When Grief Doesn't Go Away: Understanding Loss, Prolonged Grief Disorder, and the Path to Healing

Grief is one of the most universal human experiences. It visits every one of us — through the death of a loved one, the end of a relationship, a devastating diagnosis, or the loss of a life we had imagined. For most people, grief is an agonizing but natural process that gradually softens over time. Life slowly expands to include loss rather than being consumed by it.

But for a significant number of people, grief does not soften. It intensifies, locks in, and begins to disrupt every area of life — work, relationships, physical health, and the basic ability to imagine a future. This experience now has a formal clinical name: Prolonged Grief Disorder (PGD). Understanding the difference between grief and prolonged grief is not about rushing the healing process or putting a clock on someone's pain. It is about knowing when grief has become something that requires — and responds to — professional support.

In this article, we explore what grief really is, how it is supposed to work, when it becomes prolonged, what the research tells us, and what treatments are most effective.

What Is Normal Grief?

Normal grief encompasses the full range of emotional, physical, cognitive, and behavioral responses to significant loss. Sadness, anger, guilt, relief, numbness, confusion, longing, and even moments of unexpected laughter can all be part of grief. There is no single correct way to grieve, and no universal timeline.

The widely known 'five stages of grief' model — denial, anger, bargaining, depression, acceptance — was introduced by Dr. Elisabeth Kübler-Ross in her 1969 book 'On Death and Dying.' It was originally developed to describe the experiences of terminally ill patients, not bereaved loved ones. While Kübler-Ross's work was groundbreaking in opening conversations about death, the stages model has been widely misapplied as a rigid sequence everyone must move through. Modern grief research, including guidance from the American Psychological Association (APA), emphasizes that grief is highly individual, non-linear, and shaped by culture, relationship, personality, and circumstances of the loss.

What adaptive grief tends to look like over time is not the disappearance of pain, but the gradual integration of loss into one's identity and life. The grief does not go away — but it changes shape, and the space for other experiences — joy, connection, purpose — gradually expands again. The person finds a way to carry their love for the deceased forward into a life that still feels worth living.

The Many Faces of Loss

Loss is not limited to the death of a person. Grief can arise from many types of loss, including:

• The death of a spouse, child, parent, sibling, or close friend

• Pregnancy loss, including miscarriage, stillbirth, or infertility

• Divorce or the end of a significant relationship

• Job loss, especially when tied to identity and purpose

• Serious illness — one's own or a loved one's — and the losses that accompany it

• Loss of a home, community, or way of life

• The death of a beloved pet

• Ambiguous loss — when a person is physically present but emotionally absent (dementia, addiction, estrangement)

Ambiguous loss, a term coined by family therapist Dr. Pauline Boss, is particularly challenging because society does not always recognize or validate it. There is no funeral, no clear moment of loss — and yet the grief can be just as profound and disorienting as any other.

When Grief Becomes Prolonged Grief Disorder

Prolonged Grief Disorder (PGD) — previously called complicated grief — was formally added to the DSM-5-TR in 2022 and to the ICD-11 in 2019, recognizing it as a distinct clinical condition that requires its own treatment approach, separate from depression or PTSD.

PGD is characterized by intense, persistent longing for the deceased; difficulty accepting the reality of the loss; bitterness or anger about the death; a feeling that life is meaningless without the person; difficulty trusting others since the loss; and a sense of having lost part of oneself. To meet diagnostic criteria, these symptoms must persist for at least 12 months after the loss in adults (6 months in children and adolescents), be present on most days, and cause significant functional impairment.

The data on PGD is striking. According to a landmark study published in JAMA Network Open (2024), among bereaved adults in the United States, the presumptive prevalence rate for PGD was 20%, with 30% also experiencing major depressive disorder and 34% experiencing post-traumatic stress disorder. These conditions frequently co-occur, and their overlap can make accurate diagnosis — and effective treatment — especially challenging.

The American Psychiatric Association estimates that 7-10% of bereaved adults will experience the persistent symptoms that characterize PGD. A 2024 cross-national analysis published in the Journal of Affective Disorders found that approximately 13% of bereaved adults worldwide meet diagnostic criteria for PGD — a figure researchers note may be an underestimate given widespread underdiagnosis.

For those who have experienced traumatic loss — sudden death, violence, accident, or suicide — the risk of developing PGD is significantly elevated. According to TherapyRoute's 2025 analysis, PGD prevalence can reach as high as 49% among survivors of traumatic loss, compared to approximately 9.8% among those bereaved by natural, non-violent deaths.

Risk Factors: Who Is Most Vulnerable?

Anyone can develop PGD following bereavement, but research consistently identifies certain factors that increase vulnerability:

• Losing a spouse, child, or parent — the closeness and centrality of the relationship is one of the strongest predictors

• Experiencing a sudden, violent, unexpected, or traumatic death

• Losing a child, regardless of the child's age at the time of death

• Having a prior history of depression, anxiety, or traumatic loss

• Lacking social support or facing social isolation during bereavement

• Low socioeconomic status and reduced access to mental health care

• Being female — research consistently shows women experience more intense and prolonged grief responses

• A dependent or ambivalent relationship with the deceased — when the relationship was complicated or unresolved

• Experiencing multiple losses in a short period of time

A population-based study published in the European Journal of Psychotraumatology found that severe grief reactions were overrepresented among individuals with lower education and lower income — a reminder that grief, like so many mental health challenges, intersects with social and economic inequity.

How Grief Affects the Body

Grief is not only an emotional experience — it is a whole-body experience with measurable physiological effects. The bereaved are at elevated risk for a range of physical health problems, including:

• Cardiovascular events — the phenomenon of dying from a 'broken heart' (Takotsubo cardiomyopathy) is real and documented in the medical literature

• Compromised immune function, increasing susceptibility to illness

• Disrupted sleep, including insomnia and hypersomnia

• Appetite changes and unintentional weight loss or gain

• Fatigue and reduced energy that can resemble depression

• Heightened inflammatory responses linked to chronic disease

One of the most tragic patterns in grief research is the elevated mortality risk among bereaved spouses — particularly in the first few months after the loss. Studies have found that recently widowed individuals have significantly higher mortality rates than non-bereaved peers, driven by cardiovascular disease, suicide, and reduced immune function.

This is why grief is never just an emotional matter, and why it deserves serious medical and psychological attention — especially when it is prolonged or intensifying.

Signs That Grief May Need Professional Support

It can be genuinely difficult to know when grief has crossed into something that requires professional help. These warning signs are worth paying attention to:

• Persistent inability to accept the reality of the loss, many months or years later

• Feeling that life has no purpose or meaning without the person

• Inability to trust others or invest in new relationships since the loss

• Feeling emotionally numb, detached, or cut off from others

• Engaging in risky or self-destructive behavior, including substance use

• Intense bitterness, anger, or resentment that does not soften over time

• Avoiding all reminders of the deceased, or conversely, being unable to change anything about how they lived

• Thoughts of suicide or wishing to die to be with the person who passed

If you recognize these signs in yourself or someone you care about, reaching out to a mental health professional is an act of courage. The Crisis Text Line (text HOME to 741741) and the 988 Suicide and Crisis Lifeline (call or text 988) are available 24/7 and free.

Evidence-Based Treatments for Prolonged Grief Disorder

PGD responds to targeted treatment — but it requires a different approach than standard depression therapy, which is why treating grief with generic antidepressants often produces limited results.

The most well-researched treatment is Complicated Grief Treatment (CGT), developed by Dr. M. Katherine Shear at Columbia University. CGT combines elements of interpersonal therapy and cognitive behavioral therapy, specifically addressing grief-related avoidance, the integration of the loss into one's life narrative, and the restoration of positive emotions and future orientation. Clinical trials have shown CGT to be significantly more effective than interpersonal therapy alone for PGD.

Other evidence-based approaches include:

• Grief-focused Cognitive Behavioral Therapy (CBT) — addresses maladaptive thought patterns that maintain grief

• Acceptance and Commitment Therapy (ACT) — helps people build psychological flexibility around grief and reconnect with what they value

• Narrative Exposure Therapy (NET) — particularly helpful when traumatic loss is involved

• EMDR (Eye Movement Desensitization and Reprocessing) — especially useful when traumatic elements accompany the grief

• Bereavement support groups — the experience of shared loss with others who truly understand can be profoundly healing

For those experiencing PGD alongside significant depression or anxiety, medication may also be an important part of the picture. Antidepressants do not treat grief itself, but they can reduce the severity of co-occurring depression, making it more possible to engage in grief-specific therapy.

Resources including GriefShare, the What's Your Grief community, and the National Alliance for Grieving Children offer peer support, community, and educational resources for bereaved people at every stage.

How to Support Someone Who Is Grieving

Many people feel helpless or afraid of saying the wrong thing when someone they love is grieving. The result is often distance — which the grieving person experiences as abandonment, compounding an already devastating loss.

The most valuable thing most people can offer is consistent, patient presence — not problem-solving or meaning-making, but simply being there. Here are some research-supported ways to support a grieving person:

• Say the name of the person who died — many grievers treasure hearing it and fear that others have already forgotten

• Offer specific, practical help rather than 'Let me know if you need anything' (which places the burden on the griever)

• Acknowledge their pain directly — 'I'm so sorry. This is devastating and I love you' is far more helpful than 'At least they lived a long life'

• Check in weeks, months, and even years later — grief does not end when the casseroles stop arriving

• Avoid saying things like 'They're in a better place,' 'Everything happens for a reason,' or 'You should be moving on by now'

• Simply sit with them — grief does not need to be fixed, only witnessed

If you are worried about a grieving person's safety, do not hesitate to ask them directly whether they are having thoughts of harming themselves. Asking does not plant the idea — it opens the door.

Frequently Asked Questions About Grief

How long does grief last?

There is no set timeline for grief, and anyone who tells you there is should be treated with skepticism. Research suggests that for most people, the most acute phase of grief — the period of most intense, disruptive pain — tends to soften within the first 12-24 months. However, grief does not have an expiration date, and grief that resurfaces for years after a loss is entirely normal. What changes over time is usually not the love, but the intensity of the acute pain.

Is it normal to feel relieved after someone dies?

Yes, absolutely. Relief — particularly after a long illness, or when the relationship was complicated — is a completely normal part of grief. It does not mean you did not love the person. It often coexists with profound sadness and can itself become a source of guilt that benefits from working through with a therapist.

Can children experience prolonged grief disorder?

Yes. Children experience grief differently than adults and may express it through behavioral changes, physical complaints, or regression rather than visible sadness. PGD in children has been recognized in the DSM-5-TR with a shorter duration threshold (6 months rather than 12). Resources such as The Dougy Center specialize in grief support for children and families.

A Final Thought: Grief as Love

Grief is not a problem to be solved or a phase to be pushed through. It is the price of love, and in that sense it is one of the most profoundly human experiences there is. The goal of grief support is never to stop missing someone, or to pretend the loss was not devastating. It is to find a way to carry your love for that person forward into a life that can still hold meaning, connection, and joy.

With the right support — whether from loved ones, a therapist, a support group, or all of the above — that is not only possible, it is what happens for the vast majority of people who receive appropriate care. You do not have to grieve alone.

To find a grief therapist, visit the Psychology Today Therapist Directory and filter by 'grief' as a specialty. The NAMI helpline at 1-800-950-NAMI is also available for guidance.

Sources: JAMA Network Open 2024 | APA on Grief | TherapyRoute PGD Statistics 2025 | Journal of Affective Disorders 2024 | European Journal of Psychotraumatology

Frequently Asked Questions

What is Prolonged Grief Disorder?

Prolonged Grief Disorder (PGD) is a formal clinical condition in which grief does not soften over time but instead intensifies and disrupts work, relationships, physical health, and the ability to imagine a future. Unlike normal grief, PGD requires and responds to professional treatment.

How is normal grief different from prolonged grief?

Normal grief is painful but gradually softens, allowing life to expand to include the loss rather than being consumed by it. Prolonged grief, by contrast, locks in and intensifies, persistently disrupting major areas of life and functioning.

Are the five stages of grief accurate?

The five stages model by Dr. Elisabeth Kübler-Ross was originally developed in 1969 to describe terminally ill patients, not bereaved people, and has been widely misapplied as a rigid sequence. Modern grief research and the APA emphasize that grief is individual, non-linear, and shaped by culture, relationship, and circumstances.

Is there a normal timeline for grieving?

No, there is no universal timeline for grief. Grieving is highly individual and shaped by personality, culture, the relationship with the deceased, and the circumstances of the loss.

What does healthy grief look like over time?

Healthy or adaptive grief does not mean pain disappears, but that the loss becomes gradually integrated into one's identity and life. Over time, space reopens for joy, connection, and purpose while the person carries their love for the deceased forward.

When should someone seek professional help for grief?

Professional help is warranted when grief stops softening and instead intensifies, persistently disrupting work, relationships, physical health, or the ability to envision a future. These signs may indicate Prolonged Grief Disorder, which responds well to clinical support.