Psych · General adult psychiatry — trauma and stressor-related disorders
Grief and prolonged grief disorder
Also known as Prolonged grief disorder · Complicated grief · Persistent complex bereavement disorder · Pathological grief · Traumatic grief · Bereavement
Exam-exhaustive fellowship reference on normal grief versus prolonged grief disorder (DSM-5-TR and ICD-11), differential from major depression, dual-process and cognitive-behavioural mechanisms, suicide risk, Complicated Grief Treatment and grief-focused CBT evidence, selective pharmacotherapy for comorbidity, and cultural care. FRANZCP-primary, globally tagged.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Active suicidal ideation, plan, or means — including desire for 'reunion' with the deceased that has shifted into actionable planning
- Full major depressive episode, PTSD after traumatic death, or psychosis — diagnose and treat the full syndrome; do not soft-label as 'just grief'
- Suicide or homicide bereavement with family contagion risk, ongoing violence exposure, or acute traumatisation
- Severe functional collapse months to years after loss with avoidance of all reminders and identity freeze — screen for PGD and comorbidity
- Child or adolescent bereavement with self-harm, school collapse, or unsafe caregiving arrangements
- Chronic daily benzodiazepines or alcohol used to numb grief — dependence risk and blocked psychological work
Meet the patient
A 67-year-old man is brought in by his daughter. His wife died fourteen months ago. He still sets two places at dinner. He has not opened the bedroom door since the funeral. When you ask about her, he says quietly: "Part of me died with her. Every day I wait for her key in the door." He is not sleeping, and last week he told his daughter he "wouldn't mind" if he didn't wake up.[4][7]
Every registrar's first instinct splits two ways: "it's just grief, give it time" or "that's depression, start an SSRI." Every examiner's question: "name the clock, name the core symptom, and tell me what the evidence says to treat." This topic is all three.[4][8][1]
References20ShowHide
- [1]Shear K, Frank E, Houck PR, Reynolds CF 3rd Treatment of complicated grief: a randomized controlled trial JAMA, 2005.PMID 15928281
- [2]Shear MK, Reynolds CF 3rd, Simon NM, Zisook S, et al. Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial JAMA Psychiatry, 2016.PMID 27276373
- [3]Shear MK, Wang Y, Skritskaya N, Duan N, et al. Treatment of complicated grief in elderly persons: a randomized clinical trial JAMA Psychiatry, 2014.PMID 25250737
- [4]Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11 PLoS Med, 2009.PMID 19652695
- [5]Lundorff M, Holmgren H, Zachariae R, Farver-Vestergaard I, et al. Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis J Affect Disord, 2017.PMID 28167398
- [6]Maciejewski PK, Maercker A, Boelen PA, Prigerson HG "Prolonged grief disorder" and "persistent complex bereavement disorder", but not "complicated grief", are one and the same diagnostic entity World Psychiatry, 2016.PMID 27717273
- [7]Mauro C, Reynolds CF, Maercker A, Skritskaya N, et al. Prolonged grief disorder: clinical utility of ICD-11 diagnostic guidelines Psychol Med, 2019.PMID 29909789
- [8]Simon NM, Shear MK, Reynolds CF, Cozza SJ, et al. Commentary on evidence in support of a grief-related condition as a DSM diagnosis Depress Anxiety, 2020.PMID 31916663
- [9]Iglewicz A, Seay K, Zetumer SD, Zisook S The removal of the bereavement exclusion in the DSM-5: exploring the evidence Curr Psychiatry Rep, 2013.PMID 24136623
- [10]Zisook S, Corruble E, Duan N, Iglewicz A, et al. The bereavement exclusion and DSM-5 Depress Anxiety, 2012.PMID 22495967
- [11]Kendler KS, Myers J, Zisook S Does bereavement-related major depression differ from major depression associated with other stressful life events? Am J Psychiatry, 2008.PMID 18708488
- [12]Zisook S, Shear MK, Reynolds CF, Simon NM, et al. Treatment of Complicated Grief in Survivors of Suicide Loss: A HEAL Report J Clin Psychiatry, 2018.PMID 29617064
- [13]Hao F, Qiu F, Liang Z, Li P Psychotherapies for prolonged grief disorder in adults: A systematic review and network meta-analysis Asian J Psychiatr, 2024.PMID 38970900
- [14]Eisma MC, Boelen PA, van den Bout J, Stroebe W, et al. Internet-Based Exposure and Behavioral Activation for Complicated Grief and Rumination: A Randomized Controlled Trial Behav Ther, 2015.PMID 26520217
- [15]Stroebe M, Schut H The dual process model of coping with bereavement: a decade on Omega (Westport), 2010.PMID 21058610
- [16]Comtesse H, Smid GE, Rummel AM, Spreeuwenberg P, et al. Cross-national analysis of the prevalence of prolonged grief disorder J Affect Disord, 2024.PMID 38220101
- [17]Moore BS, da Silva JP, Farias M Diagnosing Prolonged Grief Disorder: Cultural Challenges to the DSM-5-TR Criteria Cult Med Psychiatry, 2025.PMID 40830691
- [18]Sarkar S, Gupta P, Sahu A, Anwar N, et al. A qualitative phenomenological exploration of prolonged grief in New Delhi, India Transcult Psychiatry, 2023.PMID 37993997
- [19]Simon NM, Saxe GN, Marmar CR Mental Health Disorders Related to COVID-19-Related Deaths JAMA, 2020.PMID 33044510
- [20]Glickman K, Shear MK, Wall MM Mediators of Outcome in Complicated Grief Treatment J Clin Psychol, 2017.PMID 27755654