With the advent of a pandemic resulting in severe illness, lingering symptoms and the unexpected loss of family members, friends, coworkers, and others within our circle of acquaintances, many individuals have sought counseling for grief over the loss of a loved one or assistance with depressive symptoms resulting from the pandemic experience. The experience of grief is normal. How a person copes with their grief is unique in many ways: the duration of symptoms, the intensity of emotions, and how the loss is processed by the individual varies from person to person. It is generally recognized that the symptoms of the grieving process will lessen over several months and everyday functioning returns to normal (although re-experiencing moments of grief may be experienced and is not uncommon). But the mental health profession has recognized that for some, their grief remains intense beyond what would be considered a normal grieving experience of several months.
Many of these people state they cannot move past the loss and absence of the deceased. They present to therapy with symptoms very similar to depression, making it difficult to function at home, work, school, or other significant areas. These individuals may be experiencing what the DSM-V describes as Prolonged Grief Disorder (PGD).
What is PGD and how is it different from grief? Prolonged Grief Disorder, also called complicated grief, can occur when a person close to you has died within the past year. A persistent longing for that person and thoughts that fixate on the deceased which interfere with the ability to function normally for a prolonged period of time, differentiates PGD from grief. Typically, the intense emotional reaction to a loss improves over the course of several months. Prolonged grief, however, does not. Thoughts and memories of the deceased are difficult to control and push away. Typically, prolonged grief occurs after a sudden violent or abrupt death of a partner or a child.
Symptoms of PGD are similar to grief, however the intensity does not wane and may be present most of the day, every day. Other signs of PGD would include feeling as though a part of you has died (identity disruption), avoidance of things or places that remind you of the death of the person, very strong emotional pain such as bitterness, sorrow or even anger or emotional numbness, feelings that life is meaningless, difficulty moving on with your life and extreme loneliness. Other signs could be leaving the deceased’s belongings untouched, lack of trust in other people, increased substance or alcohol use and suicidal thoughts or behaviors.
Diagnosis of prolonged grief can be mistaken for severe depression and is differentiated by the continued focus on the loss. It does occur comorbidly with other mental health disorders such as PTSD, anxiety and/or depression. Another symptom is disrupted sleep of which 80% of people diagnosed with PGD have reported.
Treatment of prolonged grief incorporates cognitive behavior therapy and other approaches which focus on accepting the reality of the loss, working toward goals, and re-establishing a connection to life without the deceased. Research on the effect of anti-depressant medications with prolonged grief did not reflect any improvement of symptoms, however medication did assist in reducing co-occurring symptoms of depression if present. There are therapists trained to treat PGD and more information can be found at https://prolongedgrief.columbia.edu/.
If you believe your experience at losing a loved one is too difficult to deal with and are feeling isolated or alone, please contact your medical provider or reach out to a mental health provider for support. Additional assessment will determine if your experience is more than grief and will provide you with resources and any necessary referrals.
Ann Hogan, MSCP, LCPC