Prolonged Grief Disorder

The permanent absence of a loved one can seem endless. The mornings are full of mourning and emptiness no amount of OJ or coffee or alcohol can fill.

If the sadness appears to extend to infinity, therapists have a less poetic task. They must determine whether your extreme unhappiness fits the criteria for Prolonged Grief Disorder (PGD). This diagnostic category is new, but the ailment is as old as human history.

To start, here are some of the symptoms of PGD in the American Psychiatric Association’s September 23, 2021 press release describing the soon-to-be-published complete formulation. A prior draft indicated that at least three of the eight must be present for the diagnosis to apply:

  • Identity disruption (e.g., feeling as though part of oneself has died).
  • Marked sense of disbelief about the death.
  • Avoidance of reminders that the person is dead.
  • Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
  • Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future).
  • Emotional numbness.
  • Feeling that life is meaningless.
  • Intense loneliness (i.e., feeling alone or detached from others).

They also state the following:

The bereaved individual may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death.

These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Moreover, the length of the condition goes beyond cultural norms.

Experienced therapists know people are not so easy to categorize as labels suggest. Many times counselors encounter individuals with more than one psychological concern. For example, depression might be coupled with substance abuse or PTSD.

In the case of forms of bereavement, many have questioned the appropriateness of putting an identifying sticker on an almost inevitable experience in life. Our time by itself has created nearly five million deaths from COVID-19 and a much larger number of their loving survivors.

However, the APA emphasizes that Prolonged Grief Disorder goes farther than the normal grieving observed within one’s community. To the good, the health care field will help you take on your heartache and impairment, whatever name is given to it.

The APA’s announcement and a publicly available 2020 draft do not mention causes of extended lamentation other than death. A few come to mind.

We might include those who become caretakers to their radically changed lifelong partners, parents, or children. Transforming accidents, dementia, or lasting vegetative afflictions often create a world of joylessness in those who take on a job for which they did not apply.

Calamity takes too many faces. Mortals needn’t die to cause dear ones the realization they are no longer interacting with the “same person.”

While discussions about lengthy sorrows have been ongoing, the APA’s decision to recognize and define PGD can be expected to produce more words and productive research.

Even now, if you find yourself among those suffering from unrelenting adversity of the kind suggested here, professional consultation is recommended to discover if you fall into the new category.

Finding the best treatment options for PGD — something distinct from conditions like Major Depressive Disorder or Dysthymia — is a first step in the direction of recovery.

Click here for an infographic on Prolonged Grief Disorder

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The first of two works by the Ecuadorian artist Oswaldo Guayasamin is called Spring. The second is Project for a Poster. Both of these date from 1956.

2 thoughts on “Prolonged Grief Disorder

  1. Thanks for discussing this issue, Dr. Stein. The pandemic has taken thousands of lives in our communities. Some families have lost both parents. In my view, the chances of more individuals suffering from PGD may be closer to home than we imagine. I dislike prying into the lives of others, but remain available and to listen.

    Liked by 1 person

  2. No doubt, Rosaliene. Unless our human sisters and brothers come together enough to push back sufficiently on climate change, much else is ahead. To the good, we still have some time …

    Liked by 2 people

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