Glossary // Glossary term Clinical

Prolonged grief disorder

A clinical condition in which intense grief, centred on yearning for the deceased and accompanied by symptoms such as difficulty accepting the loss or feeling that life is meaningless, persists long after a death and impairs functioning. It is included in ICD-11; a meta-analysis of non-violent bereavement estimated a pooled prevalence of about one in ten bereaved adults. Only a qualified professional can assess it; intense grief in the first months is not in itself a disorder.

Where the site uses it

Grief and mourning rituals: what rituals do, and where grief becomes a clinical question
Most bereaved people adapt without professional help, and rituals after a loss were followed by lower grief in experiments. This note reviews rituals, continuing bonds and the dual process model, and marks the clinical boundary of prolonged grief.
Mark a loss with a ritual that gives structure, not pressure to express
Rituals after a loss were followed by lower grief in experiments, apparently by restoring a sense of control. How to use a simple ritual, why grief need not be forced out, and when grief warrants professional help.

Studies behind it

The works the definition rests on, with the level of evidence each was appraised at.

Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Raphael, B., Marwit, S. J., Wortman, C., Neimeyer, R. A., Bonanno, G., Block, S. D., Kissane, D., Boelen, P., Maercker, A., Litz, B. T., Johnson, J. G., First, M. B., & Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. doi:10.1371/journal.pmed.1000121

Level C Longitudinal study

Supports the claim that proposed criteria for prolonged grief disorder centre on yearning plus further symptoms persisting at least six months after the death with functional impairment. Prolonged grief disorder has since entered ICD-11; the 2009 paper is cited for the logic of the boundary, not for current thresholds.
Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O'Connor, M. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. doi:10.1016/j.jad.2017.01.030

Level D Meta-analysis

Supports the claim that the pooled prevalence of prolonged grief disorder was 9.8% (95% CI 6.8 to 14.0) and higher with higher mean age. Pools observational prevalence studies with heterogeneous methods and high risk of external validity bias, so it is graded D.
Johannsen, M., Damholdt, M. F., Zachariae, R., Lundorff, M., Farver-Vestergaard, I., & O'Connor, M. (2019). Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. doi:10.1016/j.jad.2019.04.065

Level A Meta-analysis

Supports the claim that psychological interventions reduced grief symptoms (g = 0.41 post-intervention, 0.31 after adjustment for publication bias, 0.45 at follow-up), with larger effects in people at least six months post-loss and with high baseline symptoms. Heterogeneous trials of varying quality.