The Hidden Dangers of Pathologizing Grief

“The new definition of prolonged grief disorder will potentially result in even less social support,” the author argues. Visual: Malte Mueller / Getty Images

Prolonged grief has officially been recognized as a mental health disorder. The decision could do more harm than good.


THE WEEKEND THAT I graduated from law school, my mother told me that she had amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease, a neurological disease for which there is currently no cure. As I recalled in a recent essay, I spent the following year watching as her muscles atrophied until she died.

A year and a half later, my father was diagnosed with cancer. He successfully completed one round of chemotherapy, but then, less than two years later, the cancer returned, killing him within months. He died on Aug. 12, my mother’s birthday.

After my parents died, I wanted to focus on work, friends, and dating, like most other people in their 20s and 30s, but I couldn’t. I struggled with intense emotional sadness and anxiety. I constantly longed to see my parents again — even if just to give them one hug — and I struggled to accept that they were gone for good.

As of this March, the feelings that I experienced could now be categorized under a new mental health disorder. That month, the American Psychiatric Association officially added Prolonged Grief Disorder, or PGD, to the latest edition of its Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM, a widely used guide for psychiatric diagnoses.

Since the 1990s, some mental health experts have argued that intense or prolonged grief should be categorized as a distinct mental health disorder and treated differently from other disorders like depression. In 2018, the World Health Organization approved PGD as an official diagnosis in its International Classification of Diseases, applicable when “persistent and pervasive grief response” is present six months or more after a person’s bereavement. (The ICD definition — similar to the recent DSM addition — allowed exceptions to that timeframe based on the individual’s expected “social, cultural or religious norms.”) In 2019, researchers came together to agree on a precise set of symptoms for PGD, also sometimes referred to as complicated grief disorder, for the DSM.

The APA describes PGD as occurring when a bereaved person experiences a persistent longing for the deceased person, intense emotional pain, along with a preoccupation with thoughts and memories of the deceased. According to the DSM, PGD “causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” In order to be diagnosed with PGD, a person must also experience at least three of eight additional symptoms that include “disbelief, intense emotional pain, feeling of identity confusion, avoidance of reminders of the loss, feelings of numbness, intense loneliness, meaninglessness, or difficulty engaging in ongoing life” according to Columbia University’s Center for Prolonged Grief. For an adult to meet the criteria for a PGD diagnosis, the death of a loved one must have occurred at least one year ago, and the symptoms must be present most days since the loss and nearly every day for at least the last month. For children, the symptoms can be potentially diagnosed as PGD after six months.

This new definition and terminology risks pathologizing common grief reactions, and it will likely create an inaccurate societal expectation about what grief should look like.

This new definition and terminology risks pathologizing common grief reactions, and it will likely create an inaccurate societal expectation about what grief should look like.

After all, I have experienced many of the symptoms associated with PGD. I definitely had “difficulty moving on with life,” described as a symptom of PGD in an APA press release. And my experience is not an anomaly. “I meet people every day who might meet a criteria for prolonged grief,” said Joanne Cacciatore, a professor in the School of Social Work at Arizona State University and founder of the MISS Foundation, an organization that provides support to families struggling with traumatic grief.

“There is no smoking gun here as to when grief is pathological,” Jerome Wakefield, a professor of social work and bioethics at New York University, told me. If you look at the criteria, he says, “the symptoms are all normal symptoms of acute grief,” referring to the intense feelings of loss that occur after a loved one’s death. The essence of the PGD diagnosis, says Wakefield, is that if grief goes on too long, it’s no longer on a normal trajectory toward being resolved, and “something pathological is happening.”

This arbitrary one year time limit on grief sets up dangerous societal expectations. Since my parents died, I’ve felt like I’ve been fighting against a belief that grief is a short, finite process after which one magically, and fairly suddenly, returns to their prior self. Months after my parents’ parting, family members stopped checking in…


F. Kaskais Web Guru

One thought on “The Hidden Dangers of Pathologizing Grief

  1. Many times families and friends want to define how long grief should last. Their treatment of someone with PGD actually can make the situation worse, causing the person to withdraw from family or social situations . I would also suggest to you that a parent does not have to suffer the death of a child to experience PGD. A parent whose child never or rarely contacts them, grieves the same way as if the child has died. The difference is, the child is dead to them and not to others and has chosen to exclude the parent from their life. I relate to this as the difference between death and divorce.


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