Prolonged Grief Disorder and the Extreme Side of Grief

Most individuals in the U.S. will experience some form of grief in their lifetime. Whether it be caused by a sudden career change or job termination, a relocation or decline in health, or the loss of a loved one, grief occurs as the result of a loss. With 2.6 million average deaths per year in the U.S., the experience of grief is common, yet increasingly misunderstood.

Despite this commonality, there is no timeline for how long a person will experience the emotional and behavioral symptoms related to grief. Everyone experiences grief differently and will cope with loss in their own way. Even if someone feels they are “done,” or recovered from suffering a great loss, the feelings of grief will likely remain a part of their psyche for years to come, impacting the way they move through the world. Grief has been shown to play a role in a person’s physical health just as much as their mental health, causing severe symptoms in individuals experiencing long-term grief reactions, like Prolonged Grief Disorder (PGD).

If the grieving process is so personal, how do you know when it’s time to seek help from a professional?

The Stages and Complexities of Grief

Since the 1996 publication of the infamous psychiatry book, On Death and Dying, by Elizabeth Kubler-Ross, grief has been commonly broken down into 5 ordered stages: denial, anger, bargaining, depression, and then lastly, acceptance. In recent years, however, experts are breaking down the “5 stages” myth and beginning to redefine the grieving period. As it turns out, grief does not occur in defined or pre-set stages. An individual can experience any one of these emotions at any time, in any order, in relation to their grief.

It is also common to experience physical symptoms of grief, including fatigue, headaches, nausea, restlessness, loss of appetite, heart palpitations, tightness in the chest, trouble sleeping, and more. Behavioral changes like confusion, trouble making decisions, hopelessness, memory loss and focus are also common.

Experts continue to study and learn more about grief and grief related illnesses, most recently adding complicated grief to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The diagnosis of complicated grief is given when symptoms continue for a year after the loss is suffered. At this time, it’s estimated that 7% of adults who experience grief will be diagnosed with complicated grief. Due to the nature of grief’s complexity, the process is typically categorized in the following forms:

• Anticipatory – grieving before the actual loss, say when learning of a loved one’s terminal illness.
• Abbreviated – moving through the grieving process quickly, perhaps following anticipatory grief.
• Delayed – rather than experiencing the symptoms and feelings of grief directly after a loss, you feel them days, weeks, months, or even years later. In some instances, the shock of the loss causes the body to pause in its ability to work through emotions or the practical matters that accompany loss (funeral planning, will assessment) may delay feelings of grief.
• Inhibited – repressing emotions even when not realizing you are doing so. The delay of grief or rejection of acknowledging the loss can often arise as more physical symptoms such as an upset stomach, insomnia, anxiety, or panic attacks.
• Cumulative – working through multiple losses at a time.
• Collective – a collective or group grieving process – common with major events like wars, terrorism, natural disasters, shootings, and other mass events.

While there is no “normal” way to process grief, grieving defined as “normal,” often involves a reaction soon after the loss and subsequent reactions and behaviors experienced as a result of the loss.

When Grief Isn’t Just Grieving

The process of grief is complicated, and so is the timeline for healing. The American Psychiatric Association (APA) defines grief as lasting between six months and two years. For most people, the symptoms related to their grief decrease over time. However, an estimated 7-10% of bereaved adults experience grief long after suffering a loss. A persistent feeling of prolonged grief, coupled with symptoms severe enough to inhibit daily activities and normal life is known as Prolonged Grief Disorder (PGD).

Someone who experiences PGD often feels an intense longing for or preoccupation with the person or experience they lost. In children and adolescents, the feelings or preoccupation is often directed around the circumstances of the death. Performing daily activities at home, work, or other areas of life are interrupted and feelings of grief may be so strong that the individual is unable to function or get out of bed long past when typical grieving subsides.

A diagnosis of PGD is defined by the APA as someone who experiences at least 3 of the following symptoms everyday for the last month prior to being diagnosed:

• Identity disruption
• Marked sense of disbelief about the death
• Avoidance of reminders that the person is dead
• Intense emotional pain related to the death
• Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future)
• Emotional numbness
• Feeling that life is meaningless
• Intense loneliness

Certain individuals are at greater risk for developing PGD, especially those who have suffered from or been diagnosed with depression or bipolar disorder in the past. According to the APA, PGD commonly occurs alongside other mental health disorders, including PTSD, anxiety and depression. Sleep problems and insomnia are also common with PGD, and affect an estimated 80% of people with the disorder.

If you or someone you love is experiencing PGD or another mental health condition related to a recent or significant loss, there are treatments available. While it is common to experience intense grief after a loss, there is a difference between “normal” grief and the persistent, enduring and often disabling feelings of prolonged grief. Support from a clinician or residential treatment center can help you process your grief and heal.

We’re Here to Support You

At Amend, seeking treatment for the effects of grief or depression requires a specialized knowledge base and skills set. This is why our clinicians are among the highest trained and experienced professionals in the industry.

With daily therapy, a dedicated treatment team, and an individualized residential treatment plan, you are able to focus exclusively on your unique recovery needs in the comfort and safety of a home-like setting.

Our client promise ensures that we will always deploy and use the most effective clinical and behavioral treatments to help our clients’ lasting transformation from hopelessness to optimism, confidence and belief – and we provide the tools to put them on a different path. Your well-being is of the utmost importance. Your journey to be well starts today.

Connect with our team to begin your journey today.

We are here for you.

Feel free to reach out to us to start your journey or if you have any questions. We’re here to assist you and look forward to connecting with you soon.

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