Prolonged grief disorder (complicated grief)

Prolonged grief disorder (complicated grief) arises when grief cannot be integrated, resulting in persistent and severe emotional distress that impairs functioning on most days for at least 12 months after death. It is characterised by maladaptive thoughts, dysfunctional behaviours and compromised emotional regulation such as:

preoccupation with the deceased
intense yearning for the deceased
feelings of purposelessness and futility
numbness or detachment
distressing intrusive images or memories about the death, often related to the circumstance of death (indicative of a posttraumatic stress response)
excessive guilt, remorse and self-reproach, especially relating to events surrounding the death or the deceased
sense of life being empty or meaningless without the deceased
excessive irritability, bitterness or anger.

Certain personal factors or factors around the patient’s death or illness can increase the risk of prolonged grief disorder—see Risk factors for prolonged grief disorder (complicated grief) in adults for adults and Risk factors for prolonged grief disorder (complicated grief) in children for children.

If prolonged grief disorder is suspected, further assessment and management is required; the Prolonged Grief Disorder-13 Revised tool (PG-13-R)Prigerson, 2021 or Brief Grief Questionnaire may assist with diagnosis. Consider referral for specialist bereavement interventions; options include:

specialist bereavement counsellors
specialist palliative care services (usually offer bereavement follow-up, often based on a risk assessment but may accept referrals from other sources)
other mental health professionals (eg psychiatrists, psychologists).

Treatment options available from specialist providers include specific complicated grief therapy, behavioural activation with therapeutic exposure, interpersonal psychotherapy, acceptance and commitment therapy, focused family grief therapy and group therapy.