An extended grieving period may now be classified as a mental health condition, according to the American Psychiatric Association (APA). The new diagnosis—prolonged grief disorder—provides a new framework for treating patients affected by loss, and allows providers to bill insurance companies for treatment services.
The March addition to the APA's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) comes after years of debate as to whether grief should be classified as a mental illness. According to a press release by the APA, recent events have shown the necessity to distinguish and treat "incapacitating feelings of grief."
"The timing of this addition to the DSM is also important, since there is so much loss in the world right now and many people are experiencing the long-term effects of that," Naomi Torres-Mackie, PhD, clinical psychologist at Lenox Hill Hospital in New York and head of research at The Mental Health Coalition, told Health.com.
Below, what you should know about the new diagnosis—including symptoms of prolonged grief disorder, and what to do if you suspect you or a loved one are suffering from it.
What Is Prolonged Grief Disorder?
Prolonged grief disorder occurs when a person loses someone close to them, and the grieving person develops an intense yearning or longing for the deceased person, or a preoccupation with them, according to the APA.
For children, diagnosis can occur within six months of a loss; for adults, it can occur within 12 months, according to the APA. Diagnosis hinges on whether a person's bereavement extends longer than is expected socially, culturally, or religiously—and whether their symptoms can be explained by another mental disorder.
The following are warning signs of prolonged grief disorder, according to the APA:
- Identity disruption (for example, feeling like part of oneself has died)
- Marked sense of disbelief about the death
- Avoidance of reminders that the person is dead
- Intense emotional pain (for example, anger, bitterness, or sorrow) related to the death
- Difficulty with reintegration (for example, difficulty engaging with friends, pursuing interests, or planning for the future)
- Emotional numbness
- Feeling that life is meaningless
- Intense loneliness (for example, feeling alone or detached from others)
Prolonged Grief Disorder Added to the DSM-5
Prolonged grief disorder was added to the manual's trauma- and stressor-related disorders chapter. When a disorder is added to the DSM-5, it gives healthcare professionals a shared understanding and shared terminology about the condition, Torres-Mackie said.
"Clinicians can be clear about what condition they are treating, and patients can put words to what they have been experiencing. It also makes it easier for clinicians to coordinate care with treatment teams, since the DSM provides clinical language that all clinicians are familiar with," Torres-Mackie explained.
The inclusion also makes care more accessible to more patients since insurance companies often require an official diagnosis to cover the cost of treatments, forcing patients without an official diagnosis to pay out-of-pocket.
In order for a condition to be added to the manual, experts must prove that it stands separate from all other possible diagnoses.
"New diagnoses must also be sufficiently different from categories of illness already recognized by the manual," Gina Moffa, LCSW, a New-York based psychotherapist, told Health.com. "Researchers and clinicians inevitably must show that a new addition to the DSM is going to be distinct from other similar conditions."
Controversy Over Prolonged Grief Disorder
Some experts were against the establishment of prolonged grief disorder as a diagnosis, citing the fact that grief is neither a linear process nor a one-size-fits-all experience, Torres-Mackie said.
"Many people mourn for far longer than a year, and that should not be pathologized. We don't want to confuse normal responses to loss that can last years for mental illness, if that person does not truly have a mental health condition," she said.
Another reason some were against the change is that grief is a natural response to loss, Moffa said: "Grief in and of itself is most definitely not a pathological disorder. We should be careful not to make mainstream the idea of grief as something to necessarily be 'fixed,' as it is a natural human response."
Additionally, the grieving process can result in isolation and shame for some people, Moffa added, explaining that receiving an official diagnosis might cause even deeper shame.
However, when grief is so intense that it disrupts a person's day-to-day functioning indefinitely, they may need access to a specific type of therapy that focuses on short-term goals and gives them the motivation to move forward—and this is where treatment for prolonged grief disorder comes into play.
"People who are enduring grief to this extent have usually exhausted their support system and inner resources, which then renders them further isolated, ashamed, and feeling deeply depressed," Moffa said. "[Treatment] does not take away grief in and of itself, but, rather, helps someone move forward with the grief."
What to Do If You Suspect Prolonged Grief Disorder
If you notice symptoms of prolonged grief disorder in a loved one, you should check in with them in an open, inviting manner, Torres-Mackie said: "Don't judge or try to problem solve, just let them know that you are there for them."
If you notice symptoms in yourself, try connecting with a friend or family member for initial support. You can then ask your doctor for a referral to a mental health professional, Torres-Mackie said: "Psychologists, counselors, and clinical social workers can all work with symptoms of grief. There are also many online therapist directories that can be helpful in connecting with a clinician."
Treatments for Prolonged Grief Disorder
Psychotherapy, sometimes known as talk therapy, is used to treat any form of grief, including prolonged grief disorder, Torres-Mackie said. Some therapists are specifically trained to address symptoms of grief.
Examples of evidence-based treatments for grief that mental health professionals may use include the following, according to Torres-Mackie and Moffa:
- Cognitive behavioral therapy (CBT) for grief is intended to help patients become aware of negative thought patterns that may make it hard to process grief.
- Complicated grief treatment is a semi-structured treatment, the goal of which is to help patients see a future with meaning again. "Structure and predictability can be incredibly helpful for someone grieving, as people grieving tend to feel a sense of being out of control," Moffa said.
- Grief and trauma intervention for children (GTI) was designed for kids ages seven to 12 who experience posttraumatic stress caused by violence, disaster, or witnessing a loved one experiencing violence.
Treatment success depends on the type of loss a person has suffered, Moffa said. "People who have endured ambiguous loss, or a traumatic loss, have several factors that can complicate their grief process," she explained. "Type of loss, relationship to the deceased, and the time passed are all equal considerations when doing grief therapy of any kind."
There are currently no medications that treat prolonged grief disorder. But peer support groups can be helpful, in addition to therapy, Torres-Mackie said, noting that they can establish a sense of connection for patients processing a loss.
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