 months apart. I have not been able to pull my self back to the real me. This is when everything started in a downward spiral. I still see the fear in my brothers eyes when I told him I needed to be at work the next day and would be back that night. The nurses, assured me he was going to pull through the stroke. The very next morning as I arrived at work. I recieved a phone call telling me my brother was brain dead. I later found out that his wife of 33 yrs. refused medical treatment upon arrival at the hospital, while he was still unconcious. Also, she insisted that the nurses needed me to sign a form stating he was brain dead. Later when my sister was dying, I asked her doctor if a brain dead person shed tears when you talked to them. I was ask to do this on the night he died by his wife. I ask her why, they said he was brain dead. She could not or would not answer that question. As I talked to him of my love for him and to for him to tell our mother in heaven hi for me. There were tears running down his face. My sister's doctor informed me he was not brain dead. I was told at the funeral for his wife in 2003, but the grown children they would buy headstones. He had already been dead several years. They were not buried next to each other she was placed some distance away with her mother. 2007, I went to a funeral at the cemetary expecting to find his grave, still no headstone, 19 yrs. after his death. I purchased one and had it put up on his birthdate a few months later. The fear in his eyes still haunt me and I still cry and can not talk about him. He was my brother, best friend and acting father, our own father did not care about us. I was 6 when mom died and he was 12. I was lied to by the wife, hospital and ask to sign his death warrant. To this day it is still extremely painful.

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