Recognizing and Healing from Prolonged Grief Disorder
- Griffin Oakley
- Mar 20, 2025
- 6 min read
It's been a year, and the grief hasn't moved.
That's not how this was supposed to go. The well-meaning friends, the standard cultural script, the things people say in cards — all of them said it would have softened by now. Heavy at three months. Less heavy at six. Tolerable by a year.
Yours hasn't done any of that. The weight is the same as the week after they died. Sometimes worse.
If something inside you just nodded reading that, this is for you.
What you might be experiencing has a name. As of 2022, it has a diagnosis — Prolonged Grief Disorder (PGD), added to the DSM-5-TR after decades of researchers documenting what therapists already knew: for some people, grief doesn't soften on the timeline society expects. And when it doesn't, something specific is happening that responds to something specific.
This article is about what that something is, and what actually helps.
What prolonged grief looks like (when grief gets stuck)
For most people, grief moves. Not in a clean linear way — it loops back, ambushes you in a grocery store aisle, lives in your sleep, recedes in the daylight, returns at the anniversary. But it moves. Over months and years, the shape of it slowly changes. It stops being the loudest thing in the room.
Prolonged grief is what happens when that movement doesn't start.
A year in, the world is supposed to come back online. The texture of ordinary things — coffee, work, conversations — is supposed to start mattering again, even if everything also still hurts. With prolonged grief, that doesn't happen. The grief is still the entire room. You're functioning, maybe, but you're not living. You're carrying.
The clinical criteria added to the DSM-5-TR in 2022 are specific. The death has to be at least twelve months in the past (six months for children and teens). The grief has to involve persistent yearning or preoccupation with the person who died. And at least three of the following have to be present, nearly every day, for the past month (American Psychiatric Association, 2022; Prigerson et al., 2021):
A sense that part of you died with them — that your identity has been disrupted
Disbelief that they're actually gone
Avoidance of reminders that they died
Intense emotional pain — anger, bitterness, sorrow — that hasn't softened
Difficulty re-engaging with relationships, work, or future plans
Emotional numbness
A sense that life has lost meaning
Intense loneliness, even around people who care about you
If a year out, several of those describe your daily experience — this is what we're talking about.
It's about 1 in 10 bereaved adults. A 2017 meta-analysis pooling data from 14 studies found that 9.8% of bereaved adults develop prolonged grief in the way the diagnosis describes (Lundorff et al., 2017). For people who lose someone suddenly or violently — a sudden death, a suicide, an overdose — the rate is much higher.
This isn't rare. It's just not talked about.
Why grief gets stuck
There's no single answer. Different patterns get stuck differently. But a few things make it more likely:
The death was traumatic, sudden, or violent. Your system didn't get to brace. There was no goodbye, or the goodbye was awful, or the death itself was the kind of thing that goes into trauma memory rather than grief memory. The body holds those losses differently.
The relationship was complicated. It's harder to grieve someone you had unfinished business with — someone who hurt you, or someone you couldn't get close to, or someone you loved and resented in the same breath. The grief has nowhere clean to land. You can't fully say goodbye because you couldn't fully say hello.
You weren't allowed to grieve, or didn't have the support afterward. Maybe you were the one holding everyone else together. Maybe you were a kid when it happened and no one talked about it. Maybe the culture you grew up in expected you back at work the following Monday. Grief that doesn't get processed at the time can sit in the body and wait.
This isn't your first big loss. Grief is cumulative — that's the part most people don't realize. I sometimes describe it to clients as a snowball. Each loss adds to the weight of every loss before it that didn't fully process. A new grief often pulls older griefs back up to the surface. If the older ones were never fully integrated, the new one is doing the work of all of them at once. That's why a death that "shouldn't" hit this hard sometimes does. It isn't just this loss. It's all of them.
The loss was central to your identity. Some people you lose, you lose a small part of yourself with them. Others, you lose your whole map. Spouses of decades. Parents to adult only children. A child to a parent. The system isn't just grieving the person — it's reorganizing around their absence.
What actually helps
Grief work isn't a hack. There isn't a five-step checklist that resolves it. But there are specific things that move it, and a couple of those have real research behind them.
Grief-specific therapy. Not all therapy moves grief. Generic talk therapy can sit on top of a grief that needs actual processing. Approaches built specifically for prolonged grief — most prominently Complicated Grief Treatment (CGT), developed by Katherine Shear at Columbia — have shown significantly better outcomes than standard talk therapy in randomized clinical trials (Shear et al., 2005). CGT involves slowly approaching the memories that the system has been refusing to fully integrate, while also rebuilding a life that has space for both the loss and the future.
Letting the grief have a shape. Some people find this in writing — a letter to the person, the kind you can't send. Others in ritual — an annual something, a candle, a place. Others in talking about the dead person, by name, with someone who knew them or someone who didn't. The point is the same. Grief that has nowhere to go stays stuck. Grief that has a container can move through.
Sleep and basic body care, taken seriously. Grief is exhausting at a cellular level. Sleep is when the system processes emotional material; if grief is keeping you from sleeping, the grief has nothing to work with. This is the boring part of grief work, and the part that gets dismissed most often. It also makes the rest of the work possible.
People who can say the dead person's name. A body that's been alone with a grief for years softens, slowly, when there's reliably another body in the room willing to name what happened and not flinch. Grief is one of the lonelier human experiences, and a lot of the loneliness comes from how quickly other people stop being willing to talk about it. Find the one person who will.
One last thing...
If you've been carrying a grief that hasn't moved, the goal isn't to get over it.
Nobody who loved deeply gets over the loss. That's not what healing means here. What can change is that the grief stops being the entire room. It becomes a part of the room — a corner, a presence, a piece of who you are — instead of the whole thing.
That shift is slower than most things in life. There isn't a hack for it. But it's also more possible than it might feel right now, because what you've been managing isn't a personal failing or a sign you loved them wrong. It's a system that needs more than time. It needs the right conditions.
You're not stuck because something is wrong with you. You're stuck because the grief hasn't had what it needs to move.
Griffin Oakley, MSCP, NCC, LMHC, LPC Founder & Therapist, Curious Mind Counseling
📞 971-365-3642
About The Author
Griffin is a licensed telehealth therapist and the founder of Curious Mind Counseling, serving Oregon and Florida. His work focuses on complex trauma, attachment, and identity — including grief counseling for people whose loss hasn't moved on the timeline anyone expected.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
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. Journal of Affective Disorders, 212, 138–149. https://doi.org/10.1016/j.jad.2017.01.030
Prigerson, H. G., Boelen, P. A., Xu, J., Smith, K. V., & Maciejewski, P. K. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry, 20(1), 96–106. https://doi.org/10.1002/wps.20823
Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. (2005). Treatment of complicated grief: A randomized controlled trial. JAMA, 293(21), 2601–2608. https://doi.org/10.1001/jama.293.21.2601
