Understanding The Symptoms of Grief


In March 2022, the American Psychiatric Association (APA) added prolonged grief to the revised version of the DSM-5, the go-to manual for diagnosing mental disorders.

As normal grief is a natural part of the human experience, many psychologists were reluctant to include ideas of grief as a mental health disorder. However, prolonged grief that exceeds cultural and social norms surrounding the grieving process can be pervasive and disruptive to a young person’s life, stopping them from functioning in society and pursuing their goals.

Experts hope that the inclusion of the diagnosis will encourage further research into prolonged grief, helping us understand the condition and find effective ways to treat it.

What Is Prolonged Grief Disorder?

Prolonged grief disorder, also known as complicated grief, is when you continue to experience intense longing for or preoccupation with thoughts of a deceased loved one for an extended period.

Grief is a natural response to the death of a loved one. Normal grief often comes in waves and may be triggered by external and internal reminders like birthdays or things you associate with the person. People experience grief differently from one another and process it in different ways. It’s not possible to construct a “normal” timeline for grief, and there is no right or wrong way to cope with it.

For most young people, while they may always experience feelings of grief for a loved one, they’re able to find other things to love in life, look to the future, and take pleasure in other things. With prolonged grief disorder, however, the grief remains pervasive and destructive. About 7% of bereaved people may experience complicated grief.

What Are the Symptoms of Prolonged Grief Disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines prolonged grief disorder is when someone experiences at least 3 of the following symptoms nearly every day for at least a month, at least a year after the death of a loved one.

The symptoms of unresolved grief included in the DSM-5 are:

  • identity disruption, such as feeling like a part of you is missing
  • a pronounced sense of disbelief about the death
  • avoiding reminders that the person has died
  • intense emotional pain, such as sorrow, bitterness, and anger
  • difficulties moving on with life, such as problems maintaining relationships, planning for the future, or pursuing goals and aims
  • emotional numbness
  • feeling that life is meaningless
  • intense loneliness

For someone to receive a complicated grief diagnosis, their symptoms must cause clinically significant distress or difficulties in important areas of functioning. The duration of the grief process should exceed the expected norms for the individual’s culture and context.

The DSM-5 is a diagnostic tool to help psychiatrists diagnose mental health disorders, and its list of symptoms is not exhaustive. A young person experiencing complicated grief may exhibit several other physical and emotional grief symptoms.

Common physical symptoms of grief include:

  • Digestive problems
  • Fatigue
  • Headaches
  • Insomnia
  • Loss of appetite
  • Stress

Other emotional symptoms of grief include:

  • Suicidal thoughts
  • Excessively seeking proximity to reminders of the person
  • Intrusive thoughts about the person who had died

Suicide Prevention

Any signs of a young person thinking about suicide should be taken seriously. You can speak to a GP or mental health professional or contact helplines such as the Samaritans for immediate support. Call the emergency services immediately if you think your child is in immediate danger.

Are There Different Stages of Grief?

In 1969, Elisabeth Kubler-Ross wrote about the 5 stages of grief in her book, On Death and Dying. However, contemporary research shows that there is no clear pattern for the experience of grief. Grieving individuals need to accept their emotions and be kind to themselves throughout the grieving process.

What Is Anticipatory Grief?

Anticipatory grief is grief that you feel when you are expecting a loved one to die, such as when they have a terminal illness. While not frequently discussed, anticipatory grief is common and can help people find closure and reconcile with loved ones before their death.

Anticipatory grief has similar symptoms to normal grief but may involve additional atypical responses. Some people experiencing anticipatory grief may feel confused and split between wanting to keep hold of hope while grieving the death.

Anticipatory grief can be difficult, but like normal grief, it is considered a natural human response rather than a mental health disorder.

How Can You Treat Prolonged Grief?

Researchers have been developing specialised treatments for complicated grief since the 1990s. Standard depression treatments such as anti-depressants and talk therapies for depression often aren’t effective for prolonged grief. Instead, treatments that focus on the specific nature of grief can help people reconstruct their lives and reinvent meaning.

One evidence-based treatment approach is grief-focused cognitive behaviour therapy (CBT). Grief-focused CBT helps people identify the thinking traps that intensify the experience of grief, learn to confront situations that remind them of their loss, and re-engage in enjoyable activities. It can also be helpful for people to join support groups where they share time with others in the grieving process and learn to grieve collectively.

The Wave’s Transformative Experience

At the Wave, we offer psychiatric management, neuropsychiatric and trauma treatment for young people living with prolonged grief and other mental health problems.

We work with young people to build solid foundations and stable futures, uncovering their skills and qualities and transforming them into invaluable life skills. We help every young person to feel supported and cherished, helping them to overcome emotional distress and grow into themselves.

Our program focuses on global citizenship, helping young people from different backgrounds and cultures to be prepared to take on the world. We collectively celebrate different cultures as well as the individual milestones and achievements of each young person.

If your child is living with prolonged grief or other mental health concerns, contact us today to begin their journey.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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