Prolonged grief disorder

Grief after a death is painful, but for most people the sharpest pain slowly softens. For a smaller group, grief stays just as raw month after month. It crowds out daily life and does not let up.

Since 2022, doctors have had a name for this: prolonged grief disorder.¹ It is not a sign of weakness, and it is not "loving too much." It is a treatable condition. This page explains the signs in plain words, who is most at risk, and the kind of therapy that helps.

Normal grief and grief that gets stuck

Grief is not an illness. It is a normal response to losing someone you love. For most people, grief becomes less frequent and less intense within about 6 months to 2 years.⁶ You may still have hard days, especially on birthdays or holidays. But over time you can laugh, make plans and enjoy people again, even while you miss the person.

With prolonged grief, that softening does not happen. The pain stays near the center of every day. A person may feel that part of them died too, or that life has no point without the one they lost.¹

There is no "right" amount of time to grieve. The question is not whether you still miss someone. It is whether grief has taken over so much that you cannot live your life.

Learn more about ordinary grief on What grief can feel like.

The signs, in plain words

In March 2022, the American Psychiatric Association added prolonged grief disorder to its diagnosis manual, the DSM-5-TR.¹ Here is what a doctor or therapist looks for, in everyday language.¹

1. Enough time has passed. The death happened at least 12 months ago for an adult, or at least 6 months ago for a child or teen.

2. One of two core feelings, nearly every day.

• A deep, aching longing for the person who died, or
• Being so taken up with thoughts or memories of them that it fills your mind. In children and teens, this may focus on how the death happened.

3. At least 3 of these 8 signs, nearly every day, for at least the past month:

4. It goes beyond what is expected in your culture or faith. Grief looks different in different families, cultures and religions. The grief must clearly last longer than is normal for your community.¹

5. It causes real harm. The grief causes great distress or makes it hard to manage at home, at work or with family.¹

You may see older names for this problem, such as "complicated grief." The World Health Organization's disease list (ICD-11) also includes prolonged grief disorder. It uses a shorter time frame of 6 months after the death.⁵

How it differs from depression and PTSD

Prolonged grief can overlap with depression and with PTSD (post-traumatic stress disorder, a reaction to a frightening event). But they are not the same thing, and each needs its own approach.

• Depression tends to color everything. The low mood is steady, and people often feel worthless. In grief, the pain usually comes and goes in waves, and people often keep their sense of self-worth.⁶
• Prolonged grief centers on missing the person and being unable to accept the loss.¹ In one large study, a therapy that works well for depression helped far fewer people with prolonged grief than a grief-focused therapy did.²
• PTSD can come with grief after a violent or sudden death. Grief-focused therapy also tends to ease trauma symptoms.⁴ See our PTSD and trauma pages.

A person can have more than one of these at the same time. A good clinician will check for all of them. Read more on Depression in later life.

How common is it?

Most grieving people do not develop prolonged grief disorder. Estimates vary because studies measure it in different ways.

• The American Psychiatric Association estimates that about 4% to 15% of bereaved adults have lasting symptoms.¹
• After a natural death, such as from an illness, about 1 in 10 people develop it.⁷
• A 2024 review of studies from 16 countries found an average of about 13%. Studies that sampled the general public most carefully found lower rates, around 5%, or 1 in 20.⁸
• After an unnatural death, such as an accident, suicide, homicide or disaster, the rate was much higher. In one review, nearly half of grieving adults had it.⁷

Who is at higher risk?

Anyone can develop prolonged grief. Some things raise the chances. They include:^1,6,7

• How the person died. A sudden, unexpected or violent death raises risk. So does a death in an intensive care unit (ICU) compared with a death at home.
• Who died. Losing a child or a husband, wife or partner carries higher risk. Losing an only child carries especially high risk.
• The relationship. Having depended on the person a great deal, emotionally or in daily life.
• Your own history. Past depression or other mental health problems, past trauma, or very strong grief even before the death.
• Your support. Having few people to lean on.
• Your circumstances. Lower income.

Being female and older age are linked with more severe grief.¹ In the 2024 review, studies of older groups found higher rates.⁸ For older adults, losing a spouse can also mean losing a daily companion, a caregiver or a driver all at once. See Losing a husband or wife.

Family caregivers can also carry heavy grief before a death. In a study of people caring for a loved one with terminal cancer, strong grief before the death was more common in those with low support, past depression and lower income.⁵ If you are caring for someone with dementia or a serious illness, see Grieving someone still here.

What helps: therapy made for grief

The best-tested treatment is a short, structured talk therapy designed for prolonged grief. It was developed by Dr. Katherine Shear at Columbia University. It has had several names: complicated grief treatment (CGT), prolonged grief disorder therapy (PGDT), and now prolonged grief treatment (PGT).^9,11 They all describe the same approach.

What happens in this therapy

It usually takes about 16 weekly sessions over 4 months.¹¹ It mixes ideas from cognitive behavioral therapy (CBT, which works on thoughts and actions) and interpersonal therapy (which works on relationships).⁵ Parts of the therapy include:¹¹

• Learning how grief works and why it can get stuck
• Rating your grief each day to notice patterns
• Bringing in a trusted person from your life
• Gently facing the loss and the places or activities you have been avoiding
• Working with memories of the person, both happy and painful
• Setting personal goals, caring for yourself and rebuilding relationships

The aim is not to forget the person or to "get over" them. It is to accept that the death is real, ease the pain, and find a way to live a meaningful life while still loving them.^9,11

How well does it work?

In the 395-person study, about 8 in 10 people who got grief therapy improved, with or without the medicine. Grief therapy also lowered thoughts of suicide more than care without it.³

What about medicine?

As of October 2026, no medicine is approved to treat grief itself.¹ If you also have depression, an antidepressant may help that part.^3,6 It may take longer to work than in depression without grief.⁶ Talk with your doctor or pharmacist before starting, stopping or changing any medicine.

Sleep often suffers during grief. CBT for insomnia, a short talk therapy for sleep, can help when sleep problems come with prolonged grief.¹ See Insomnia.

Finding this kind of help

1. Start with your doctor. Tell them how long it has been since the death and how grief affects your days. A written list of the signs that fit you can help. Ask them to check for depression, sleep problems and physical health issues too.
2. Look for a therapist trained in grief. The Columbia Center for Prolonged Grief keeps a list of therapists trained in its method, sorted by state.¹⁰ Ask any therapist directly: "Do you use a therapy designed for prolonged grief?"
3. Ask about video visits. If no trained therapist is near you, ask about telehealth from a therapist licensed in your state.
4. Check your coverage. Medicare Part B covers individual and group therapy. That includes visits with psychologists, clinical social workers, marriage and family therapists and mental health counselors. You usually pay 20% of the approved amount after the yearly deductible.¹² See Paying for therapy.

For more help choosing a therapist, see How to find a therapist. If you are worried about someone else, see Helping someone who is grieving.

When to get help

Reach out to a doctor or therapist if, a year or more after a death:

• Grief still feels as intense as in the first weeks
• You cannot accept that the person is gone
• You avoid nearly everything that reminds you of them, or you can think of little else
• You have pulled away from friends, family and things you used to enjoy
• You are not eating, sleeping or caring for yourself
• You are drinking more or using other substances to cope

You do not have to wait a full year to ask for help. If grief feels unbearable at any point, talking with someone is a good step. You can also use our check-in to look at how you have been feeling.

Does having prolonged grief mean I loved them more?

No. How much you grieve is not a measure of how much you loved someone. Prolonged grief is about grief getting stuck, often because of how the death happened, your own history or a lack of support.^1,7 Treatment can help you carry your love for the person in a way that hurts less.

Will therapy make me forget the person?

No. The goal of grief-focused therapy is to help you accept the loss and rebuild your life. It includes working with your memories of the person, not erasing them.¹¹

I am in my 70s. Is it too late for therapy to help?

No. The main study of this therapy enrolled adults aged 50 and older, with an average age of 66. Older age did not make the therapy work less well.²

Is it normal to still cry about my husband years later?

Yes. Many people feel waves of sadness for years, especially on special dates. That alone is not prolonged grief. What matters is whether grief still fills most days and keeps you from living your life.^1,6

Return to the Grief overview.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.