Understanding Prolonged Grief Disorder: Moving from Overwhelm to Healing
Grief is an inevitable part of the human experience. When we develop close and meaningful relationships with people, we also accept the possibility of their loss. Feeling the pain of that loss isn’t a fault, but rather a reflection of the profound love that we have for them.
However, there are cases when the pain of grief becomes so intense and debilitating that it leaves individuals feeling overwhelmed and completely unable to function. When the grieving process stalls, achieving mental wellness requires more than just time. This concept of ‘maladaptive grief’ has recently gained acceptance by clinical psychology, leading to a new diagnostic category called Prolonged Grief Disorder (PGD).
In this article, we’ll explore the history of PGD, its symptoms, and how it presents differently than typical grief. Whether you are seeking a mental health clinic for comprehensive psychotherapy services, or simply looking to understand this diagnosis, we will delve into clinical treatments that enable us to recognize and address PGD effectively.
The Standard Portrait of Grief
Before we can explore PGD as a diagnostic category, we must first understand how grief is framed in a non-pathological context.
The first clinical descriptions of grief focused on outward manifestations. During the 1940s, a picture of the normal grief response developed, characterized by:
Preoccupation with the deceased
Guilt
Hostile reactions
Disruption in regular behaviors
Somatic distress
From there, concepts about grief were heavily influenced by attachment theory. Because grief is a physical and emotional response to the loss of an attachment figure, it often bleeds into our remaining relationships. This is why many bereaved partners eventually seek relationship therapy or couples counseling; a major loss can easily strain a marriage, emphasizing the need for helping couples conflict and building better communication skills for couples.
John Bowlby, the originator of attachment theory, proposed four stages of normal reaction to loss: shock-numbness, yearning and searching, disorganization and despair, and reorganization. Elisabeth Kubler-Ross later built off this framework with her famous five stages: denial and dissociation, anger, bargaining, depression, and acceptance. Although grief leaves people forever changed, there has always been a sense that it could be worked through and resolved.
Pathological Grief: Prolonged Grief Disorder
In the 1990s, psychologists started to recognize that some presentations of grief differed greatly from the typical clinical picture. One strong piece of evidence for this distinct category was that it was generally unresponsive to standard anxiety and depression counseling and antidepressant medications.
Landmark studies provided evidence for pathological grief as its own diagnostic category, officially incorporated into the DSM-5-TR as ‘Prolonged Grief Disorder’ in 2022.
There are three major criteria for PGD:
A death in at least the past 12 months (6 months for children) of somebody close to the client.
A grief response occurring nearly every day over the past month, consisting of yearning and/or preoccupation with the deceased.
Three or more of the following symptoms occurring nearly every day over the past month:
Identity disruption
Disbelief
Avoidance
Emotional pain
Difficulty reintegrating
Numbness
Meaninglessness
Loneliness
The prevalence of PGD suggests that about 1 in 10 bereaved people are at risk. Because this persistent distress often mimics severe cognitive loops, working with an overthinking specialist or seeking therapy for overthinking can be an important piece of the diagnostic puzzle.
Duration and Dysfunction
We know that grief has no set time-frame, but the grief associated with PGD is characterized by persistent distress continuing for at least 12 months after the loss. This extended period creates a heavy physiological toll, often requiring chronic stress treatment and targeted mental fatigue recovery.
The dysfunctional aspects of PGD are reflected in identity disruption, avoidance, and difficulty reintegrating. Avoidance behaviors can sometimes become so pervasive that they mimic severe task-avoidance, leading some to initially seek therapy for procrastination before realizing grief is the root cause.
Loss does not discriminate, impacting all walks of life. We see this heavily in specialized populations—from providing therapy for college students who have lost a parent, to offering therapy for entrepreneurs who are struggling to keep their businesses afloat amidst profound personal tragedy. Sometimes, stepping into a deceased loved one's role can even trigger severe self-doubt, necessitating imposter syndrome therapy as part of the healing journey.
Differential Diagnoses
How does PGD differ from closely related diagnoses like Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD)?
Major Depressive Disorder: It is clear that depression and pathological grief share symptoms like low mood. However, MDD and PGD are distinguished by the fact that the sadness of depression tends to be generalized, whereas in PGD, it centers specifically around the deceased.
Post-Traumatic Stress Disorder: PGD shares symptoms with PTSD, such as intrusive thoughts and avoidance. However, PGD differs because the intrusive thoughts relate more to the person than the traumatic circumstances of the death. Furthermore, the overall effect in PTSD is fear, while PGD is characterized by yearning. When these symptoms cause emotional flooding, overwhelm therapy can be highly beneficial for stabilization.
The Reward-Pathway Theory
Some authors propose that PGD is related to dysregulation in the brain’s reward systems. Clients with PGD become stuck in a reward cycle where constant thoughts of the deceased provide behavioral reinforcement. Because of this intense rumination, clients desperately need help with overthinking. Utilizing techniques like detached mindfulness can help individuals step back from these painful mental loops without judgment.
Effective Treatments for Prolonged Grief Disorder at Steady Mind, PLLC
Because PGD is largely impervious to standard treatments, specialized approaches are required. A form of Cognitive-Behavioral Therapy known as Complicated Grief Treatment (CGT) has proven highly effective. It involves two elements:
Loss-focused: Encourages the client to accept the reality of the loss and change their relationship with the deceased.
Restoration-focused: Encourages the client to reintegrate with their past activities and create new sources of meaning.
At Steady Mind, PLLC, the main goal is to help clients move through their grief-work. To supplement CGT, we utilize skill building therapy to equip clients with practical therapy skills. Our holistic approach often incorporates relaxation techniques therapy, meditation workshops, and structured emotional resilience training to help soothe the nervous system.
If the loss has created a profound rift in a family or marriage, individual therapy can be paired with high conflict couples therapy. For our local clients experiencing relationship strain after a loss, seeking specialized couples therapy michigan providers can offer a safe space to reconnect and grieve together.
Conclusion
Prolonged Grief Disorder encapsulates symptoms following a loss that are more intense, long-lasting, and dysfunctional than typical grief. Although research is still emerging, utilizing targeted cognitive methods helps address the core thoughts contributing to pathological grief. By staying informed about PGD, we empower ourselves to treat it effectively, helping individuals and families emerge from the darkness of grief and step back into a meaningful life.