Grief is a universal emotional response to the death of a loved one or the loss of something
meaningful. The ways in which different cultures approach and express grief can be vastly different,
from emphasis on emotional expression and sharing stories, to stoicism and restraint, to loud
celebration of the cycle of life. While mourning is a deeply personal and cultural process, most
people feel intense grief in the initial weeks following the loss. The pain of the grief typically eases
with time, resurfacing when triggered by internal (e.g. memories) or external reminders (e.g.
anniversaries). Eventually, the loss becomes accepted and integrated into life (Boelen & van den
Bout, 2007).
However, some individuals may find themselves trapped in a state of unrelenting sorrow and despair
that continues and continues, as though “stuck” in grief. Research suggests that approximately one
in ten mourners will experience a persistent and impairing grief that lingers longer than culturally
expected (Treml et a., 2020). Prolonged Grief Disorder (PGD) is a relatively new term introduced in
the DSM-5 Text Revision (APA, 2022) to describe a severe and persistent form of grief. PGD
symptoms typically persist for at least six months, significantly impairing the individual’s daily
functioning and overall well-being. They include:
- Intense and Persistent Yearning: Individuals with PGD experience a deep longing for the
deceased that continues over an extended period, often accompanied by intrusive thoughts
and memories of the lost loved one. - Emotional Numbness: A common symptom of PGD is emotional numbing, where individuals
may feel disconnected from their emotions or struggle to experience positive emotions. - Difficulty Accepting the Loss: Accepting the reality of the loss can be a significant challenge
for those with PGD. They may persistently deny the death or feel as though they are living in
a dream-like state. - Identity Confusion: Losing a loved one can lead to a sense of identity confusion, where
individuals struggle to redefine themselves in the absence of their loved one’s presence. - Social Withdrawal: People with PGD may isolate themselves from friends and family, finding
it challenging to engage in social interactions. - Apathy and Loss of Interest: PGD can lead to a lack of interest in activities that were once
enjoyable, including hobbies and social events.
Similarity
The symptoms of Prolonged Grief Disorder bear similarities to those found in depressive disorders,
especially Major Depressive Disorder (MDD; APA, 2013). Depression is a more global experience of
low mood, whereas in the case of PGD, thoughts and feelings revolve around the loss or the person
who died specifically (Kristensen et al., 2017). Both conditions involve profound feelings of sadness,
emptiness, and loss, which can be challenging to differentiate at times. Similarities between PGD
and MDD include:
- Persistent Sadness: Both PGD and MDD feature persistent feelings of sadness, low mood,
and hopelessness. - Social Withdrawal: Individuals with MDD and PGD may withdraw from social activities and
isolate themselves from others. - Sleep Disturbances: Both conditions can disrupt sleep patterns, leading to either insomnia or
excessive sleeping. - Apathy: People with MDD and PGD may lose interest in activities they once enjoyed and
have difficulty finding pleasure in daily life. - Cognitive Impairment: Both disorders may lead to difficulties with concentration, decision-
making, and memory.
Summary
To summarise, grief is a natural response to loss, but when it becomes overwhelming and prolonged,
it may indicate the presence of prolonged grief disorder. This condition shares overlapping
symptoms with depressive disorders, making accurate diagnosis and treatment vital. By recognising
the signs and seeking professional help, individuals can find support and healing on their journey to
recovery.
If you or someone you know is struggling with prolonged grief or depressive symptoms, seeking
professional help is essential for recovery and healing. The Centre for Clinical Psychology,
Melbourne, offers a supportive and compassionate environment to address your mental health
needs. To book an appointment, you can reach them at Phone: 03 9077 0122 or visit their website
https://ccp.net.au/booking/.
References:
APA. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Fifth edition. ed.).
American Psychiatric Association.APA. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text
revision. ed.). American Psychiatric Association Publishing.
Boelen, P. A., & van den Bout, J. (2007). Complicated grief and uncomplicated grief are
distinguishable constructs. Psychiatry Research, 157(1), 311-314.
https://doi.org/10.1016/j.psychres.2007.05.013
Kristensen, P., Dyregrov, K., & Dyregrov, A. (2017). What distinguishes prolonged grief disorder from
depression? Tidsskrift for den Norske Lægeforening, 137(7), 538-539.
https://doi.org/10.4045/tidsskr.16.0629
Treml, J., Kaiser, J., Plexnies, A., & Kersting, A. (2020). Assessing prolonged grief disorder: A
systematic review of assessment instruments. Journal of Affective Disorders, 274, 420-434.
https://doi.org/https://doi.org/10.1016/j.jad.2020.05.049
