Grief
Grief is the natural response to loss; prolonged grief disorder is a distinct diagnosis for grief that remains severely disabling well beyond the expected course, defined per DSM-5-TR.
Symptoms
Normal grief involves waves of sadness that gradually ease over time. Prolonged grief disorder involves persistent yearning or preoccupation with the deceased, plus intense emotional pain, difficulty moving forward, and functional impairment that continues beyond cultural norms.
Causes and risk
The death of someone close; risk for prolonged grief disorder is higher after a sudden, violent, or unexpected death, or when the relationship with the deceased was especially close.
How it is evaluated
DSM-5-TR requires symptoms persisting 12 months or longer (6 months in children/adolescents) with clinically significant impairment; ICD-11 uses a 6-month threshold, per diagnostic validation research.
Treatment
Grief-focused psychotherapy is first-line; antidepressants target co-occurring depression rather than the core grief symptoms themselves, per current NEJM clinical guidance.
When to seek care
Grief carries a documented suicide risk, particularly in prolonged grief disorder. Any thoughts of self-harm should prompt immediate crisis support via 911 or the 988 Suicide and Crisis Lifeline.