Complicated grief

Definition and diagnostic criteria

Complicated grief, officially known as prolonged grief disorder (PGD), is a diagnosis included in the ICD-11 classification in 2022. It describes a condition in which grief symptoms persist with unusual intensity and impair daily life for at least six months after the loss. Diagnostic criteria require that the grieving person experiences daily paralysing yearning and at least several of the following symptoms: difficulty accepting the loss, erosion of identity, emotional numbness, social withdrawal and a sense of meaninglessness in life.

It is important to distinguish complicated grief from normal grief. Grief work is a natural process that gradually eases, although waves of grief may return even years later. In complicated grief, adjustment does not occur, and symptoms remain equally intense or even worsen over time.

Risk factors

Risk factors for complicated grief have been identified in numerous studies. The circumstances of the loss have a significant effect: a sudden, unexpected or violent death considerably increases the risk. Losing a child is a particularly strong risk factor. The quality of the relationship also matters: an extremely close or dependent relationship with the deceased, as well as a conflicted relationship, can predispose to complicated grief.

Individual factors, such as previous mental health problems, insecure attachment style, weak social support and concurrent life changes, increase the risk. Anticipatory grief that has lasted a long time can also exhaust the family member to the point that post-death adjustment becomes more difficult. Identifying risk factors enables early intervention.

Treatment and therapy

Evidence-based methods have been developed for treating complicated grief. The best known is complicated grief therapy (Complicated Grief Treatment, CGT) developed by M. Katherine Shear, which combines grief work elements and cognitive-behavioural techniques. The therapy helps the grieving person process the loss safely, work through their avoidance and rebuild a meaningful life.

In Finland, treatment can be accessed through the health centre, occupational health services or psychiatric specialist care. Medication, particularly antidepressants, can also be used to ease symptoms. Peer support groups and parish pastoral care complement professional treatment. The most important thing is to seek help if grief does not ease over months and daily life does not resume.

The role of loved ones

The loved ones of a person suffering from complicated grief have an important role. The grieving person should not be pressured to "get over" the loss, but they can be encouraged to seek professional help. Concrete everyday assistance, such as cooking, cleaning and running errands, eases the burden. It is also important for loved ones to take care of their own wellbeing, as a person with prolonged grief can be a burden on their surroundings.