Grief Overview 🕊️

Understanding Grief

Grief is a natural emotional response to the loss of a person, relationship, role, or other meaningful source of connection. Grief can affect emotions, thoughts, behaviors, relationships, physical functioning, identity, and a person’s sense of meaning or future. The experience varies based on the individual, nature of the loss, cultural and spiritual context, available support, and previous experiences with loss.

Grief itself is not inherently pathological. Clinicians should distinguish expected grief responses from grief that becomes persistent, pervasive, clinically significant, and impairing. Prolonged Grief Disorder (PGD) is a DSM-5-TR diagnosis characterized by a persistent grief response following the death of someone close that exceeds expected cultural, social, or religious norms and causes clinically significant distress or impairment.

Prolonged Grief Disorder

Prolonged Grief Disorder may be considered when intense grief remains persistent well beyond the expected period following a significant loss and is associated with substantial disruption in emotional, social, occupational, or other important areas of functioning. The diagnosis emphasizes persistent separation distress, including intense yearning or preoccupation with the deceased, along with additional cognitive, emotional, and behavioral symptoms.

PGD should be understood within the context of the individual’s culture, developmental stage, relationship to the deceased, circumstances of the death, and broader clinical presentation. Assessment should also consider whether symptoms are better explained by another mental disorder, substance effects, or a medical condition.

Common Grief Presentations

Individuals experiencing grief may present with:

• Sadness, longing, anger, guilt, or emotional pain
• Difficulty accepting or integrating the reality of the loss
• Preoccupation with the deceased or circumstances surrounding the death
• Changes in sleep, appetite, concentration, or energy
• Social withdrawal or difficulty re-engaging in meaningful activities
• Changes in identity, purpose, or sense of future
• Emotional numbness or difficulty experiencing positive emotions
• Loneliness and changes in relationships or support systems

Clinical Considerations

When working with grief-related concerns, clinicians should consider:

• The individual’s relationship to the deceased and meaning of the loss
• Cultural, spiritual, and family expectations surrounding grief
• Developmental factors and the individual’s stage of life
• Circumstances surrounding the death, including sudden, traumatic, or complicated losses
• Current safety, functional impairment, and available support
• The difference between supporting natural grief and treating clinically significant prolonged grief
• Co-occurring depression, trauma-related symptoms, anxiety, substance use, or other mental health concerns

Effective grief treatment should avoid pathologizing expected grief while providing appropriate intervention when grief becomes persistent, impairing, or clinically significant.

Treatment Focus

Treatment may focus on helping patients process the reality of the loss, tolerate and regulate grief-related emotions, reconnect with meaningful relationships and activities, address changes in identity and purpose, and develop an ongoing relationship with memories of the deceased that allows continued engagement with life.

For Prolonged Grief Disorder, treatment should be individualized to the patient’s presentation and may include grief-focused psychotherapy, emotional processing, meaning-making, behavioral re-engagement, relationship support, and treatment of co-occurring conditions when indicated.