- symptoms of grief persist for a minimum of 12 months following loss
- symptoms must include intense yearning for the deceased and/or excessive thoughts about the person or circumstances of the death to the point of impairment almost every day for at least the last month
- at least 3 of the 8 following symptoms must be experienced: (similar to symptoms list)
1. feeling that part of oneself has died
2. significant disbelief about death
3. avoidance of reminders of death (coupled with searching for evidence that it is not true)
4. intense anger, bitterness, sorrow regarding death
5. inability to reintegrate to life after death
6. emotional numbness
7. feeling that life has no meaning as a result of death
8. severe loneliness after death
- the symptoms cannot be better explained by major depressive disorder, PTSD, as a result of substance use, or another medical condition

DSM-5 Criteria for Prolonged Grief Disorder

Symptoms:
- identity disruption
- marked sense of disbelief about death
- avoidance of reminders that the person is dead
- intense emotional pain
- difficulty with reintegration 
- emotional numbness
- feeling that life is meaningless 
- intense loneliness
- grief period lasts longer than expected

New York University

Prolonged grief disorder occurs when a person experiences grief that persists longer and is more intense than typical grief. The grief can become severe enough to interfere with the person's day-to-day life, often affecting work, home, friendships and other important areas of life. 

Prolonged Grief Disorder

Prolonged grief disorder. Psychiatry.org - Prolonged Grief Disorder. (2022, May). https://www.psychiatry.org/patients-families/prolonged-grief-disorder 

Prolonged Grief Disorder - American Psychiatric Association

Symptoms of Prolonged Grief Disorder

Studies suggest that grief symptoms can improve after a psychedelic experience. This can be evaluated in terms of the modulation produced by psychedelics that have the capacity to trigger emotional breakthroughs that can better symptoms in certain disorders. 

Improvement of grief disorder symptoms by use of psychedelics

Untreated prolonged grief disorder can lead to a number of issues including substance abuse, suicidal thoughts, trouble sleeping, and compromised immune function. This compromised immune function can result in cancer and other severe health issues. Additionally, about 5-10% of adolescents will experience post-traumatic stress disorder and depression along with prolonged grief disorder following the loss. Prolonged grief disorder can play a significant role in triggering other psychiatric disorders. A sample was taken in which it was found that major depressive disorder had a prevalence of 55%, 48% with PTSD,  and 62% with anxiety disorders (Szuhany). In summary, prolonged grief disorder can create a higher risk of mortality as a result of many of the aforementioned effects.

Physical and Emotional Effects of Prolonged Grief Disorder

- older adults
- female gender
- those with a history of depression
- those with a history of bipolar disorder 
- caregivers
- those who experience the loss of a loved one very suddenly or traumatically
- those who feel the loss is unjust
- lower socioeconomic status
- those with childhood hardships

Risk Factors for Developing Prolonged Grief Disorder

Collection of references for prolonged grief disorder

References for Prolonged Grief Disorder

When the DSM-5 was published in 2013, it did not include Prolonged Grief Disorder as a diagnosable mental disorder. Instead, it was referred to as Persistent Complex Bereavement Disorder in the appendix and noted that it was in need of further study. After much debate, it was finally added to the DSM-5 TR in 2022. Despite its inclusion in the DSM, there is still much debate about whether or not it should be included. 

Prolonged Grief Disorder (PGD) and The DSM-5

The rate at which individual's present symptoms of  PGD and the intensity of their symptoms appear to be related to:
- Relationship with the deceased 
 - Cause of death 

Rates of Prolonged Grief Disorder (PGD)

Using functional magnetic resonance imaging, (fMRI), research has shown neural differences between those with and without prolonged grief disorder. In those with prolonged grief disorder, there is a higher level of activation in the nucleus accumbens meaning a higher activation in the reward centers of the brain. This activation in the reward center is associated with the deceased which suggests a cause for impaired judgement following the loss. Additionally, prefrontal regions, whole brain volume and cognitive function can differ in those with prolonged grief disorder versus those without.

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