When Grief Doesn't Ease: Prolonged Grief and Getting Help

For most people, the most intense pain of grief slowly eases, even though they never stop missing the person. For a smaller group, intense grief stays strong for a long time and keeps them from living their lives. When that lasts at least a year for an adult, or 6 months for a child or teen, doctors may call it prolonged grief disorder. It is treatable, and you can ask for help long before that point.

This page explains what to watch for. It is not a test, and only a qualified professional can diagnose a mental health condition.

Grief has no deadline

Grief is not an illness. The National Institute on Aging (opens in a new tab) says there are no rules about how you should feel, and that for most people the intense pain lessens over time, with good days and bad days.

The American Psychiatric Association (opens in a new tab) (APA) notes that grief can rise again at different points in time, such as anniversaries, and that this usually does not need mental health treatment. Missing someone for the rest of your life is not a disorder. It's love.

What prolonged grief disorder is

Prolonged grief disorder was added to the APA's diagnostic manual, the DSM-5-TR, in March 2022. The APA describes it as “intense and persistent grief that causes problems and interferes with daily life.” (opens in a new tab)

According to the APA, clinicians look for:

• Time. The death happened at least a year ago for adults, or at least 6 months ago for children and teens.
• Intense grief nearly every day for at least the last month, such as deep longing for the person or being preoccupied with thoughts of them. In children and teens, that preoccupation may center on how the person died.
• Other painful experiences, such as feeling that part of yourself has died, marked disbelief, avoiding reminders, emotional numbness, intense loneliness, or feeling life has no meaning without the person.
• Real problems in daily life at home, at work, or with family and friends.
• Grief that lasts longer than expected by your social, cultural or religious norms.

The APA estimates that 4% to 15% of bereaved adults (opens in a new tab) develop these persistent symptoms. You may also hear the older term complicated grief; the National Institute on Aging uses it to describe mourning that goes on so long, or is so distressing, that it becomes unhealthy.

Who is at higher risk

The APA lists several risk factors, including:

• a death that happened very suddenly or under unnatural circumstances (opens in a new tab), such as an accident;
• the death of a child or a spouse or partner;
• a history of depression or other mental illness;
• being very close to, or emotionally dependent on, the person who died;
• lack of social support.

SAMHSA adds that after a traumatic event, many things can disrupt the normal process of grieving (opens in a new tab). If someone you love drowned, see grief after a drowning.

These are not predictions about you. They are good reasons to build support early.

Signs it's time to reach out

You don't need to wait a year, or to meet any criteria, to talk with someone. Consider reaching out to a doctor or grief counselor if:

• months have passed and your grief isn't easing at all, or is getting stronger;
• you can't keep up with work, school, meals, sleep or caring for your family;
• you avoid everything that reminds you of the person, or can think of nothing else;
• you feel numb, cut off from people, or that life has no meaning;
• you are using alcohol or drugs to get through the day;
• guilt or self-blame won't let go (see guilt after a loss).

For children, the American Academy of Pediatrics suggests calling your child's doctor if grief causes major changes in everyday life (opens in a new tab), like a talkative child going quiet or a gentle preschooler starting to hit. The National Child Traumatic Stress Network notes that some children develop Childhood Traumatic Grief (opens in a new tab) after a sudden death.

Kinds of help that work

Good help for grief exists, and it doesn't mean forgetting the person.

• Grief-focused therapy. The APA says treatments that use elements of cognitive behavioral therapy (CBT) have been found to reduce prolonged grief symptoms. One approach, Prolonged Grief Therapy, focuses on accepting the reality of the loss and on restoration: working toward goals and satisfaction in a life without the person. In a 2005 randomized trial of 95 adults with complicated grief, published in JAMA, 51% responded (opens in a new tab) to a grief-specific treatment over 16 sessions, compared with 28% who received a standard talk therapy.
• Therapy for children and teens. The APA notes research showing CBT can help young people with prolonged grief symptoms.
• Help with sleep. CBT for insomnia is effective, the APA says, and can help with the sleep problems that often come with grief.
• Support groups and peer support. The APA says they help people feel less alone, which matters because isolation raises the risk of prolonged grief.
• Medication. There are currently no medicines for the specific symptoms of grief, according to the APA. A doctor may still treat related conditions, such as depression or anxiety.

How to find a grief counselor

The National Institute of Mental Health (opens in a new tab) suggests starting with your primary care provider, your health insurance plan, an employee assistance program at work, or FindTreatment.gov (opens in a new tab). When you call, ask:

• What experience do you have treating grief like mine?
• How do you usually treat it?
• How long might treatment last?
• Do you take my insurance, and what will it cost?

If cost is a barrier, the National Institute on Aging suggests asking about a sliding-fee scale or a payment plan. Our grief support directory lists free groups and culturally specific options, including for Muslim and South Asian families.

What you can do today

• Ask yourself honestly: is my grief slowly softening, staying the same, or getting heavier?
• Tell one person you trust how you've really been doing.
• Book an appointment with your doctor, and say, “I'm grieving and I'm struggling.”
• Look up one grief counselor or support group, using the questions above.
• Keep up one small daily habit from making room for grief, like a short walk or a regular meal.
• If you think about ending your life, call or text 988 now.