Grief & Loss
Prolonged Grief Disorder (DSM-5-TR, new in TR)
Normal and complicated grief following bereavement, other losses, or life transitions. Prolonged grief disorder is now a DSM-5-TR diagnosis. Most grief does not require clinical intervention; therapy indicated when grief becomes prolonged or debilitating.
Prevalence: ~10% of bereaved adults develop prolonged grief (Lundorff et al., 2017, pooled across 14 studies); higher after violent or sudden loss
Clinical Picture
Grief is not a disorder; it's the natural human response to loss. Most grief does not require clinical treatment; it requires time, community, and the willingness to feel what needs to be felt. Therapy becomes relevant when grief is complicated: when it becomes prolonged, when it's disenfranchised (not recognized by others), when it intersects with trauma (as in sudden or violent loss), or when pre-existing attachment patterns make the loss unbearable. The DSM-5-TR's addition of Prolonged Grief Disorder as a diagnosis has been controversial, with some arguing it pathologizes normal suffering.
Treatment Considerations
Prolonged Grief Disorder Treatment (Shear), published and trialed under its original name Complicated Grief Treatment, has the strongest evidence for prolonged grief disorder. Psychodynamic approaches attend to the internal relationship with the lost person and the meaning-making process. Existential approaches sit with grief as a confrontation with mortality, finitude, and meaning. Narrative approaches help the bereaved revision their relationship with the deceased without relinquishing the bond. For traumatic bereavement (suicide, homicide, accident), trauma-processing may need to precede or accompany grief work. Grief groups can provide normalization and community that individual therapy cannot.
22 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Related Clinical Vignettes
Sources & References
Prevalence data from NIMH, WHO, and DSM-5-TR field trial publications. Evidence tiers reflect guideline status (APA, NICE, VA/DoD, WHO) and meta-analytic findings as of early 2025. Individual modality citations are listed on each modality page. Full bibliography available on the Sources page.