Complicated Grief - Prolonged Grief Disorder

Complicated Grief or Prolonged Grief Disorder (PGD) may occur when normal grief and loss processes appear to become 'stuck' and the symptoms continue unresolved for months and perhaps years.

The nature and closeness of the relationship you had with your loved one (such as the death of a partner, child or parent) and the nature of death (for instance a tragic death) may also prolong the grieving process.

If the usual feelings of disbelief, loss, anguish and bitterness over your loss do not go away after six months or more, and if you have difficulty functioning normally, you may have symptoms of Complicated Grief (Prolonged Grief Disorder or PGD).

General characteristics of Complicated Grief may include:


  • Anger 
  • Sadness
  • Guilt
  • Despair
  • Overwhelm
  • Denial
  • Betrayal
  • Emptiness


  • This is not real 
  • This is unfair 
  • I will never get over this 
  • It's my fault


  • Withdrawal from social groups and/or events
  • Addictive or reckless behaviour
  • Avoidance of places and people
  • Avoidance of being alone.

General Health:

  • Fatigue
  • Loss of motivation
  • Sleeping problems
  • Loss of appetite
  • Pain
  • Symptoms of anxiety

Criteria for Prolonged Grief Disorder (Complicated Grief)

It may help to know that what you could be going through is now recognised by health professionals as Complicated Grief or Prolonged Grief Disorder. The assessment tool Consensus Criteria for Prolonged Grief Disorder is used by grief and bereavement specialists. If you can relate to the assessment categories and feel you have:

  • three or more symptoms of separation distress (B), as well as -
  • five of the nine cognitive, emotional and behavioural symptoms (C), and you have - 
  • felt this way for six months or more, 

you may be suffering from Prolonged Grief Disorder. If so, it is recommended that you seek the assistance of a clinical professional. 

Consensus Criteria for Prolonged Grief Disorder

A. Event CriterionBereavement (loss of a significant other)
B. Separation DistressThe bereaved person experiences at least one of the three following symptoms which must be experienced daily or to a distressing or disruptive degree:

  1. Intrusive thoughts related to the lost relationship
  2. Intense feelings or emotional pain, sorrow, or pangs or grief related to the lost relationship
  3. Yearning for the lost person
C. Cognitive, Emotional and Behavioural SymptomsThe bereaved person must have 5 (or more) of the following symptoms experienced daily or to a distressing or disruptive degree:
  1. Confusion about one's identity (e.g., role in life or diminished sense of self, feeling that a part of oneself has died)
  2. Difficulty accepting the loss
  3. Avoidance of reminders of the reality of the loss
  4. Inability to trust others since the loss
  5. Bitterness or anger related to the loss
  6. Difficulty moving on with life (e.g., making new friends, pursuing interests)
  7. Numbness (absence of emotion) since the loss
  8. Feeling that life is unfulfilling, empty and meaningless since the loss
  9. Feeling stunned, dazed or shocked by the loss
D. DurationDuration at least six months from the onset of separation distress
E. ImpairmentThe above smyptomatic disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (e.g., domestic responsibilities)
F. Relation to Other Mental Disorders Not better accounted for by Major Depressive Disorder, Generalised Anxiety Disorder, or Post Traumatic Stress Disorder.
It has been found that there is a need for the accurate detection and specialized treatment of PGD. It is considered that there are effective treatment strategies for people who have experienced a major loss and who meet the above criteria. Prigerson HG, Horowitz MJ, et al. have suggested that psychotherapies designed specifically to improve symptoms of PGD have demonstrated effectiveness.

Consensus Criteria for Prolonged Grief Disorder provided with thanks to Assoc. Professor Holly Prigerson

A Grief Treatment Program for Complicated Grief was conducted at the Centre for Traumatic Stress, Westmead Hospital, Sydney.

The program was established as a research project to assess the effectiveness of structured treatment strategies on reducing grief reactions.

You will note from the list below that many of the treatment strategies used in this program are probably strategies that you have used or are familiar with.

Often with the trauma of grief and everyday living we either forget or do not bother to practice these basic, yet effective, strategies.

Each of the strategies presented in the Complicated Grief treatment program will be included throughout this website. 

Treatment Strategies - Grief Treatment Program

Learning to be mindful

Buddhist teachings and meditations talk of mindfulness and how we can pay attention to our life in the moment, with intention and without judgement. Echhart Tolle teaches us to have a pain free life by living fully in the present -The Power of Now - a guide to spiritual enlightenment

Managing Stress

Managing the fight-or-flight response. As we have to deal with one of life's greatest stress events we are aslo encountering other grief related as well as normal life stressful events and situations

A simple yet structured approach to identifying issues, searching for options and working on possible solutions

Setting Goals

Even at times of great pain there are things we may want or need to achieve in life. It may be to reduce our current levels of pain, or to become financially secure

Managing Anger

We may feel that our emotional responses are out of our control. However, there are some strategies we can use to control emotions and make life easier for ourselves and for others

Relaxation Techniques

Some of these ideas may help you to relax. How relaxed are you at the moment? What is your mind doing? Where are your thoughts? What is your body doing?

Dealing with Conflict

There are different levels and degrees of conflict. The grief period is a time of mixed and difficult emotions, consequently we may become more susceptible to conflict situations

Scheduling Enjoyable Activities

We have just lost someone very close to us, perhaps our partner or companion. It is important that we now schedule to do something that will bring us joy and fill some of the space

Improving Sleep

A good sleeping pattern is crucial for normal healthy functioning. Are you getting adequate and restful sleep?

Understanding Anxiety

A feeling of dread, fear, or worry. We all experience anxiety at some time or another, but when anxiety becomes too severe it can interfere with everyday functioning

Please let me know (contact me) if something helps you or if you receive healing or support from other avenues for Complicated Grief that you would like to share.

Personal Comment

It was some years after the death of my husband I was introduced to the concept of Complicated Grief, or Prolonged Grief Disorder. I participated in a ten week Grief Treatment Program at The Centre for Traumatic Stress, Westmead Hospital, Sydney.

I was not sure if I should be pleased I had been accepted into the program or depressed at the confirmation that something was wrong with me.

Being the only person in the group whose bereavement was by suicide (a horrible dark shadow still strangles my heart at the thought of it), I did not feel that anyone else could relate to me or to my grief and I almost did not start the program.

Six of us plus two facilitators met for several hours each week over ten weeks. As we drifted and came together we were amazed at the relief. We felt that we could be honest with each other and with ourselves, leaving behind the pretence we were living outside the group. 

Personal Comment: contributed by Jan H. Sydney