Most grief eases with time, even though missing the person may never stop. For a small minority of bereaved people it does not ease. The pain stays as sharp and as consuming as it was in the first weeks, and ordinary life stays out of reach. Clinicians now have a name for this: prolonged grief disorder.
What follows explains the diagnosis in plain words. It is not a checklist to score yourself against. The criteria depend on clinical judgment at almost every step, and many people who recognize a few items here are grieving in an ordinary way. For what is typical over time, see how long grief lasts.
What is prolonged grief disorder?
It is the newest diagnosis in the DSM, the manual American clinicians use to diagnose mental health conditions. According to the American Psychiatric Association, it was added in the text revision known as DSM-5-TR, released in March 2022, after a two-year process of review and public comment. The earlier DSM-5 (2013) listed a similar condition, under a different name, only as a subject for further study.
You may also see the term "complicated grief." That is the older research name for the same clinical problem, and many older studies use it.
One limit matters. Under both major diagnostic systems, prolonged grief disorder is defined only for the death of a person. Divorce, estrangement, illness or the loss of a career can cause real grief, but that grief cannot be diagnosed as prolonged grief disorder. Those losses are covered in grieving a loss that is not a death.
What do the DSM-5-TR criteria require?
The criteria have several parts, and all of them have to be met. In plain words:
- Time. Someone close to the person died at least 12 months ago. For children and adolescents, the minimum is 6 months.
- Yearning or preoccupation. Intense longing for the person who died, preoccupation with thoughts or memories of them, or both.
- At least 3 of 8 further symptoms. The eight are: feeling as though part of oneself has died, a marked sense of disbelief about the death, avoiding reminders that the person is dead, intense emotional pain such as anger, bitterness or sorrow, difficulty rejoining life (seeing friends, pursuing interests, planning for the future), emotional numbness, feeling that life is meaningless, and intense loneliness.
- Frequency. These are present to a clinically significant degree nearly every day, or more often, for at least the last month.
- Impairment. The grief causes clinically significant distress or gets in the way of work, relationships or other important parts of life.
- Beyond cultural norms. The duration and severity clearly exceed what would be expected in the person's own social, cultural or religious context.
- No better explanation. The symptoms are not better explained by major depression, post-traumatic stress disorder, another mental disorder, a substance or a medical condition.
The "3 of 8" rule is often quoted alone. Without the other parts it describes a great many people in ordinary grief.
How is the ICD-11 definition different?
ICD-11 is the World Health Organization's classification, which lists prolonged grief disorder under code 6B42. It describes a persistent and pervasive grief response marked by longing for, or persistent preoccupation with, the person who died, accompanied by intense emotional pain. Like the DSM, it requires significant impairment and a response that clearly exceeds the norms of the person's culture and context.
The main difference is timing. ICD-11 requires that the grief has lasted an atypically long time, more than 6 months at a minimum. DSM-5-TR requires 12 months for adults. So the common statement that prolonged grief disorder means "grieving for more than 6 months" is not how the diagnosis works for adults in the United States.
How common is it?
Estimates vary with how the question is asked. The American Psychiatric Association gives a range: an estimated 4% to 15% of bereaved adults will experience the persistent symptoms of prolonged grief disorder.
The figure often repeated as "1 in 10" comes from a 2017 meta-analysis of 14 studies of adults after non-violent deaths, which found a pooled rate of 9.8%. Its authors asked for caution. The studies differed in their methods, only half used probability sampling, and all of them predate the current criteria.
A 2021 study of a representative sample of the German population used the current criteria. Among 914 bereaved people, 4.2% met the ICD-11 definition and 3.3% the DSM-5-TR definition. That study relied on a self-report questionnaire that was not designed around those criteria.
Rates look far higher after violent or sudden deaths. A 2020 meta-analysis of 25 articles on loss through accident, disaster, suicide or homicide found a pooled rate of 49%, and its authors also urged caution because the studies differed so much in method. That topic has its own guide: grief after a sudden or traumatic loss.
Who is at higher risk?
The American Psychiatric Association says the risk is greater when a death happens very suddenly or under unnatural circumstances. It also lists a history of depression, high levels of grief before the death, having been very close to or emotionally dependent on the person, the death of a child or a spouse or partner, a death from violent causes, a death in an intensive care unit as opposed to at home, and a lack of social support.
A risk factor is not a forecast. Many people with several of these do not develop prolonged grief disorder, and some people with none of them do.
Which treatments have been studied?
A 2024 review of the research concluded that grief-focused therapies based on cognitive behavioral therapy (CBT) currently have the strongest evidence for prolonged grief disorder, while noting significant differences and bias among the existing studies. The American Psychiatric Association says there are currently no medications to treat specific symptoms of grief. Support groups can ease isolation, but the same 2024 review found limited support for them as a treatment for the disorder itself.
The individual trials, including where the evidence is thin, are laid out in types of grief therapy and what the research says.
Why this is not a self-test
Words such as "clinically significant," "beyond cultural norms" and "not better explained by" are judgments a trained clinician makes after listening carefully. Prolonged grief can also overlap with depression or post-traumatic stress, and telling them apart is part of an assessment. See grief vs. depression for one of those distinctions.
If your grief has stayed this intense for a long time, that is a good reason to talk with a licensed mental health clinician. Dr. Rabin offers grief and loss therapy in Brookline and by telehealth across Massachusetts, and a free consultation of about 15 minutes by phone. On that call you can ask how she would approach grief like yours, a question worth putting to any therapist you consider. You can reach her through the contact page.
Keep reading
Sources
- American Psychiatric Association, Prolonged Grief Disorder (2025)
- Prigerson, Boelen, Xu, Smith and Maciejewski, Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale, World Psychiatry (2021)
- World Health Organization, ICD-11 for Mortality and Morbidity Statistics, 6B42 Prolonged grief disorder (2025)
- Lundorff, Holmgren, Zachariae, Farver-Vestergaard and O'Connor, Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis, Journal of Affective Disorders (2017)
- Rosner, Comtesse, Vogel and Doering, Prevalence of prolonged grief disorder, Journal of Affective Disorders (2021)
- Djelantik, Smid, Mroz, Kleber and Boelen, The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis, Journal of Affective Disorders (2020)
- LaPlante, Hardt, Maciejewski and Prigerson, State of the Science: Psychotherapeutic Interventions for Prolonged Grief Disorder, Behavior Therapy (2024)
- Bonanno et al., Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss, Journal of Personality and Social Psychology (2002)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis, call or text 988, or call 911 in an emergency.
