Prolonged grief disorder is associated with higher risk for suicidal ideation and behaviors, even when controlling for depression and posttraumatic stress disorder (PTSD) ( 15), and is further pronounced for survivors of suicide ( 16, 17). Prolonged grief disorder is associated with negative outcomes that result in higher risk of all-cause mortality ( 14). Factors that may contribute to prolonged grief reactions are maladaptive thoughts (e.g., blame), avoidance behaviors, inability to manage painful emotions, differences in health and social status, and lack of social support that interferes with adaptation to loss ( 11– 13). Prolonged grief disorder is characterized by elevated and persistent mental distress following the loss. Nevertheless, a significant minority will experience unrelenting bereavement responses resulting in functional impairment beyond cultural norms, which historically has been labeled complicated, traumatic, persistent, or pathological however, most recently, the consensus name is prolonged grief disorder ( 10). Relatively low rates of psychopathology after a death are consistent with high levels of resilience seen after other traumatic events (e.g., combat trauma, accidents) ( 9).

Integrated grief outcomes, occurring approximately 6–12 months postloss, have been observed in multiple longitudinal population studies, including prospective studies measuring well-being before and after the loss ( 5– 8). Acute grief varies in its intensity and length, and it has both religious and cultural influences.įor most bereaved individuals, this period of acute grief is followed by integrated grief, meaning the individual has adapted to the loss so that grief is more in the background and they can meaningfully reengage in a life without the deceased ( 1). Acute grief usually involves a period of intense emotions with preoccupation with thoughts and memories of the deceased person that may result in a period of reduced engagement with life and prior activities. An individual who has lost more than one loved one may experience acute grief differently for different deaths, depending on a variety of factors, including the nature of the relationship to the deceased as well as other circumstances associated with the specific death. Finally, a minority of individuals (approximately 7%–10%) will evidence stable, high-grief trajectories this subgroup probably represents the subgroup with a prolonged grief condition and will likely warrant intervention if persistent symptoms are linked to distress or functional impairment ( 2– 4).Īs noted, most people who experience an important death manage to successfully adapt to the loss over time, and grief progresses from an acute to a more integrated form. Furthermore, a small subgroup of individuals (10%) may develop grief later, showing low levels initially and higher levels 6 months postloss this trajectory has been reported for some bereaved partners ( 1, 3).

In addition, many individuals will experience high (16%–20%) or moderate (30%–33%) levels of grief immediately postloss that decrease over time, often without intervention ( 2, 3). The most common trajectory following a loss is stable, low levels of grief symptoms this trajectory occurs for approximately 26%–45% of bereaved individuals ( 2, 3). Trajectory models assessing the course of grief following a loss for up to 3 years postloss have identified several patterns ( 1– 3). Grief responses are not based on predefined stages but rather follow heterogeneous patterns as people adapt to an important death ( 1). The loss of a loved one is among life’s most challenging yet common stressors, resulting in the cascade of emotional, cognitive, and behavioral responses that define grief.

Ptsd diagnostic criteria for dsm 5