How to Recognize Complicated Grief (Prolonged Grief Disorder)

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How to Recognize Complicated Grief – Prolonged Grief DisorderIt is normal for people to experience acute grief when they lose a loved one. As first explored in the book “On Death and Dying” by Elisabeth Kubler-Ross, there are five accepted stages of grief. People move through these stages at different intervals, but most people find themselves in the end stages within several months of a loss.


Normal Grief

Normal or typical grief is experienced whenever we lose something that is important to us. The loss may be the death of a loved, the death of a cherished pet, or even the loss of a job. Each person spends different lengths of time moving through each stage of grief, and each is experienced with differing intensity. For some, the five stages are followed in order, but other people may skip through stages in seemingly no order at all.

During normal grief, people navigate the following stages: denial, anger, bargaining, depression, and acceptance.

In the denial stage, people often refuse to believe that their loved one is really gone. When the grieved become angry, they may lash out at those around them. In the bargaining stage, people often try to make deals with a higher power. I will do this or that if you return my loved one to me. Finally, people work through the depression stage and into the acceptance stage.

This process is completely normal, no matter the loss. No one can be rushed through the process. What is not “normal,” however, is for someone to still be working through these stages a year or more after they experience a loss.


Complicated Grief

People are considered to be embroiled in complicated grief or prolonged grief disorder (PGD) when they cannot navigate through the symptoms of normal grief. These people appear to be stuck in one stage of grief or another, unable to move on. When the symptoms of normal grief extend beyond a few months, friends and loved ones should be on the lookout for the general characteristics of PGD.

  • Feelings – There are several feelings associated with PGD. These include guilt, sadness, anger, denial, betrayal, guilt, and emptiness.
  • Responses – People with complicated grief may withdrawal from friends, develop additive behaviors, and either avoid social events or being alone.
  • Thoughts – People who are dealing with PGD often have thoughts of the death not being real. They think they will never get over the grief of losing their loved one.
  • Physical Health – During struggles with PGD, people often lose their appetite, have sleeping problems, lack motivation to do anything, and experience persistent fatigue.

To be diagnosed with PGD, people have to meet a sense of criterion. These include:

  • Event – Loss of a loved one or significant other.
  • Separation Distress – One of the following three symptoms must be experienced to a disruptive degree: intrusive thoughts, intense feelings such as pain and sorrow, and a yearning for the person that has been lost.
  • Cognitive/Emotional/Behavioral Symptoms – Five or more of the following symptoms must be present to be diagnosed with PGD:

1. Diminished sense of self or identity confusion.

2. A difficult time accepting the loss.

3. Avoidance of mementos, memorabilia or other reminders of the loss.

4. A loss of trust in others.

5. Anger or extreme bitterness.

6. Inability to move forward with life.

7. Absence of emotion.

8. A feeling that life is meaningless.

9. Remaining shocked or stunned by the loss.

  • Duration – The symptoms of grief must persist beyond six months of the date of loss.
  • Impairment – The symptoms of PGD cause impairment or significant distress in areas of functioning.
  • Other Mental Disorders – PGD should not be diagnosed in lieu of other medical disorders such as PTSD, major depressive disorder, or generalized anxiety disorder.

People who are dealing with PGD need to treat their symptoms of grief a bit differently than they would treat symptoms of normal grief. Caregivers should also be mindful of treatment strategies for this type of grief. It is extraordinarily rare for people dealing with PGD to be able to get through it on their own.


Treatment strategies for PGD include:

  • Mindfulness – People with PGD should learn to be mindful of the moment. This is a Buddhist teaching not unlike meditation. Learn to experience your emotions in the present so that you can better control them.
  • Stress Management – The way that people manage stress is an individual process. Learn how to manage your stress effectively. You may do so by listening to music, creating something with your hands, or exercising.
  • Problem Solving – Learn successful problem solving skills. These include knowing how to identify the problem, and how to identify the options available for solving the problem.
  • Set Goals – Set short- and long-term goals for yourself. What do you want to do tomorrow? What do you want to achieve next week? Work towards these goals daily.
  • Manage Anger – No matter how much anger you feel, you must keep it under control. A professional counselor or therapist can give you coping strategies for your overwhelming feelings.
  • Participate in Activities – Your first instinct may be to shut yourself off from the world, but don’t. Participate in activities that you find enjoyable, whether by yourself or with a friend.
  • Sleep – Develop proper sleeping patterns. This may take time but it can be achieved by going to bed at the same time and waking up at the same time.
  • Know Your Anxiety – Anxiety is a normal human emotion. Learn how to identify your anxiety and label its level. Develop coping mechanisms for your anxiety.


Treatment methods and coping skills for PGD can be delivered by a trained counselor or therapist. It is very difficult to understand how to get through this overwhelming and emotional time on your own. Professional grief counselors can teach you how to understand, label and cope with the emotions that you feel on a daily basis. The important thing to understand is that, even if you don’t believe you will, you can move on.


| Your Tribute Founder

Jason Ropchan is the Founder and CEO of Your Tribute, an online resource for Funeral and Grief information and products. He has more than 15 years experience in the funeral industry developing and marketing funeral technology. He has worked with thousands of funeral homes worldwide to help them provide online memo...