What are grief disorders, also known as Prolonged Grief Disorder (PGD)?

From the Guidelines

Grief disorders, particularly Prolonged Grief Disorder (PGD), should be treated with grief-focused psychotherapy, such as cognitive behavioral therapy (CBT) or complicated grief therapy (CGT), as the first line of treatment. According to the changes from ICD-10 to ICD-11, Prolonged Grief Disorder is characterized by an abnormally persistent, pervasive, and disabling response to bereavement 1. The diagnosis of PGD involves persistent yearning and preoccupation with the deceased beyond 12 months after loss.

Key Characteristics of Prolonged Grief Disorder

• Persistent and pervasive grief response
• Disability in social, occupational, or other areas of functioning
• Duration of more than 12 months after the loss
• Intense yearning and preoccupation with the deceased

Treatment Approaches

• Grief-focused psychotherapy, such as CBT or CGT, to help patients process their loss and develop coping strategies
• Selective serotonin reuptake inhibitors (SSRIs) like sertraline or escitalopram may be used to manage accompanying depression or anxiety symptoms, but are not specifically approved for grief disorders 1
• Support groups can provide valuable peer connection and social support
• Maintaining self-care routines, such as regular sleep, nutrition, and exercise, is essential during the healing process

When to Seek Help

• Grief persistently interferes with daily functioning
• Presence of suicidal thoughts or substance abuse as a coping mechanism
• Pre-existing mental health conditions that may exacerbate the grieving process 1

From the Research

Definition and Prevalence of Grief Disorders

• Grief disorders, also known as complicated grief, are intense, prolonged, and disabling grief symptoms associated with considerable morbidity and mortality 2.
• In the United States, about 10 million persons are newly bereaved each year, with a significant minority experiencing complicated grief 2.

Treatment Approaches for Grief Disorders

• Complicated grief therapy (CGT) is a relatively new psychotherapy model designed to address symptoms of complicated grief, drawing from attachment theory and roots in both interpersonal therapy (IPT) and cognitive-behavioral therapy 3.
• CGT involves techniques such as repeatedly telling the story of the death, in vivo exposure activities, focusing on personal goals, and relationships 3.
• Cognitive-behavioral therapy (CBT) is also an effective treatment approach for grief disorders, with a focus on cognitive restructuring and exposure therapy 4, 5.
• Mindfulness-based cognitive therapy is a viable alternative treatment approach for prolonged grief disorder, although grief-focused CBT may be more effective 6.

Efficacy of Treatment Approaches

• CGT has been demonstrated to be effective in reducing symptoms of complicated grief, with a response rate of 51% compared to 28% for IPT 3.
• CBT has been shown to be effective in reducing symptoms of complicated grief, with a focus on cognitive restructuring and exposure therapy 4, 5.
• A randomized clinical trial found that grief-focused CBT conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy 6.

Implementation of Treatment Approaches

• CGT can be implemented in a variety of settings, taking into consideration the needs of the patient, the limitations of the setting, and the skills and experiences of each clinician 2.
• CBT can be implemented in individual or group settings, with a focus on cognitive restructuring and exposure therapy 4, 5.
• Mindfulness-based cognitive therapy can be implemented in individual or group settings, with a focus on mindfulness exercises adapted to tolerate grief-related distress 6.