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Grief is not a problem to be solved — it is a natural response to loss. For most people, grief is intensely painful in the early months, then gradually, unevenly, begins to become more bearable. Life rebuilds itself slowly around the loss. The person who has died becomes a presence you carry rather than an absence that stops you.
But for roughly 10 to 15 percent of bereaved people, this natural movement toward integration doesn't happen — or it happens far more slowly and with far more disruption than typical grief. This is what researchers and clinicians call complicated grief, also known as Prolonged Grief Disorder (PGD), which was officially recognized in the DSM-5-TR in 2022.
If you suspect you or someone you love is experiencing complicated grief, this article is for you.
What Is Complicated Grief?
Complicated grief is not grief that is "wrong" or a sign of weakness. It is a clinical condition in which the normal grief process becomes stuck — the bereaved person remains in acute, debilitating grief well beyond what would be expected, and struggles to return to functioning in daily life.
The term "complicated" doesn't mean the grief itself is complex (though it may be) — it means that the grief has been complicated in its course, in the way a wound can become complicated by infection.
Clinically, Prolonged Grief Disorder is generally diagnosed when intense grief symptoms persist for more than 12 months after the death of an adult (6 months for children) and continue to cause significant impairment in daily life.
Signs and Symptoms of Complicated Grief
Complicated grief shares many features with regular grief — but the key difference is intensity, duration, and the degree to which the symptoms interfere with functioning. Common signs include:
- Intense longing for the person who died that doesn't ease with time — a yearning that remains as acute as it was in the early days
- Difficulty accepting the death — a persistent sense of disbelief or unreality, even long after the loss
- Bitterness or anger about the death that remains intense and disruptive
- Feeling that life is meaningless without the person who died
- Inability to trust others since the loss, or profound difficulty in relationships
- Feeling emotionally numb or detached from other people and from life
- Avoiding reminders of the person in ways that significantly constrain your life — or the opposite: being unable to stop fixating on reminders and grief-related thoughts
- Feeling that a part of yourself has died — not just that you've lost someone, but that you've lost yourself
- Difficulty engaging in activities or planning for the future
Who Is at Higher Risk for Complicated Grief?
Certain factors are associated with a higher likelihood of developing complicated grief:
- Traumatic or sudden loss — deaths by accident, suicide, homicide, or sudden illness leave less time for psychological preparation
- Loss of a child — consistently associated with the most prolonged and intense grief responses
- Loss through suicide — carries particular burdens of guilt, unanswered questions, and sometimes social stigma that complicate the grief
- A very close or dependent relationship with the person who died
- Prior history of depression, anxiety, or trauma
- Lack of social support — isolation is one of the strongest risk factors for complicated grief
- Multiple losses in a short period of time
- Difficult or ambivalent relationship with the person who died — when the relationship was complicated by conflict, estrangement, or abuse, the grief often is too
How Complicated Grief Differs from Depression
Complicated grief and depression share many surface features — low energy, withdrawal from life, difficulty functioning — and they can co-occur. But they are different conditions, and the distinction matters for treatment.
In depression, the low mood tends to be pervasive and undifferentiated. Everything feels flat. In complicated grief, the pain is more specifically focused: the yearning is for the particular person who died, the difficulty with the future is connected to the loss of that specific person, and reminders of the deceased tend to intensify rather than neutralize the distress.
Another key distinction: in complicated grief, positive emotions are often still accessible in contexts unrelated to the loss — a person can laugh at something funny, enjoy a meal, feel briefly engaged in an activity — before the grief reasserts itself. In clinical depression, positive emotions are often suppressed across the board.
This distinction matters because standard antidepressant treatment, while helpful for depression, has shown limited specific effectiveness for complicated grief. Complicated Grief Treatment (CGT) outperforms antidepressants for complicated grief specifically. Getting the right diagnosis leads to the right treatment.
What Complicated Grief Treatment Actually Looks Like
Complicated Grief Treatment (CGT) is a structured 16-session therapy developed specifically for prolonged grief disorder. Understanding what it involves can help demystify it and lower the barrier to seeking it out.
CGT has two main components that run in parallel throughout treatment. The first is loss-focused work — directly processing the loss through exercises like revisiting the story of the death, identifying what makes acceptance difficult, and working through unfinished aspects of the relationship with the person who died. This can include imaginal conversations with the deceased, which many people find both difficult and unexpectedly healing.
The second component is restoration-focused work — actively rebuilding engagement with life. This means identifying goals and activities that have been abandoned since the loss, addressing avoidance patterns, and gradually re-engaging with people and experiences that have meaning. The idea is that healing from grief isn't just about processing the loss — it's also about rebuilding a life that feels worth living.
CGT is available in person and, increasingly, via telehealth. Finding a CGT-trained therapist specifically can take some searching — the Columbia Center for Complicated Grief maintains a training directory.
What You Can Do Alongside Therapy
While professional treatment is the most effective intervention for complicated grief, there are things you can do in parallel — or while waiting to access therapy — that can support the process.
- Name what you're experiencing. Simply identifying "this is complicated grief, this is a recognized condition" can reduce the shame and self-blame that often surrounds prolonged grief. You are not failing. You have a condition.
- Resist total avoidance. The instinct to avoid reminders of the person who died is understandable but tends to maintain and intensify grief over time. Gradual, gentle exposure — looking at photos, visiting meaningful places, saying their name — is part of how grief begins to move.
- Maintain basic structure. Sleep, eating, and minimal daily routine are not cures for complicated grief, but their complete collapse makes everything harder. Protecting basic physical functioning is worthwhile even when motivation is very low.
- Find a community of understanding. Online and in-person grief support groups — particularly those focused on specific loss types — provide something therapists alone cannot: the deep recognition of shared experience. Knowing you are not alone in this matters more than it might seem.
- Write. Journaling about the person who died, about what you miss, about what feels impossible — this kind of expressive writing has consistent research support for helping with grief processing. It doesn't have to be coherent or literary. It just has to be honest.
- Be patient with the timeline. Complicated grief does not resolve as quickly as ordinary grief, and treatment typically takes months rather than weeks. The pace of healing can itself be a source of frustration and despair. Understanding that recovery from complicated grief is genuinely slower — and that slower does not mean impossible — can help you stay the course.
What Helps: Treatment and Support for Complicated Grief
Complicated grief responds to treatment — this is one of the most important things to understand. It is not a permanent state. With the right support, most people with complicated grief do find their way toward healing.
Complicated Grief Treatment (CGT)
A therapy called Complicated Grief Treatment, developed by Dr. Katherine Shear at Columbia University, is the most evidence-based treatment for this condition. It combines elements of cognitive-behavioral therapy with techniques specifically designed to help the bereaved process their loss and reconnect with life. Studies have shown it to be significantly more effective than standard depression treatment for complicated grief.
General psychotherapy
Working with a therapist who specializes in grief and bereavement — even outside of formal CGT — can provide meaningful support and movement. Look for therapists with specific bereavement or grief training, and don't hesitate to ask directly whether they have experience with prolonged grief disorder.
Medication
Antidepressants have limited specific evidence for complicated grief, but if depression is also present — which it often is — they may be helpful for the depressive symptoms. Medication is generally most useful as a support alongside therapy rather than as a standalone treatment for complicated grief.
Grief support groups
Being in community with others who have experienced significant loss — especially when the losses share features (loss of a child, loss through suicide) — can provide genuine comfort and reduce isolation. The recognition of shared experience that comes from a grief group is something that individual therapy alone often can't replicate.
Frequently Asked Questions
How is complicated grief diagnosed?
Prolonged Grief Disorder is diagnosed when intense grief symptoms — particularly yearning for the deceased, difficulty accepting the loss, and significant impairment in daily functioning — persist for more than 12 months after the death of an adult (6 months for children). Diagnosis is made by a qualified mental health professional, typically through a clinical interview and standardized assessment tools.
Can complicated grief go away on its own?
Sometimes, but research suggests it is unlikely to resolve fully without some form of intervention. Unlike ordinary grief, which tends to move naturally toward integration over time, complicated grief tends to remain stuck without active treatment. Seeking professional support significantly improves outcomes.
Is complicated grief the same as PTSD?
No, though they can co-occur — particularly after traumatic or sudden loss. PTSD is centered on fear and the re-experiencing of a traumatic event. Complicated grief is centered on yearning and the inability to accept and adapt to loss. They respond to different treatments, though some therapists are trained in both.
How do I find a CGT-trained therapist?
The Columbia Center for Complicated Grief maintains a directory of CGT-trained clinicians. Online therapy platforms like BetterHelp, Talkspace, and Online-Therapy.com also have grief-specialized therapists who may have CGT training or equivalent experience with prolonged grief. When contacting a therapist, ask directly whether they have experience treating prolonged grief disorder.
Finding a grief-specialized therapist
Online therapy platforms can connect you with therapists who specialize in grief and bereavement, often within 48 hours. This can be a meaningful first step toward getting the support complicated grief deserves.
Compare therapy options →If you recognize yourself in this article — if grief has held you at its worst for longer than a year, if you feel unable to imagine a future or find meaning in daily life — please consider reaching out to a professional. You are not weak. You are not failing at grief. You are someone dealing with a recognizable clinical condition that has real, effective treatments.
You deserve support. And with the right help, things can genuinely get better.
This article is for informational purposes only and does not constitute clinical diagnosis or treatment recommendations. Please consult a qualified mental health professional. If you are in crisis, please call or text 988.