One of the worst yet most frequent stresses in life is losing a loved one, which sets off a series of emotional, mental, and behavioral reactions that come to be known as grieving. People’s grief reactions vary depending on how they adjust to a significant death; they are not based on predetermined stages. When someone experiences a significant death, most go on to effectively adjust to the loss over time, and their sorrow develops from an acute to a more integrated state. A person who has lost more than one loved one may react to each death’s intense sorrow differently, based on a number of variables such as the deceased’s relationship to the survivor and other circumstances related to the particular loss. Acute grieving often entails a time of intense feelings and obsession with memories and thoughts of the departed individual, which may lead to a period of diminished involvement in life and previous activities. The duration and severity of acute grieving vary, and it is influenced by culture and religion. Most grieving people have integrated sorrow after this intense phase of mourning, which means they have come to terms with the loss and are able to meaningfully resume their life without the departed.

However, a sizable minority may experience relentless grieving reactions that lead to functional impairment that surpasses cultural norms; historically, these reactions have been classified as complex, traumatic, persistent, or pathological; more recently, Prolonged Grief Disorder (PGD) has become the accepted term.

According to the empirical evidence, PGD prevalence estimates varies from 10.4% to 32%. Gender, cognitive avoidance, long-term stresses such financial difficulties, trauma or other losses, and exposure to these factors seem to be linked to more severe symptoms or maybe a larger chance of PGD. On the other hand, statistics indicate that social support could be shielding.

As far as the diagnosis of PGD is concerned, the DSM 5 TR has put forward the following criteria and features to identify PGD:

Diagnostic Criteria

A. A person close to the bereaved died at least 12 months ago.

B. Since the death, there has been a consistent grief reaction marked by either one or both of the following symptoms, which remain present on the majority of days to a clinically significant degree. Furthermore, the symptom(s) have happened almost every day for at least the last month:

1. Strong desire/longing for the deceased individual.
2. Obsession with thoughts or recollections of the departed person (among children and adolescents, preoccupation may center on the circumstances of the death).

C. Following the death, no less than three of the following symptoms have been persisted on the majority of days in a clinically meaningful way. Furthermore, the symptoms have appeared almost every day for at least the last month:

1. Identity disturbance (e.g., feeling as if a part of oneself has perished) following death.
2. A strong sensation of disbelief regarding the death.
3. Avoidance of reminders that the person has died (in children and adolescents, this may manifest as efforts to avoid reminders).
4. Extreme emotional suffering (e.g., anger, bitterness, and grief) caused by the death.
5. Difficulty reintegrating into one’s relationships and activities following death.
6. Emotional numbness (no sign or significant reduction in emotional experience) as a result of death.
7. Feeling as if existence is pointless after death. 8. Extreme loneliness as a result of the death.

D. The disturbance results in clinically substantial distress or impairment in social, vocational, or other critical areas of functioning.
E. The duration and severity of the grief reaction plainly exceed the individual’s cultural and religious norms.
F. The symptoms cannot be explained by another mental disorder, such as major depressive disorder or posttraumatic stress disorder, and they are not caused by the physiological effects of a drug (e.g., medication, alcohol) or another medical condition.

Diagnostic Features

• Prolonged Grief Disorder (PGD) is a condition marked by a persistent and maladaptive grief reaction.
• It can be diagnosed when symptoms last at least 12 months following the death of a close connection (6 months in children and adolescents).
• PGD is characterized by a chronic grief reaction that includes deep desire or wanting for the departed, continuous obsession with memories or ideas about them, or, for children, the circumstances of the death.
• The acute craving or obsession must be persistent on the majority of days and to a clinically noticeable extent for at least the previous month.
• Furthermore, at least three of the subsequent signs and symptoms need to be present. Among these are identity disruptions, such having the sensation that a piece of oneself has vanished.
• Another sign that someone is having trouble accepting the loss is disbelief about the death.
• Key signs also include avoiding thoughts of the deceased and experiencing severe emotional distress, such as remorse or wrath.
• Emotional numbness and trouble reintegrating into social interactions and activities are possible symptoms.
• PGD is additionally characterized by a pervasive sensation of profound loneliness or meaninglessness in life.
• The majority of the time, these symptoms must be present to a clinically significant extent, severely impairing the person’s ability to operate on a daily basis and maintain emotional stability.
• These symptoms must cause considerable discomfort or impairment in social, occupational, or other crucial areas of functioning while also exceeding ordinary societal, cultural, or religious standards.
• PGD may impact people of all genders, social backgrounds, and cultures, indicating a common yet diverse mourning experience.